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HYPERTENSIVE DISORDERS OF PREGNANCY.pptx
- 1. HYPERTENSIVE DISORDERS OF PREGNANCY -Dr Tanvi Vasalla
- 2. Mrs.Sushma 36 yr old female Resident of Nandgaon, vadodra Hindu by religion Homemaker by occupation educated till graduation Belongs to upper middle class according to modified kuppuswami scale G2P1L1 LMP -21/8/2021 EDD-28/5/2022
- 3. Chief complain of amenorrhea since 8 months and came to opd for routine antenatal check up and her blood pressure recording was found to be high.
- 4. HOPI Came to opd for routine anc check up , BP was found to be high and was admitted for monitoring and further evaluation. She was perceiving adequate fetal movements. No history of headache, blurring of vision, chest pain, decreased urine output, swelling of feet, excessive weight gain. No history of pain in abdomen. Leaking pv, bleeding pv.
- 5. History of present pregnancy FIRST TRIMESTER Spontaneous conception Non consanguineous marriage LMP -21/8/2021 EDD-28/5/2022 NO history of irregular cycles hence sure of date Diagnosed at 1.5 months of amenorrhea by UPT Booked at government hospital at 2 months of period of gestation Advised anc investigations-normal 1st USG done: normal Advised 1 yellow tablet od taken regularly No history of excessive nausea and vomiting , fever or rashes, radiation exposure, drug exposure, bleeding per vaginum, discharge per vaginum, burning micturition.
- 6. SECOND TRIMESTER Quickening at 3 months of amenorrhea Perceiving adequate fetal movements 2 doses of TT taken at 4 and 5 th month Vaccinated for COVID as well second usg done at 5th months-normal Lab investigations done-normal History of regular intake of red/yellow/white tablet OD and took another white tablet BD. No history of high BP Recorded No history of epigastric pain, blurred vision, headache,decreased urine output and swelling of feet. No history of excessive hunger and thirst, frequesncy of micturition or recurrent UTI No history of easy fatiguability, breathlessness,dyspnea on exertion. Palpitation,syncopal attack and chest pain No history of fever, burning micturartion, bleeding per vaginum and leaking per vaginum
- 7. THIRD TRIMESTER On her 1st visit in 3rd trimester she came for routine anc check up and her BP recordings were found to be high. She was admitted for survillence and further evaluation. No other complains of epigastric pain, blurring of vision, headache, dyspnea, chest pain. Reduced urine output were there.
- 8. MENSTRUAL HISTORY Age of menarche 14 yrs LMP 21/8/2021 EDD 28/5/2022 PAST cycles regular 3-5 days / 28-30 days No history of dysmenorrhea or passage of clots
- 9. OBSTRETIC HISTORY G2P1L1 G1-11 yr male child full term emergency lscs was done due to fetal distress .history of high BP RECORDINGS in term, treatment with anti hypertensive was done. Intrapartum. Post partum was uneventful . Child exclusive breastfed for 6 months, fully immunised, normal developemental milestones , Contraception was not used.
- 10. Past history: not significant Family history: history of hypertension in mother 10 years back . Controlled by oral antihypertensives Personal history: adequate sleep Normal bowel and bladder No history of any addiction/alcohol /smoking Belongs to middle class No drug addiction
- 11. Dietary history: Mixed diet by 24 hr recall method Consumes 2500 kcal /day With 62 gms protein daily
- 12. GENERAL examination: Sitting comfortably Concious oriented with time, person and place Average build/ well nourished General condition fair Ht 152 cm Bmi-32 Pre pregnancy weight 72 kgs Present wt 84 kgs
- 13. Hydration adequate Afebrile on touch PR 84 /min in rt radial artery with good volume normal character no radiofemoral delay all peripheral pulses are palpable. BP 160/110 mm hg in right arm in supine position repeated after 15 mins RR 18/min thoracoabdominal Jvp not raised
- 14. Normal hair texture Orodental hygiene fair No pallor icterus .cyanosis, clubbing Grade 2 pedal odema No palpable lymph node Bilateral breast normal changes of pregnancy seen
- 15. Systemic examination Respiratory system: air entry bilateral equal . No added sound Cardiovascular system: apex beat in 4th intercostal place in anterior axillary line S1 S2 normal no murmur heard Central nervous system:no sensory /motor deficit, all reflxes are normal
- 16. ABDOMINAL EXAMINATION Inspection: Uniformly distended Uterine ovoid in longitudinal axis All quadrants moving well with respiration Umblicus central/inverted Linea nigra stria gravidarum seen No dilated veins all hernial spots free on cough impulse Previous cesarian scar present-transverse
- 17. PALPATION All the inspected findings are confirmed Local temperature not raised Sfh=30 cm AG 92 cm Uterus measures 32 weeks size Fetus cephalic presentation Uterus relaxed non tender Liquor adequate Efw:2.5 kg Previous cesrian scar present no scar tenderness
- 18. AUSCULTATION: FHS on right spinoumblical line regular 142 beats per minute Per speculum not done Per vaginum not done Urine albumin ++
- 19. PROVISIONAL DIAGNOSIS: 36 Yr female with G2P1L1 with 32 weeks 5 days period of gestation with singleton live fetus in longitudinal lie cephalic presentation with preclampsia with severe features , not in labor.