Hypertensive disorders of pregnancy include preeclampsia, gestational hypertension, and chronic hypertension. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. Symptoms include headache, visual changes, and edema. Timely delivery is the only cure. Complications for the mother include liver or kidney failure and for the baby include intrauterine growth restriction and stillbirth.

1. Hypertensive Disorders of Pregnancy Qu Quanxin Tianjin First Centre Hospital

2. Definition It is a condition that the pregnant women appear at least 2 of the 3 signs, including hypertension , proteinuria and edema after 20th week of pregnancy.

10. Pathology Uteroplacental ischemia ‘ toxins’ Hypertension and vascular spasmus Ischmia and impairment of varies organs (liver function, renal function, heart function, cerebral lesion, etc) Result in signs and symptoms (headache, faint, nause, epigastric pain, convulsion, coma, etc)

11. Fluid retention During the normal pregnency period, the average weight gain is about 12kg. In the first trimester, a loss of weight maybe happen for morrning sickness. In the second and third trimester, the average weight gain is about 0.5kg/wk. If the weight gain is greater than 1kg/wk, closely measurement for blood pressure and urine specimen investigation should be done

12. Hypertension The blood pressure fluctates within the range of 110-120/60-70mmHg in a rest condition. The standards of hypertension used in general medicine are not appropriate in obstetrics. The dividing point between physiology and pathology is accepted as 140/90mmHg or increase of 30/15mmHg over the baseline reading. During pregnancy period, the increased blood pressure should be below 30/15mmHg

13. Edema During normal pregnancy period, the extracellular fluid increases about 2500ml. The excessive fluid retention eventually results in edema and is often firstly found over the lower subcutaneous surface of the tibia by gentle sustained pressure, and gradually the feet and ankles are obviously swoolen.

14. Proteinuria The proteinura means that the protein components mainly including albuminuria and globulins are found in urine sample. But there are many causes can give rise to proteinuria , which contamination from vaginal discharge, urinary tract infection and chronic renal disease.

16. + Edema only limits on feet and calf and can not disappear after rest. ++ Edema develops to thigh. +++ Edema raise to vulva and abdomen. ++++ Edema distributes to all of the body and sometimes company with ascites

19. Pre-eclampsia On the above basic, the patient appears headache, giddy and faint, nausea, epigastric pain and even vomiting, this is called pre-eclampsia. If the patient does not accept treatment appropriately and in time, she will develop to eclampsia.

20. Eclampsia The patient abruptly comes forth convulsion with or without coma. During convulsion, the patient stops breathing temporarily and face becomes cyanose. This will last for about 1min. After convulsion, patient often drops into coma.

24. Influence to pregnant women and fetus Pregnant women: heart failure,liver and kidney function failure, DIC, plcenta abruption, HELLP,postpartum haemorrhage Fetus : preterm labor, oligohydramnios, IUGR, fetal distress, death, stillbirth, neonatal death,etc

25. Therapy Relife convulsion Sedation Antihypertension Diuretics Delivery To terminate pregnancy is the key to resolve the problem. The method to end pregnancy includes induced labour by oxytocin or caesaren section.

26. Management for pre-eclampsia and eclampsia * Keep the patients in a quiet circumstance and reduce external stimuli as possible * Relief convulsion * Reduce blood pressure * Relief pain during delivery either by vaginal or operation

27. Question If the patients appeared BP 150/100mmHg, proteinuria (++), edema(++) at 34 gestational age, then the diagnosis should be: A. Mild degree of PIH B. Moderate degree of PIH C. Serious degree of PIH D. Pre-eclampsia E. Eclampsia

28. Question The influence on pregnant women with PIH is A.Form plcenta praevia B.Result in megaloblastic anemia C.Result in abruptio plcenta D.Result in gestational diabetics E. Result in iron-deficiency anemia

29. Question The influence on fetus in pregnant women with PIH is A.Fetal malformation B.Fetal heart disease C.Fetal heamorrhage D.Fetal anemia E.IUGR

30. * Definition of Hypertensive Disorders of Pregnancy * Types of Hypertensive Disorders of Pregnancy and the diagnostic standard * Degree of edema in Hypertensive Disorders of Pregnancy