management of hypertensive disorders in pregnancy
DESCRIPTION
An evidence based approach to the management of hypertensive disorders in pregnancy. Based on the NICE guidelines (August 2010) NICE Guideline 107TRANSCRIPT
MANAGEMENT OF HYPERTENSIVE DISORDERS IN PREGNANCY
- An evidence based approach
Dr. Mohammed Sadiq Azam M.D. (Int Med)Senior Resident, Department of Medicine, Osmania General Hospital
Physician, Princess Esra Hospital
What are we dealing with?
Is it Gestational HTN.. Or Chronic HTN?
Routine investigations
Proteinuria – How to assess??
Prevention strategy – Do s
and Don’t s…
NO EVIDENCE TO PROVE BENEFIT AS PRIMARY PREVENTIVE AGENTS IN THIS REGARD
CHRONIC HYPERTENSION
PRE PREGNANCY ADVICE
GESTATIONAL HYPERTENSIONOnce upon a time called PIH, now known as...
Decide on Timing of birth
Mild Hypertension Moderate HypertensionSevere Hypertension
PRE ECCLAMPSIA
Pre ecclampsia – Who are at risk?
Signs of Severe Pre-ecclampsia
Decide on Timing of birth
Mild Hypertension Moderate Hypertension
Severe Hypertension not requiring referral to a level 2 setup
ECCLAMPSIA
Antihypertensives – WHAT NOT TO USE
Antihypertensives used - Pharmacology
Antihypertensives used – Beta Blockers
Antihypertensives used - Pharmacology
Antihypertensives used – Methyldopa
Antihypertensives used - Pharmacology
Antihypertensives used - Nifedipine
Antihypertensives used - Pharmacology
Antihypertensives used - Hydralazine
Antihypertensives used - Thiazides
Methyldopa vs Labetolol – The King vs the Challenger?
“Can I feed the baby while on my antihypertensive meds?”
Lifestyle advice
What next?
Conclusions• Hypertensive disorders complicating pregnancy are one of the major
causes of maternal and foetal mortality and morbidity.
• Early diagnosis and management can help in circumventing many of the
complications of the same.
• Both labetolol and methydopa have been recommended as first-line
drugs in various studies. Final use depends on a careful assessment of risk
benefit ratio and clinician judgement.
• Nifidipine sustained release should be used as a second line drug and
SUBLINGUAL NIFIDIPINE should NEVER be used.
Conclusions• Watch for and screen for pre-ecclampsia in high risk individuals at regular
intervals.
• Test of choice for proteinuria is an automated reagent strip reading device or
urinary spot protein:creatinine ratio.
• Aspirin is the ONLY PROVEN method of primary prevention of hypertensive
disorders in high risk individuals.
• Patient counselling and education regarding nature of illness and informed
consent prior to initiating treatment is mandatory.
• With early detection and appropriate management, the journey with
hypertension can be made a smooth one for both mother and child.
THANK YOUAny questions??
Download the presentation online at: www.drmdsadiq.in