Hypertensive Disorders of Pregnancy

◆Severe features (any one mandates delivery)

• •BP ≥160 systolic or ≥110 diastolic
• •Platelets <100,000
• •AST/ALT ≥2× ULN + RUQ/epigastric pain
• •Cr >1.1 or doubling
• •Pulmonary edema
• •Persistent headache or visual changes (scotomata)
• •Seizures (eclampsia)

◆Treatment by stage

• •<37 weeks + NO severe features: expectant management with monitoring
• •≥37 weeks OR ANY severe features: DELIVER
• •BP control: labetalol, hydralazine, nifedipine (NOT methyldopa for acute — slow onset)
• •Magnesium sulfate for seizure prophylaxis in severe preeclampsia + eclampsia
• •Continue Mg 24 hours postpartum

◆Magnesium toxicity

• •Loss of DTRs first → respiratory depression → cardiac arrest
• •Rescue: IV calcium gluconate

◆Eclampsia management

• •First-line: IV magnesium sulfate (NOT benzos)
• •Add benzos if refractory
• •Stabilize mother first, then deliver
• •Can occur up to 6 weeks postpartum

◆HELLP

• •Hemolysis + Elevated LFTs + Low Platelets
• •May have NORMAL BP (atypical preeclampsia)
• •Severe feature → DELIVER regardless of GA
• •Postpartum HELLP can occur up to 7 days after delivery

◆Antihypertensives in pregnancy

• •Safe: 'Hypertensive moms Love nifedipine' — Hydralazine, methyldopa (chronic), Labetalol, Nifedipine
• •TERATOGENIC: ACE inhibitors, ARBs (renal agenesis, Potter sequence, oligohydramnios)
• •Avoid diuretics in preeclampsia (volume-depleted state)

◆Preeclampsia prevention

• •Low-dose aspirin (81 mg) starting 12–28 weeks in high-risk women
• •High-risk: prior preeclampsia, chronic HTN, DM, autoimmune (SLE, APS), multiple gestation, renal disease

Classification of HTN in pregnancy