Book of Medical Disorders in Pregnancy - Tintash

differentiating between chronic
hypertension and pregnancy in-duced
hypertension when a patient becomes
hypertensive in the early third trimester.
Patients, who require less than 7 mg of
angiotensin II per kilogram of body
weight per minute to elicit a pressure
response at this time, can be diagnosed
as case of preeclampsia. The student
must be cautioned here that in normal
clinical practice such tests can not be
done, therefore no attempt should be
made to perform this test. Such cases
should be referred to a referral centre
equipped with these diagnostic facilities.
Chronic hypertension with
superimposed pre eclampsia:
Chronic hypertension with superimposed
pre-eclampsia is the result of acute aggravation
of the already existing underlying
hypertension, with the rapid development
of edema and proteinuria. The
funduscopic findings showing re-tinal
sheen, hemorrhages, and exudates may
become more prominent. There is often
a quick progression to eclampsia, which
may develop before the 30th week of
gestation. Strict diagnostic criteria are
sometimes difficult to establish but
depend on the following.
When documented evidence is available
that the patient had chronic hypertension
along with the evidence of a
superimposed acute process, as
demonstrated by elevation of systolic
blood pressure by 30 mm Hg or diastolic
blood pressure by 15 to 20 mm Hg
above the base line on two occasions at
least 6-hours apart. Proteinuria and or
edema as observed in women with preeclampsia
are also present. The
development of any one of the three
signs of superimposed preeclampsia, that
53
is, worsening hyper-tension, proteinuria,
or edema, may al-one if severe enough,
justify the diagnosis of superimposed
preeclampsia. However, the diagnosis
should re-quire the presence of
accelerated hyper-tension accompanied
by at least one of the two other signs.
If the gravida with chronic hypertension
requires less than 7 mg/kg/minute of
angiotensin II to elicit a 20 mm Hg
increase in diastolic blood pressure, it is
likely that she has superimposed preeclampsia.
Normal
blood
flow
Carotid
Arteries
Brain
Decreased
Blood flow
Fig4.6: Shows brain vessels exposed.
Latent or transient hypertension:
The category of 'Intent or transient
hypertension includes only those patients
whose transient elevations of blood pressure
are observed during labor or in the
early puerperium.
Their illnesses may range widely from
mild preeclampsia to latent or early
vascular hypertension.
Management of pregnancy induced
hypertension:
The management includes prevention
and therapeutic treatment.