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Published byMabel Jefferson Modified over 8 years ago
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HYPERTENSION IN PREGNANCY LEADING CAUSE OF MATERNAL DEATH AND PERINATAL MORTALITY / MORBIDITY BP MONITORING IS MAJOR ACTIVITY OF ANTENATAL CARE AFFECTS UP TO 10 % OF ALL PREGNANCIES
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TERMINOLOGY dbs wks 75 70 0 40 korotkofF V normal pregnancy ABNORMAL VALUES ? > 140 / 90 ( NELSON) DBP > 90 two readings systolic rise > 30 or diastolic > 15 PROTEINURIA > 0. 3 GM IN 24 HOURS
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CLASSIFICATION PREGNANCY INDUCED HYPERTENSION DEVELOPING AFTER 20 / 40 PREVIOUSLY NORMOTENSIVE PROTEINURIC PIH ( PRE - ECLAMPSIA) > 0. 3 G / 24 HR CHRONIC HYPERTENSION DIAGNOSED BEFORE OR DURING PREGNANCY - essential - renal disease - phaeo / conn’s - coartation CHRONIC HYPERTENSION WITH SUPERIMPOSED PRE – ECLAMPSIA ECLAMPSIACONVULSION DURING PREGNANCY OR WITHIN 7 DAYS OF DELIV., NOT CAUSED BY EPILEPSY
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PET AETIOLOGY GLYCEROPHOSPHOLIPIDS ARACHIDONIC ACID CYCLO OXYGENASE ASPIRIN PROSTAGLANDINS THROMBOXANES PROSTACYCINS ?IMMNUNOLOGIC MECHANISMS
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PET RISK FACTORS PRIMIGRAVIDA OR NEW PARTNER AGE RACE LOW SOCIAL CLASS FAMILIAL TREND ? SINGLE GENE UNDERLYING HYPERTENSIVE DISORDER 20 % DIABETES 50 % TWINS ( MONO) 30 % HYDATIDIFORM MOLE PREVIOUS PET 30 %
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SEVERE ( FULMINATING ) PET DBP > 110 WITH PROTEINURIA SYMPTOMS HEADACHE VISUAL SPOTS EPIGASTRIC PAIN VOMITING HYPER - REFLEXIA
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head ache
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PET MANAGEMENT MILD-MONITOR, DELIVER NEAR TERM MODERATE-FETUS MATURE, DELIVER -FETUS IMMATURE, MONITOR MOTHERLFT URIC ACID, BUN CREATININE CLEARANCE COAGULATION SYMPTOMS BABYBIOPHYSICAL GROWTH DOPPLER NST
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ANTIHYPERTENSIVES LONG TERM METHYL DOPA LABETOLOL ATENOLOL NIFEDIPINE HYDRALLAZINE ACUTE HYDRALLAZINE SODIUM NITRO – PRUSSIDE LABETOLOL
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ANTICONVULSANTS PROPHYLAXIS MAGNESIUM SULPHATE PHENYTOIN DIAZEPAM TREATMENT DIAZEPAM
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ECLAMPSIA RxControl airway Stop convulsion reduce BP Deliver ( GA C. Section) watch postnatally † FROM BRAIN HEMORRHAGE AND 60 % HAVE LIVER DYSFUNCTION
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PREDICTION OF PET RISK FACTORS ROLL OVER TEST OF GANT ANGIOTENSION II PRESSOR TEST URIC ACID COAGULATION FACTORS SERUM RHUBARB DOPPLER ULTRASOUND
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