Hypertensive Disorders in Pregnancy Definisi Hypertensive disorders complicating pregnancy Gestational hypertension: any form of new-onset pregnancy-related hypertension.

Preeklampsia: pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation. Eklampsia: The onset of convulsions in a woman with preeclampsia that cannot be attributed to other causes Klasifikasi Gestational hypertension Preeclampsia. Eclampsia. Preeclampsia superimposed on chronic hypertension Chronic hypertension. Epidemiologi 3.7 percent of pregnancies (Martin and colleagues, 2002), 16 percent of 3201 pregnancy-related deaths (Berg and colleagues,2003)

Keluhan Faktor Risiko Nulipara, chronic hypertension as discussed, multifetal gestation, maternal age over 35 years, obesity, and African-American ethnicity smoking has consistently been associated with a reduced risk of hypertension during pregnancy (Bainbridge and associates, 2005; Zhang and colleagues, 1999).

Klinis Penyebab 1. Abnormal trophoblastic invasion of uterine vessels. 2. Immunological intolerance between maternal and fetoplacental tissues.

3. Maternal maladaptation to cardiovascular or inflammatory changes of normal pregnancy. 4. Dietary deficiencies. 5. Genetic influences.

supplementation with various elements such as zinc, calcium, and magnesium to prevent preeclampsia general population a diet high in fruits and vegetables that have antioxidant activity is associated with decreased blood pressure predisposition to hereditary hypertension undoubtedly is linked to preeclampsia (Ness and colleagues, 2003), and the tendency for preeclampsiaeclampsia is inherited. Kilpatrick and associates (1989), reported an association between the histocompatibility antigen HLA-DR4 and proteinuric hypertension

Diagnosis

Gestational hypertension BP >= 140/90 mm Hg for first time during pregnancy No proteinuria BP returns to normal < 12 weeks' postpartum Final diagnosis made only postpartum

Epigastric or right upper quadrant pain is thought to result from hepatocellular necrosis, ischemia, and edema that stretches the Glisson capsule accompanied by elevated serum

May have other signs or symptoms of preeclampsia, for example, epigastric discomfort or thrombocytopenia Preeclampsia BP >= 140/90 mm Hg after 20 weeks' gestation Proteinuria >= 300 mg/24 hours or >= 1+ dipstick BP 160/110 mg Hg Proteinuria 2.0 g/24 hours or 2+ dipstick Serum creatinine > 1.2 mg/dL unless known to be previously elevated Platelets < 100,000/mm3 Microangiopathic hemolysis (increased LDH) Elevated ALT or AST Persistent headache or other cerebral or visual disturbance Persistent epigastric pain Eclampsia Seizures that cannot be attributed to other causes in a woman with preeclampsia Superimposed Preeclampsia (on chronic hypertension) New-onset proteinuria >= 300 mg/24 hours in hypertensive women but no proteinuria before 20 weeks' gestation A sudden increase in proteinuria or blood pressure or platelet count < 100,000/mm3 in women with hypertension and proteinuria before 20 weeks' gestation Chronic Hypertension BP >= 140/90 mm Hg before pregnancy or diagnosed before 20 weeks' gestation not attributable to gestational trophoblastic disease Hypertension first diagnosed after 20 weeks' gestation and persistent after 12 weeks' postpartum Lab Tatalaksana Preventive: none of these have been found to be clinically efficacious (Sibai, 2003). suplemen kalsium, low-dose aspirin, vitamin C, E Basic management objectives for any pregnancy

hepatic transaminase levels PEB disertai gejala sakit kepala, gangguan penglihatan, upper abdominal pain, oliguria, serum kreatinin meningkat, trombositopenia, enzim liver meningkat, edema pulmoner.

complicated by preeclampsia are: 1. Termination of pregnancy with the least possible trauma to mother and fetus. 2. Birth of an infant who subsequently thrives. 3. Complete restoration of health to the mother. Early Prenatal Detection: ANC lebih meningkat saat trimester 3. Antepartum Hospital Management: initially for women with new-onset hypertension, especially if there is persistent or worsening hypertension or development of proteinuria. Detailed examination Weight on admittance and every day thereafter Analysis for proteinuria Blood pressure readings Measurements of plasma or serum creatinine, hematocrit, platelets, and serum liver enzymes Frequent evaluation of fetal size and amnionic fluid volume

Termination of Pregnancy: The prime objectives are to forestall convulsions, to prevent intracranial hemorrhage and serious damage to other vital organs, and to deliver a healthy infant Antihypertensive Drug Therapy Edukasi