Hypertension in pregnancy can be gestational hypertension, chronic hypertension, or chronic hypertension appearing for the first time in pregnancy. Gestational hypertension is high blood pressure without proteinuria after 20 weeks of gestation. Pre-eclampsia includes gestational hypertension plus proteinuria. Eclampsia involves seizures in pre-eclamptic women. The pathophysiology involves placental lesions restricting blood flow and damaging the endothelium, affecting multiple maternal organs. Management involves monitoring, controlling blood pressure, delivering if complications occur, and magnesium sulfate to prevent seizures in eclampsia.
A comprehensive overview of hypertensive disorders in pregnancy with its complications and management. Mainly focused on gestational hypertension, preeclampsia and eclampsia.
Please find the power point on Gestational Diabetes Mellitus (GDM) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
A comprehensive overview of hypertensive disorders in pregnancy with its complications and management. Mainly focused on gestational hypertension, preeclampsia and eclampsia.
Please find the power point on Gestational Diabetes Mellitus (GDM) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
The kidneys filter waste and excess fluid from the blood. As kidneys fail, waste builds up.
Symptoms develop slowly and aren't specific to the disease. Some people have no symptoms at all and are diagnosed by a lab test.
Medication helps manage symptoms. In later stages, filtering the blood with a machine (dialysis) or a transplant may be required.
Although the most important causes of kidney injury in late pregnancy are preeclampsia and the associated disorders eclampsia and HELLP (hemolysis, elevated liver enzyme levels, low platelet count) syndrome, they will be discussed with the hypertensive disorders of pregnancy.
Hypertensive disorders in pregnancy refer to a group of conditions characterized by high blood pressure during pregnancy, which can include gestational hypertension (high blood pressure that develops after 20 weeks of pregnancy) and preeclampsia (a more severe form of hypertension that can also cause protein in the urine and changes in liver function). These conditions can be serious for both the mother and the baby and may require close monitoring and management. Treatment options may include medications to lower blood pressure, as well as close monitoring of the mother and baby to ensure their health and well-being.
Pregnancy is one of the wonderful gifts of God, imposed naturally to womanhood only. It is a period of enormous physio- pathological and psychological adoption in a women’s life.
Pregnancy is a normal physiological process and not a disease, but it is associated with certain risks to health and survival both for women and infant she bears.
Every minute of everyday a women dies of pregnancy related complications.
Hypertension is one of the common problems met during pregnancy and contributes significantly to maternal and perinatal morbidity and mortality.
Pregnancy-induced hypertension is one of the maternal diseases that causes the most detrimental effects to the maternal, fetal, and neonatal organisms.
Pregnancy-induced hypertension is also called toxemia or preeclampsia. It occurs most often in young women with a first pregnancy. Hypertension is the most common medical problem encountered during pregnancy, complicating 2-3% of pregnancies.
Discover the critical insights you need to understand and combat pre-eclampsia in this engaging presentation. My expertly curated slides offer a comprehensive overview of this pregnancy-related condition, covering its causes, symptoms, risk factors, diagnosis, treatment options, and preventative measures. Don't miss this opportunity to gain a deeper understanding of pre-eclampsia and protect the health of expectant mothers and their babies.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
2. Hypertension :
High blood pressure is said to be present if bp is
persistently at or above 140/90 mmHg.
3. May belong to one of the following
Gestational hypertension (occurring solely because of pregnancy)
Chronic hypertension (hypertensive from before the pregnancy)
Chronic hypertension (incidentally becoming apparent first time in
pregnancy
4. Gestational hypertension
Pregnancy induced hypertension
(Gestational hypertension is usually defined as having a blood pressure higher
than 140/90mm hg without the presence of protein in the urine and diagnosed
after 20 weeks of gestation)
Pre eclampsia
(Pre-eclampsia is gestational hypertension (blood pressure greater than
140/90) plus proteinuria (>300 mg of protein in a 24-hour urine sample).
Severe preeclampsia involves a blood pressure greater than 160/110, with
additional medical signs and symptoms)
Eclampsia
(This is when tonic-clonic seizures appear in a pregnant woman with high blood
pressure and proteinuria)
5. Pathophysiology
Disease of pregnancy.
Exact aetiology is unknown
According to the current concept it is a disease of wide spread
endothelial damage
Occurs from placental pathology and its signs are due to secondary
involvement of other organ system
6. PRIMARY PLACENTAL PATHOLOGY
two lesions have been identified
1- Lack of secondary wave of trophoblastic invasion:
Normally the spiral arteries undergo physiological changes
these are
cytotrophoblast of placenta that breaks down the endothelium, internal
elastic lamina& muscular coat of vessel
these are replaced by fibrinoid converting the vessel to sinusoids.
7. In pre eclampsia only half to 2/3rd of arteries undergo these changes.
This leads to restriction in placental blood flow
which becomes evident with advancing gestation.
More over they remain sensitive to vasomotor stimulus.
8.
9. 2-Acute atherosis :
The second lesion is called acute atherosis. ,which is characterized by
aggregates of fibrin, platelets & lipid laden macrophages
It is seen in spiral arteries the basal arteries and the decidua parietalis
.
These lasions partly or completely block the Vessels
leading to ischaemia of fetal placenta giving rise to infarcts patchy
necrosis & intracellular damage to syncytiotrophoblast
10. Secondary influences :
Maternal effects:
the abnormal placentation& production of products of inflammation effect wide range
of organs
Maternal organ involvement :
Cardiovascular system :
(rise in bp because of ↑ vascular resistance & may lead to severe hypertension)
Renal system:
first tubular dysfunction leading to hyperurecemia
then gromerular dysfunction leading to proteinuria exceeding 5 grams /24hrz.
Proteinuria leads to hypoalbumenaemia
this leads to lower colloid osmotic pressure & generalized edema,ascites,pleural
effusion pulmonary & cerebral edema .
11. Liver:
periportal and subcapsular haemorrhage , periportal fibrin deposition
areas of infarction and necrosis
Excessive haemorrhage may lead to rupture shock and maternal death .
Blood :
activation of coagulation and fibrinolytic system.
In severe cases it may lead to DIC & microangiopathic haemolytic anemia
HELLP syndrome :
(haemolysis ,elevated liver enzymes and low platelet count)
Occurs in later part of pregnancy.
The common symptoms are epigastric or right hypochondral pain, nausea ,
vomiting and visual disturbance
Respiratory system :
pulmonary edema & adult respiratory distress syndrome
13. Risk factors : May be maternal & fetal
MATERNAL :
Primigravidity
Age less than 20 & more than 35
Previous pre eclampsia & its family history
Obesity
Pregnancy with a new partner
Chronic hypertension
Diabetes
Chronic renal disease
Hypothyroidism
Migrane
15. Management :
The women is hypertensive when the bp is persistenly high at two consective readings when taken 4 or more hours
apart.
To determine the type of hypertension & where it is preeclampsia the extict of the disease
The steps are:
History
Examination
Investigations (maternal & fetal)
maternal
↓
Proteinuria ( ↑300mg/24 hrs)
Renal function test (urea ↑7mmol/l & creatinine ↑100mmol/l indicate severe disease)
LFTs
Coagulation profile (platelet count, fibrinogen level, thrombin time & fibrinogen
degradation products)
Fetal → ultrasound
16. FURTHER MANAGEMENT :
Hypertension alone
Hypertension with proteinuria
Hypertension with proteinuria and symptoms
17. Hypertension alone :
focus on antihypertensive therapy and salt intake
↓
Antihypertensive therapy
↓ ↓
emergency long term antihypertensives
↓ ↓
Hydralazine Methyl dopa
Nefidipine Diuretics
Labetalol etc
Salt intake :
Should consume salt to taste but refrain from added salt
18. Hypertension with proteinuria:
should be admitted to hosp on the same day
↓
Management in hospital
Daily observations ( urea, symptoms, kick count
chart etc )
Twice week observations ( cardiotocography twice a
week)
Weekly observations (uric acid, urea, creatinine, LFT,
ultra sound at 2 weeks interval)
19. Conservative management should be culminated in the favour of delivery when:
Pregnancy reaches term
Maternal bp Cannot be controlled
Platelet count falls below 50 ×109
/L
Creatinine rises above 120mmol/L
Women develops symptoms
Evidence of liver damage
Urinary protein loss exceeds 3g/24 hrs
Fetus is seriously compromised
20. Hypertension with proteinuria & symptoms (fulminating preeclampsia)
:
↓
Management on following lines
Hospital admission
High level of care
Fluid management ( to avoid oliguria)
Drug therapy (prophylactic anti convulsants like magnesium
sulphate & antihypertensives)
21. Management of labour & delivery :
Mode of delivery
→ vaginal delivery is the route of choice
→ pre eclampsia at times makes vaginal delivery risky
→ while managing pre eclampsia one should have low
threshold for c sec
Induction of labour
→ spontaneous labour carries best outcome
→ prostaglandins must be used with caution & patient
must be watched
properly
22. Oxytocin
→used for induction & augmentation of labour
→may lead to myocardial failure in patients with compromised
cardiac function
Fetal monitoring
Intstrumental delivery (not an indication but can be used)
Caesarean section
→ choice of anesthesia is important as GA poses specific problems in
pre eclamptic patients.
23. Management of eclampsia :
Two phases :
General measures
Specific measures
General measures :
Placed flat in the left lateral position & tight clothes are loosened
Air ways , breathing & circulation is maintained
IV line is taken preferably with a wide bore needle on both sdes
Foley,s catheter is passed for comfort of patient & measuring output
24. Specific measures :
Anticonvulsant drugs ( Diazepam is drug of choice,Mg sulpate &
phenytoin to prevent recurrence
Diazepam ( 10mg IV initially. Dose is repeated with every fit
to a total of 50mg)
Magnesium sulphate
↓
Loading dose of 4g given IV over 4 minutes & 10g IM(5g each
buttock). Dose of 2g IV over 2 min is repeated if convulsions
persist after 15 min . followed by maintainence dose of 5g IM
every 4 hrs on alternate buttock
Phenytoin ( IV dose of 18mg/kg at rate of 50 mg /min
25. Antihypertensive therapy
IV labetalol & Hydralazine
Dilivery :
After seizures & hypertension are controlled fetal well
being can be assessed & delivery is made
C section is recommended in the following
↓
all deeply unconscious patients until delivery is imminent
uncooperative patients due to restlessness
vaginal delivery is unlikely to occur within 6-8 hrs of
first fit
obstetrical indication for C section
fetal distress