00:01
Today,
we're going to talk about
one of the most common
complications of pregnancy.
00:05
And it's a grouping of disorders
called
hypertensive disorders
of pregnancy.
00:11
Hypertensive disorders
typically affect about
5% to 10%
of pregnancies overall.
00:15
And they are the leading cause
of maternal mortality.
00:19
Remember,
that's maternal death.
00:22
Therefore, different classifications
of hypertensive disorders
that we're
going to discuss today.
00:27
Chronic hypertension,
gestational hypertension,
superimposed hypertension,
and preeclampsia and eclampsia.
00:36
Let's look at
chronic hypertension.
00:39
So epidemiologically speaking,
it affects up to about
8% of pregnancies worldwide.
00:44
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.
01:00
So that definition might look
a little bit different
than some of your other guidelines
for hypertension.
01:05
So pay attention
to this particular diagnosis.
01:09
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.
01:26
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.
01:38
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.
01:51
So before 20 weeks
is chronic,
after 20 weeks seemingly
is related to the pregnancy,
and that's why it's called
gestational hypertension.
02:01
Now, in gestational hypertension,
there's an absence of proteinuria
or any other signs
of any end organ dysfunction.
02:09
So the only thing that's abnormal
is the blood pressure.
02:12
Now, 15% to 45% of these patients
will go on to develop preeclampsia.
02:18
So, at this point, no other symptoms
except an elevated blood pressure.
02:22
Now, the fancy word
superimposed hypertension
occurs with clients
who have chronic hypertension,
who then go on
to develop preeclampsia.
02:32
So by definition,
superimposed hypertension
describes the worsening
of hypertension,
and development
of new onset proteinuria
after 20 weeks.
02:41
So it's layered on top.
02:43
So you come in with a gift
and you get another one.
02:47
Now, let's talk about
the meat of our conversation.
02:50
And that is preeclampsia.
02:52
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.
03:04
16.1% of maternal deaths
of patients who were pregnant
are caused by preeclampsia.
03:11
And thinking about that
in a numeric way,
that's 76,000 maternal deaths,
500,000 fetal deaths.
03:19
That's a lot.
That is so much.
03:22
The definition of preeclampsia
is new-onset hypertension
using the 140/90 guidelines,
and proteinuria
or end-organ disease
after 20 weeks gestation.
03:34
So it looks like
superimposed hypertension,
except that a superimposed patient
had chronic hypertension first.
03:42
This client didn't have any signs
of any sort of hypertension at all
until after 20 weeks.
03:48
So what's different
about these guidelines?
What's changed?
Proteinuria is no longer required
for the diagnosis.
03:55
So a client can have
any other type of symptom
and still be classified
as preeclamptic,
and also dependent edema.
04:02
So remember, dependent edema
is gravity dependent.
04:05
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.
04:14
That's what dependent edema is.