Today, we're going to talk about
one of the most common complications of pregnancy.
And it's a grouping of disorders called
hypertensive disorders of pregnancy.
Hypertensive disorders typically affect about
5% to 10% of pregnancies overall.
And they are the leading cause of maternal mortality.
Remember, that's maternal death.
Therefore, different classifications of hypertensive disorders
that we're going to discuss today.
Chronic hypertension, gestational hypertension,
superimposed hypertension,
and preeclampsia and eclampsia.
Let's look at chronic hypertension.
So epidemiologically speaking,
it affects up to about 8% of pregnancies worldwide.
And the definition of chronic hypertension,
the way we use it in pregnancy anyway,
is blood pressure that is greater than 140/90
on two different occasions prior to 20 weeks gestation,
or after 12 weeks postpartum.
So that definition might look a little bit different
than some of your other guidelines for hypertension.
So pay attention to this particular diagnosis.
Now, other patients who experience chronic hypertension
41% will end up delivering via cesarean,
28% will experience a preterm birth,
25 to 40% will go on to develop preeclampsia,
which is different.
21% will have a baby that ends up in the neonatal intensive care unit,
17% will experience a baby of low birth weight,
and 4% will have a fetal death.
Gestational hypertension, which is the second classification
is signified by a systolic blood pressure
that's greater than 140,
and or a diastolic that's greater than 90
that occurs after 20 weeks gestation.
So before 20 weeks is chronic,
after 20 weeks seemingly is related to the pregnancy,
and that's why it's called gestational hypertension.
Now, in gestational hypertension, there's an absence of proteinuria
or any other signs of any end organ dysfunction.
So the only thing that's abnormal is the blood pressure.
Now, 15% to 45% of these patients will go on to develop preeclampsia.
So, at this point, no other symptoms except an elevated blood pressure.
Now, the fancy word superimposed hypertension
occurs with clients who have chronic hypertension,
who then go on to develop preeclampsia.
So by definition, superimposed hypertension
describes the worsening of hypertension,
and development of new onset proteinuria
after 20 weeks.
So it's layered on top.
So you come in with a gift and you get another one.
Now, let's talk about the meat of our conversation.
And that is preeclampsia.
So according to the ACOG guidelines, which stands for the
American College of Obstetrics and Gynecology,
there's an epidemiology of 2% to 8% worldwide
of incidences of preeclampsia.
16.1% of maternal deaths of patients who were pregnant
are caused by preeclampsia.
And thinking about that in a numeric way,
that's 76,000 maternal deaths, 500,000 fetal deaths.
That's a lot. That is so much.
The definition of preeclampsia is new-onset hypertension
using the 140/90 guidelines,
and proteinuria or end-organ disease
after 20 weeks gestation.
So it looks like superimposed hypertension,
except that a superimposed patient had chronic hypertension first.
This client didn't have any signs of any sort of hypertension at all
until after 20 weeks.
So what's different about these guidelines?
What's changed?
Proteinuria is no longer required for the diagnosis.
So a client can have any other type of symptom
and still be classified as preeclamptic,
and also dependent edema.
So remember, dependent edema is gravity dependent.
So when you get up in the morning, everything's fine,
but after you've been walking around all day,
or sitting in a chair, or at your computer,
you begin to get edema in your lower extremities.
That's what dependent edema is.