Book of Medical Disorders in Pregnancy - Tintash

Incidence - Its incidence varies according
to geographical location,
socioeconomic status, racial origin and
nutritional status of the patient. The
increase in frequency of eclampsia in
areas where dietary deficiencies are
common, such as China, the Philippines
and Pakistan is suggestive but not conclusive.
The proof of dietary deficiency
as causative factor is not very clear.
Etiology - The etiology of pregnancy
induced hypertension is entirely unknown.
Functioning trophoblastic tissue
is required for its initiation and maintenance,
but the presence of a fetus is not
apparently essential. Classically, it is a
disease of the young Primigravida and
characteristically, it occurs in the third
trimester. Twins and hydatidiform mole
are predisposing factors.
Classification of hypertension:
In order to classify blood pressure the
guide lines for both systolic and diastolic
blood pressure are provided It is
considered normal when BP recording is
found Systolic 90-119 mmHg and 60-
79 mmHg diastolic while it is considered
that Prehypertension is present
when BP systolic is recorded as 120-139
mmHg and diastolic as 80-89 mmHg
Stage 1 hypertension is considered as
present when systolic BP is recorded
as140-159 mmHg and diastolic as90-99
mmHg stage 2 hypertension is considered
present when systolic BP is
recorded as160 mmHg and diastolic as
100 mmHg this classification is based on
guidelines provided by American Heart
Association
Other classification used in literature:
Primary 90-95% of cases also termed
“essential” or “idiopathic”.
• Secondary – about 5% of cases
-Renal or renovascular disease
-Endocrine disease
• Pheochromocytoma
• Cushings syndrome
• Conn’s syndrome
• Acromegaly
• hypothyroidism
-Coarctation of the aorta
-Iatrogenic
• Hormonal / oral contraceptive
• NSAIDs
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High chorionic gonadotrophin le-vels are
occasionally seen in these pati-ents, but
the levels are not related to the severity
of the disease process.
A number of reversible biolo-gical
changes occur in preeclampsia. These
indicate that there are widespread
aberrations in cellular function, and
strongly suggest that it is a meta-bolic
disease.
Hypertension in pregnancy is a disease
of many theories.
Theories - A number of hypotheses have
been expressed concerning the etiology
of preeclampsia. None so far has been
able to explain the reasons for its predisposition
in primi gravidas, in multiple
pregnancy and hydatidiform mole. Similarly
other factors such as its appearance
in certain geographic areas and in poor
populations, its appearance late in
pregnancy, and its tendency not to recur
in subsequent pregnancies and its improvement
after fetal death remain unexplained.
Theory of uterine ischemia - This
hypothesis at present is greatly favored.
It is postulated that mechanical factors in
or about the uterus fail to allow the