Obstetric Complications

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Obstetric Complications

Obstetric ComplicationsHypertensive Disorders of PregnancyGestational HTN (PIH)Pre-clampsiaEclampsiaChronic HTNPreeclampsia superimposed on chronic HTNRisk Factors for Pregnancy Related HTN (PRH)Fistr pregnancyAge > 35Family historyPre-existing HTN or pre-existing vascular diseaseRenal diseaseObesityDMMutifetal pregnancyMother or sister with pre-eclampsia

PreclampsiaWhat is it?When does it occurBeside HTN, what else would be present?Effect of fetusWhat is the cure?Preventive MeasuresMeasures work best with high risk reoccurrencesPrenatal monitoringmedsEffects of Increased Vascular ResistanceRenal perfusionProteinsVascular volumeLiver circulationCerebral vesselsColloid oncotic pressurePlacental circulation6ManifestationsClassic signsAdditional signsCV systemIncreasedReponses to angiotensin IIBPSVRDecreasedCOPlasma volume

Hematologic

IncreasedHemoconcentrationViscosityPlatelet clumpingThrombocytopeniaEndothelium damage

NeurologicArterial vasospasmRupture of small capillariesSmall hemorrhagesHeadache **Hyperreflexia **Convulsions (eclampsia) RenalDecreasedGFRColloid osmotic pressureDamage to glomeruliProteinuriaFluid shift (edema)HypovolemiaIncrease HCTAngiotensin II and aldosteroneBUN and Cr and uric acidIHepaticImpairedHepatic edemaEpigastric painPlacentaDecreasedPerfusionFetal hypoxemiaAcidosisPerinatal deathNutrients IUGR

Mild PreclampsiaActivity restrictionsUAFetal assessmentDietMild SevereSBP 140 but < 160DBP >90 but 0.3 g but < 2 g in 24 hr ( 1+ dipstick)Cr (serum) normalPlatelets normalLiver enzymes normal to slightUO normalHeadache (severe)Upper quad pain visual disturbances ( absent or minimalPulm edema, Hrt failureIUGR

BP > 160DBP >110>5 g in 24 hr urine and 3+ or higher dipstick)>1.2Decreased 90 mmHgTxDietPrevent preeclampsiaMedsAldomet (Methydopa)Calcium channelBeta blockersACE not receommendedpregnancyDiuretics are avoided