1. PREGNANCY RELATED HYPERTENSION By Dr. Ali Abd El-Monsif Thabet

2. The classification of hypertensive disorders Chronic hypertension: is defined as hypertension that is present prior to pregnancy or is diagnosed before the 20 th week of gestation. Chronic hypertension: is defined as hypertension that is present prior to pregnancy or is diagnosed before the 20 th week of gestation. Chronic hypertension with superimposed Pre- eclampsia: Pre-eclampsia may occur in women already hypertensive and the prognosis for mother and fetus is much worse than with either condition alone. Chronic hypertension with superimposed Pre- eclampsia: Pre-eclampsia may occur in women already hypertensive and the prognosis for mother and fetus is much worse than with either condition alone.

3. Transient hypertension: is the development of elevated blood pressure during pregnancy or in the 1 st 24 hours post partum without other signs of pre­eclampsia. Transient hypertension: is the development of elevated blood pressure during pregnancy or in the 1 st 24 hours post partum without other signs of pre­eclampsia. Pre-eclampsia: (hypertension peculiar to pregnancy). Pre-eclampsia: (hypertension peculiar to pregnancy).

4. pre-eclampsia (PE) It is a form of hypertension that is unique to human pregnancy. Hypertension (blood pressure 140/90 mmHg after 20 weeks gestation), proteinuria and oedema are considered the classic triad of pre- eclampsia. It is a form of hypertension that is unique to human pregnancy. Hypertension (blood pressure 140/90 mmHg after 20 weeks gestation), proteinuria and oedema are considered the classic triad of pre- eclampsia.

5. Degrees Mild PE is diagnosed when the blood pressure is 140/90 mmHg and there is more than 0.3 gm/Liter of protein in urine, Mild PE is diagnosed when the blood pressure is 140/90 mmHg and there is more than 0.3 gm/Liter of protein in urine, while severe PE is characterized by diastolic blood pressure which exceeds 110 mmHg and protein excretion greater than 3 gm/day. while severe PE is characterized by diastolic blood pressure which exceeds 110 mmHg and protein excretion greater than 3 gm/day. The incidence of PE ranges between 10- 14%. in primigravidae and between 5-7 % in multiparae. The incidence of PE ranges between 10- 14%. in primigravidae and between 5-7 % in multiparae.

6. Physical Therapy Management Relaxation training in form of diaphragmatic breathing exercise for 15 minutes, in addition to Methyldopa 250 mg three times daily. Relaxation training in form of diaphragmatic breathing exercise for 15 minutes, in addition to Methyldopa 250 mg three times daily. Submaximal exercise program at 70% of maximal heart rate, in addition to the use of Methyldopa drug, 3 times daily. All movement were performed through full range of motion with repetition of 10 times. Submaximal exercise program at 70% of maximal heart rate, in addition to the use of Methyldopa drug, 3 times daily. All movement were performed through full range of motion with repetition of 10 times.

8. Definition is a common hyper-androgenic disorder and is characterized by constellation of sings and symptoms such as acne, hirsutism, male pattern baldness, obesity, hyperandrogenism, menstrual cycle disturbance and infertility is a common hyper-androgenic disorder and is characterized by constellation of sings and symptoms such as acne, hirsutism, male pattern baldness, obesity, hyperandrogenism, menstrual cycle disturbance and infertility

9. PCOS is an extremely common disorder that occurs in 7% to 10% of reproductive age. Incidence and prevalence of PCOS

10. Infertility Clinical picture of PCOS Menstrual irregularity AcneHirsutism Virilization Obesity Amenorrhea Functional bleeding Cephalic hair loss Acnthosis nigricans

11. The fundamental pathophysiologic defect of PCOS was attributed to insulin resistance, androgen excess and abnormal gonadotropin dynamics. Pathophysiologyof PCOS

12. Obesity and PCOS Obese women often suffer from a variety of menstrual cycle abnormalities including hypermenorrhea, amenorrhea, infertility and premature menopause. Obesity also appears to be associated with PCOS. So, 80% of obese patients subsequently found to have PCOS.

13. A- Prior to any treatment exclude other causes of infertility Treatment of PCOS B- Weight loss C- Ovulation induction

14. A- Exclude other factors of infertility In Patient As tubal adhesion, Endometriosis, In Husband

15. B- Weight loss Weight loss is the first line of treatment in all women with obesity and PCOS Weight loss is the first line of treatment in all women with obesity and PCOS It appear to be associated with significant improvement in menses abnormalities, ovulation and fertility rate with a reduction of hyperandrogenism and hyperinsulinemia. It appear to be associated with significant improvement in menses abnormalities, ovulation and fertility rate with a reduction of hyperandrogenism and hyperinsulinemia.

16. B- Weight loss I- Nutritional education of low calorie diet Caloric restriction including Moderate energy restriction (1200Kcal/day)

17. Calorie restricted diet accompanied by a return toward normal levels of LH, FSH with normalization of the ovulatory menses.

18. B- Weight loss II- Exercise Moderate aerobic exercise at 50-70% of Vo 2max for > 45 minutes daily for 3 -6 months. So, exercise training program reduced fasting insulin, LH pulse frequency and androgen production.

19. B- Weight loss III- Low calorie diet and exercise Addition of exercise to low calorie diet is advocated to counteract the negative metabolic adaptations that occur during caloric restriction, because exercise training prevents declines in fat oxidation.

20. B- Weight loss IV- Low calorie diet & antidiabetic drug This combination aimed to reduce insulin resistance as well as hyperinsulinemia and correct the LH abnormalities.

21. B- Weight loss Parameters of electrolipolysis *Frequency: 100 pulses/minutes. *Pulse width: 400 microseconds. *Placement of electrodes: on the abdominal and gluteal region. *Duration: 30 min on the abdominal region and other 30 min on both gluteal max.& mediums. 3 months. *Biological effect: Electrolipolysis increases oxidation of fat and glucose uptake so, it reduces weight, waist/hip ratio, LH and LH/FSH ratio, increasing FSH, resuming normal menstrual cycle and occurrence of pregnancy. V- Low calorie diet and electrolipolysis

22. As pharmacological and surgical induction of ovulation in women with PCOS is associated with negative side effects, alternative or complementary methods are needed. Thus electro acupuncture (EA) and may be an alternative or a complement to pharmacological induction of ovulation in women with PCOS who have minor metabolic disturbance. C- Non pharmacological approach for induction of ovulation

23. Electro acupuncture (EA) *It is effective in women with minor metabolic disturbance. *The needles must applied to the effective acupuncture points in somatic segments that innervates the ovary and uterus (Th 12 - L 2 and S 2-4 ). *Electric stimulation with low frequency (2Hz, pulse width 0.5ms for 30minutes. *EA was given two times/ week for two weeks, then once a week, of total treatment sessions from 10-14. *EA corrects the hypothalamic pituitary ovarian axis that resulting in the correction of some hormones such as LH, FSH.

25. Chronic pelvic pain

26. Definition Any pain in pelvic region that lasts 6 months or longer that affect entire area rather than one spot and characterized by: Any pain in pelvic region that lasts 6 months or longer that affect entire area rather than one spot and characterized by: * severe and steady pain * severe and steady pain * sharp and cramping pain * sharp and cramping pain * heaviness deep within pelvis * heaviness deep within pelvis

27. Causes A)Non cyclic: 1- Adhesions. 2- Endometriosis. 3- Salpigo-oophoritis 4- Ovarian neoplasm.

28. B- Cyclic: 1- Primary dysmenorrhea. 2- secondary dysmenorrhea.

29. P.T. Treatment Exercises

30. Relaxation Techniques

31. Hot Application

32. ULTRASOUND

33. Interferential current Frequency :- 100 Hz constant and/or 0- 100 Hz rhythmical Frequency :- 100 Hz constant and/or 0- 100 Hz rhythmical Intensity :- 12-25 mA Intensity :- 12-25 mA Time :- 15-20 min Time :- 15-20 min Duration :- 15 sessions. Duration :- 15 sessions. Sites of Application Sites of Application

34. Short waves diathermy 20- 30 min.

35. Thank you