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Pre-eclampsia/Eclampsia

In this article, we will discuss Pre-eclampsia/Eclampsia. So, let’s get started.

Pre-eclampsia/Eclampsia

Pre-eclampsia is diagnosed clinically by the development of hypertension, proteinuria, edema which may be associated with convulsions (eclampsia) or hemolysis, hepatic dysfunction, i.e. elevated liver enzymes and thrombocytopenia (HELLP syndrome) even in the absence of significant hypertension. As the risk of eclampsia is real, BP control has to be much stricter in pregnant patients. Patient with mild eclampsia should be managed conservatively with limited physical activity. For women with severe eclampsia (BP>160/110 mmHg) should be treated with I.V. labetolol or hydralazine or nicardipine. Oral nifedipine and methyldopa can be used in patients with chronic hypertension in pregnancy (patients who are hypertensive become pregnant). Therefore, women with hypertension should be followed carefully because of increased risk to mother and fetus. The ACEs and ARBs should be avoided. The target blood pressure to be achieved is <140/90 mmHg by drug therapy.

Recommended drug (drugs of choice): Hydralazine, Labetolol, Nicardipine

Drugs to avoid: Nitroprusside, Trimethophan, Diuretics

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Hypertensive Emergency

In this article, we will discuss the Hypertensive Emergency. So, let’s get started.

Hypertensive Emergency

According to JNC (Joint National Committee) VI report, a hypertensive emergency was defined as a severely elevated BP diastolic >130 mmHg with signs or symptoms of acute target organ damage (e.g. eye- hypertensive retinopathy, papilledema, kidney- renal impairment or failure, blood vessels- peripheral vascular disease, etc), requiring parenteral drug treatment, close observation in ICU and immediate reduction of blood pressure (within one hour) to avoid risk of morbidity or death.

These are patients with severe asymptomatic hypertension with BP >220/120 mmHg with ocular fundal changes.

Common Hypertensive Emergency includes:

  • Hypertensive encephalopathy or malignant hypertension
  • Hypertensive nephropathy
  • Acute aortic dissection
  • Pheochromocytoma crisis
  • Hypertension with LVF
  • Pre-eclampsia
  • MAO inhibitors with tyramine interaction
  • Intracranial hemorrhage
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