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Hypertensive Disorders in Pregnancy Milind R Shah

1:PIH: The Challenge
- INTRODUCTION
- CLASSIFICATION
  - ISSHP Classification
  - Definitions of Hypertension and Proteinuria Used in ISSHP Classification
- INCIDENCE AND AETIOLOGY
  - Early Diagnosis and Prevention
  - Prediction of PIH
- MANAGEMENT
  - Stepwise Management of Pregnancy Hypertension20
    - Screening
    - Before Delivery
  - Holistic Management in Special Situations21
- MATERNAL SEQUELAE OF SEVERE HYPERTENSION IN PREGNANCY28
- FOLLOW-UP
- FUTURE
- REFERENCES
2:Essential Hypertension and Pregnancy
- INTRODUCTION
- CLASSIFICATION
- NORMAL PHYSIOLOGICAL CHANGE IN BLOOD PRESSURE DURING PREGNANCY
- DEFINITION OF HYPERTENSION
- ESSENTIAL HYPERTENSION
- RISK FACTOR FOR HYPERTENSION
- PATHOGENESIS
- BLOOD PRESSURE MEASUREMENT
- WHITE COAT HYPERTENSION
  - Maternal Risks
  - Perinatal Risks
- CLINICAL ASSESSMENT OF THE HYPERTENSIVE PATIENT
  - Medical History
  - Physical Examination
- INVESTIGATIONS
- FETAL ASSESSMENT
- MANAGEMENT OF HYPERTENSION IN PREGNANCY
- CONCLUSION
- REFERENCES
3:Pregnancy with Renal Disease
- CHANGES IN THE KIDNEYS AND URINARY TRACT IN NORMAL PREGNANCY
- PREGNANCY WITH RENAL DISEASE
- PROGNOSTIC CRITERIA
- COMPLICATIONS
  - Fetal Distress
    - Polyhydramnios
  - Effect of Dialysis
- PREGNANCY AFTER TRANSPLANTATION
  - Pre-pregnancy Counselling
- MANAGEMENT DURING PREGNANCY
- BIBLIOGRAPHY
4:Pathophysiology of Pregnancy-induced Hypertension
- HYPERTENSION
- PRE–ECLAMPSIA
- REFERENCES
5:Aetiopathogenesis of Pre-eclampsia: Current Concept and the Controversies
- INTRODUCTION
- CIRCULATING FACTORS AND THE ENDOTHELIAL INFLAMMATORY CHANGES
  - Syncytiotrophoblast Microfragments (STBM)
  - Oxidative Stress
- VASCULAR ENDOTHELIAL CELL ACTIVATION AND DAMAGE
- COAGULATION ABNORMALITIES AND HAEMOSTATIC CHANGES
- NUTRITIONAL FACTORS
- GENETIC FACTORS IN PRE-ECLAMPSIA
- SUMMARY
- REFERENCES
6:Haemodynamics in Pregnancy and PIH
- INTRODUCTION
- REFERENCES
7:Immunological Aspects in Pre-eclampsia
- INTRODUCTION
  - Pre-eclampsia as a Modular Condition
  - Aetiology
- ABNORMAL TROPHOBLASTIC INVASION
  - Placenta as the Trigger to Pre-eclampsia
- IMMUNOLOGICAL FACTORS
  - Maternal Response
- THE VASCULOPATHY AND THE INFLAMMATORY CHANGES
- MECHANISM OF ACTION
- ADVERSE PREGNANCY OUTCOMES
  - Treatment Guidelines
  - Results of Treatment
- EVIDENCE SUMMARY—I
- EVIDENCE SUMMARY—II
  - Relevance to Under-resourced Settings
- REFERENCES FOR EVIDENCE SUMMARY—II
- EVIDENCE SUMMARY—III
  - Relevance to Under-resourced Settings
  - RESEARCH
- REFERENCES FOR EVIDENCE SUMMARY—III
- REFERENCES FOR THE TEXT (REFERENCES FOR THE EVIDENCE SUMMARY ARE PROVIDED SEPARATELY WITH EACH SUMMARY)
8:High Risk Criteria for Developing PIH
- MEDICAL DISORDERS PREDISPOSING TO PE
- CONCLUSION
- REFERENCES
9:Genetics and PIH
- INTRODUCTION
- CONCLUSION
- REFERENCES
10:Investigations in Hypertensive Disorders of Pregnancy
- PREDICTION OF PIH
- REFERENCES
11:Clinical Examination of Hypertension in Pregnancy
- INTRODUCTION
- CLINICAL FEATURES OF PRE-ECLAMPSIA
- CONCLUSION AND RECOMMENDATIONS
- ABSTRACT
- ACKNOWLEDGEMENT
- ABBREVIATIONS
- REFERENCES
12:Fetal Surveillance in PIH
- INTRODUCTION
- UTEROPLACENTAL INSUFFICIENCY (UPI)
- ANTEPARTUM FETAL TESTS
- WHEN TO BEGIN
- HOW OFTEN?
- CONCLUSION AND RECOMMENDATION
- BIBLIOGRAPHY
13:Imaging in Pregnancy-induced Hypertension
- INTRODUCTION
- CONCLUSION
- REFERENCES
14:Role of Colour Doppler in Pregnancy-induced Hypertension
- INTRODUCTION
- APPLICATION OF DOPPLER STUDIES IN PIH
- CLINICAL SIGNIFICANCE OF THE UTERINE ARTERY FLOW VELOCITY
- UTERINE ARTERY DOPPLER AS A SCREENING TOOL FOR PREDICTION OF PIH
- CLINICAL SIGNIFICANCE OF UMBILICAL ARTERY VELOCIMETRY IN PIH
  - Abnormal Umbilical Artery Flow, What Next?
- FETAL ARTERIAL BLOOD FLOW DISTRIBUTION AND VENOUS BLOOD FLOW
  - Study of Cerebral Circulation in PIH and Its Significance
  - Doppler Indices in Fetal Venous Circulation in Cases of PIH
- METHODOLOGY OF EXAMINATION OF DOPPLER VELOCIMETRY FOR DUCTUS VENOSUS AND INFERIOR VENA CAVA AND ITS SIGNIFICANCE
- CLINICAL APPLICATION OF COLOUR DOPPLER IN PIH
- ACKNOWLEGEMENTS
- REFERENCES
15:Management of Mild PIH as Outdoor Patient
- INTRODUCTION
- DEFINITION
- OUTPATIENT ASSESSMENT
- ASSESSMENT AND SURVEILLANCE
  - Levels of Care for Women with PIH
- HYPERTENSION DETECTED AT BOOKING VISIT OR FIRST VISIT
  - Preliminary Assessment
- BASIC SURVEILLANCE
- ENHANCED SURVEILLANCE
- RECOMMENDATION
- BIBLIOGRAPHY
16:Antihypertensive Drugs for the Treatment of Hypertension in Pregnancy
- INTRODUCTION
- ANTIHYPERTENSIVE TREATMENT
- AIMS OF THE ANTIHYPERTENSIVE TREATMENT
- CLASSIFICATION OF ANTIHYPERTENSIVE DRUGS
- ANTIHYPERTENSIVE DRUGS USED IN ACUTE OR SEVERE HYPERTENSION DURING PREGNANCY
- CONCLUSION
- ACKNOWLEDGEMENT
- REFERENCES
17:Role of ACE Inhibitors and Antihypertensive Drugs in Birth Defects
- INTRODUCTION
  - Animal Studies
  - Placental Transfer
- POSSIBLE MECHANISMS FOR TERATOGENICITY
- ACE INHIBITORS IN THE FIRST TRIMESTER OF PREGNANCY
- ACE INHIBITORS IN THE SECOND AND THIRD TRIMESTERS OF PREGNANCY
  - Exceptional Use of ACE Inhibitors in Pregnancy
- OVERVIEW AND CONCLUSION
- REFERENCES
18:Indication of Delivery or Termination of Pregnancy in Pregnancy-induced Hypertension
- INTRODUCTION
- METHODOLOGY
- SEVERITY OF DISEASE PROCESS
  - OBSTETRIC INTERVENTION IN MILD PREGNANCY-INDUCED HYPERTENSION
- MILD PIH NEAR TERM
- EXPECTANT TREATMENT IN MILD PIH
- OBSTETRIC INTERVENTION IN MODERATE CASE OF PIH
- OBSTETRIC INTERVENTION IN SEVERE PREGNANCY-INDUCED HYPERTENSION
- INDICATION OF DELIVERY IN ECLAMPSIA
- CONCLUSION
  - Policy Decisions
- REFERENCES
19:Postpartum Haemorrhage in Pregnancy-induced Hypertensive Disorders
- OVERVIEW
- INTRODUCTION
- DEFINITIONS
- MANAGEMENT OF ATONIC POSTPARTUM HAEMORRHAGE
- GENITAL TRACT TRAUMA
- UTERINE INVERSION
  - Types of Uterine Inversion
- SECONDARY (DELAYED / LATE) POSTPARTUM HAEMORRHAGE
- REFERENCES
20:Anaesthesia in Case of Pregnancy-induced Hypertension
- INTRODUCTION
- DEFINITION
- PATHOPHYSIOLOGY2,3
- INVESTIGATIONS
  - Control of Hypertension
- DRUGS USED IN PIH AND ITS RELEVANCE TO ANAESTHETIC MANAGEMENT
  - Anticonvulsants
  - Choice of Anaesthesia
- ANAESTHETIC MANAGEMENT
- CONCLUSION
- REFERENCES
21:Eclampsia Management— What is New?
- INTRODUCTION
- ECLAMPSIA MANAGEMENT—WHAT IS NEW?
- DIFFERENTIAL DIAGNOSIS
- INVESTIGATIONS
  - Role of CT Scan in Eclampsia
  - Magnetic Resonance Imaging (MRI) and Eclampsia
  - SPECT Scan (Single Photon Emission Computed Tomorgraphy Scan)
  - PET Scan (Positron Emission Tomography)
  - Maternal Transcranial Doppler
  - Cerebral Angiography
- TREATMENT OF ECLAMPSIA
- PRINCIPLES OF MANAGEMENT OF ECLAMPSIA
- MANAGEMENT OF ECLAMPTIC CONVULSION
- VARIOUS DRUG REGIMES USED PREVIOUSLY
  - Lytic Cocktail Regime (Menon6 1950)
  - Diazepam Therapy (Lean6)
  - Phenytoin Therapy
  - Magnesium Sulphate for Control of Convulsions
  - Magnesium Sulphate Regimes
- RECURRENCE OF CONVULSION
- PHARMACOLOGY AND TOXICOLOGY OF MAGNESIUM SULPHATE
  - Uterine Effects
  - Fetal Effects
- CLINICAL EFFICACY OF MAGNESIUM SULPHATE THERAPY
- STATUS ECLAMPTICUS/STATUS EPILEPTICUS
- MANAGEMENT
- PREVENTION OF ECLAMPSIA
- MAGPIE TRIAL17
- CONTROL OF HYPERTENSION
  - Fluid Therapy
  - Management of Labour and Delivery in Eclampsia
    - Blood Loss at Delivery
- ANALGESIA AND ANAESTHESIA
- COMPLICATIONS OF ECLAMPSIA
  - Pulmonary Oedema
- MATERNAL MORBIDITY AND MORTALITY IN ECLAMPSIA
- PERINATAL OUTCOME IN ECLAMPSIA
- MATERNAL TRANSPORT OF THE ECLAMPTIC PATIENTS
- REFERENCES
22:PIH Prophylaxis—Role of Low Dose Aspirin
- INTRODUCTION
- PHARMACOKINETICS
- INDICATIONS
- PREDICTION TESTS
- CONTRAINDICATIONS
- METHODOLOGY
- DOSAGE
- CLINICAL TRIALS
- COMPLICATIONS AND FOETAL EFFECTS
- RECOMMENDATIONS
- CONCLUSION
- REFERENCES
23:Role of Calcium Supplementation in Preventing Pregnancy-induced Hypertension
- INTRODUCTION
- AETIOLOGY
  - Pathophysiology
- CALCIUM METABOLISM IN PREGNANCY
  - Proposed Mechanism Whereby Calcium Supplementation May Reduce BP16
  - Role of Vitamin D in Causing Hypertension16
- RISK FACTORS
- RECENT TRIALS
- DISCUSSION
- REFERENCES
24:Role of Antioxidant Therapy to Prevent Pre-eclampsia
- INTRODUCTION
  - What is Oxidative Stress (OS)?
  - How does Body Protect against Free-radicals?
- ANTIOXIDANTS
- CONCLUSION
- SUMMARY
- REFERENCES
25:Fetal and Neonatal Complications in Pregnancy-induced Hypertension
- INTRODUCTION
- FETAL AND NEONATAL IMPACT OF PREGNANCY-INDUCED HYPERTENSION
- SIDS
- ACKNOWLEDGEMENT
- BIBLIOGRAPHY
26:The HELLP Syndrome
- INTRODUCTION
- HISTORY
- AETIOLOGY AND PATHOGENESIS
- INCIDENCE
- CLINICAL PRESENTATION
- CLASSIFICATION
  - Based on Criteria
  - Based on Platelet Count 12
- LABORATORY FINDINGS
- SERIOUS COMPLICATIONS IN HELLP SYNDROME PATIENTS
- TREATMENT OF HELLP PATIENTS
- ROLE OF CORTICOSTEROIDS
- PLASMA EXCHANGE AND ANTITHROMBIN III TRANSFUSIONS
- PROGNOSIS
  - Decision Making in the Management of HELLP Syndrome
- KEY POINTS
- REFERENCES
27:Risk of PIH in Future Pregnancy
- INTRODUCTION
  - Why did I get Pre-eclampsia?
- HYPOTHETICAL RISK FACTORS
- REDUCTION OF OXIDATIVE STRESS
- REFERENCES
28:Postnatal Management
- INTRODUCTION
- DEFINITION AND EPIDEMIOLOGY
- CONVULSION
- FLUID MANAGEMENT
  - Management of Haemolysis, Elevated Liver Enzymes, and Low Platelet (HELLP) Syndrome
  - Postpartum Counselling
- BIBLIOGRAPHY
29:The Role of Yoga and Relaxation in PIH
- INTRODUCTION
- CONCLUSION
- REFERENCES
30:Pre-eclampsia Influenced by Fetal Sex
- AGAINST
- REFERENCES
31:Management of PIH in Rural Practice
- INTRODUCTION
- PRENATAL MANAGEMENT
- SOME SUGGESTIONS FOR PROBLEMS IN EXPECTANT MANAGEMENT IN RURAL CARE
- SOME SUGGESTIONS FOR DEALING WITH SPECIAL PROBLEMS IN RURAL CARE
- CONCLUSION
- FURTHER READING

INDEX

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