Hypertensive Disorders in Pregnancy
Download MP3Welcome to another essential episode of the FlightBridgeED Podcast: MDCAST, where we dive deep into the complexities of critical care and continue our high-risk OB transport conversation. This episode focuses on the often overlooked yet rapidly increasing crisis of hypertensive disorders in pregnancy. Host Dr. Mike Lauria and maternal-fetal medicine specialist Dr. Elizabeth Garchar discuss the full spectrum of hypertensive disorders—from gestational hypertension to the life-threatening condition of eclampsia—and share practical insights on managing these critical patients in prehospital and transport settings.
Starting with foundational definitions of specific disorders like pre-eclampsia vs. eclampsia and HELLP syndrome, they explore the physiological mechanisms driving preeclampsia, the increased mortality rates, and why transport providers are seeing more cases in rural or under-resourced facilities. Learn how to distinguish between different diagnoses, manage acute cases in transit, and navigate treatment protocols with a detailed look at magnesium sulfate's role and the right blood pressure control strategies. This episode brings expert-level insight to providers of all backgrounds, from the basics to the most advanced interventions.
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Key Takeaways:
- Pathophysiology of Preeclampsia: This condition often arises from placental abnormalities that lead to widespread vascular issues, impacting both the mother and fetus.
- Magnesium Sulfate in Management: Magnesium sulfate is vital for preventing eclampsia and should be monitored for toxicity, especially in patients with reduced kidney function.
- Identification of Hypertensive Disorders: A blood pressure reading of 160/110 mmHg or greater post-20 weeks' gestation is a significant indicator of hypertensive disorders, warranting immediate medical attention.
References
- Sperling JD, Dahlke JS, Huber WJ, Sibai BM. The role of Headache in the classification and management of hypertensive disorders in pregnancy. Obstetrics and Gynecology. 2015; 126:297-302.
- Sabai BM. The HELLP syndrome (hemolysis, elevated liver enzymes and low platelets): much ado about nothing? Am J of Obstetrics and Gynecology. 1990; 162:311-6.
- Steegers EA, von Daselszen P, Duvekot JJ, Pijnenborg R. Pre-Eclampsia. Lancet. 2010; 376:631-44.
- Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science. 2005; 308:1592-4
- von Dadelszen P, Magee LA, Roberts JM. Subclassification of preeclampsia. Hypertens Pregnancy. 2003; 22:143-8
- Dekker GA, Sibai BM. Etiology and pathogenesis of preeclampsia: current concepts. Am J Obstet Gynecol. 1998; 179; 1359-75.
- Gillon TE, Pels A, von Dadelszen P, MacDonell K, Magee LA. Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines. PloS one. 2014; 9(12): e113715.
- Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260.
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