This document presents a case study of a 36-year-old pregnant woman. Her chief complaints are amenorrhea for 9 months and lower abdominal pain for 3 days. After examination, the provisional diagnosis is gestational hypertension. The document further discusses the classification, diagnostic criteria, and management objectives for hypertensive disorders of pregnancy such as gestational hypertension and preeclampsia.

1. PREGNANCY INDUCED
HYPERTENSION
SOURAV- 88
MOHAMMAD- 89
SABOOR- 90
TAHREEM- 91
CASE PRESENTATION

2. CASE HISTORY
• Case of Shaheen Fatima, 36 yrs old female, belonging to Muslim religion, resident of
Sangam Vihar, Housewife by occupation, married to Khalid Khan, teacher by
occupation, for 12 years.
• Belonging to Upper Middle Class according to Modified Kuppuswamy Scale.
• She is Gravida 3, Para 2, Live 2, Abortion 0 with POG 37 weeks + 1 day (as on 6th June)
• Her LMP was on 19th September 2022, which makes her EDD 26th June, 2023.
• She is a booked patient, presented to the OPD of HAHC Hospital 2 days back with
the chief complaints of
• Amenorrhea since 9 months
• Pain in lower abdomen since 3 days

3. HISTORY OF PRESENTING ILLNESS
• Patient has history of Amenorrhea since past 9 months
• According to the patient, she was apparently well 3 days back when she developed
pain in lower abdomen which was
• Gradual in onset
• Intermittent in nature
• Moderate in intensity
• Radiating towards back
• No aggravating or relieving factors
• No h/o fever, bleeding, tightening, discharge, headache

4. HISTORY OF PRESENT PREGNANCY
• Her current pregnancy is planned which was confirmed by herself with the help of
UPT after 1 month of missed periods.
• She presented to the hospital during her 2nd month and has total 8 visits.
• Increased frequency of micturition
• Folic acid supplements taken
• TD 1st dose taken in 3rd month
• USG done in 3rd month, reports of which was normal according to patient
• No h/o nausea and vomiting in 1st trimester
• No h/o fever with rash
• No h/o radiation exposure
• No h/o of spotting or bleeding pv
• 1st Trimester

5. • Quickening felt at 5th month
• TD 2nd dose taken in 4th month
• Iron and folic acid supplements taken
• Calcium supplements taken
• USG level- 2 done at 5th month, reports of which were normal according to patient
• Screening of diabetes (OGTT) done in 6th month, reports were normal according to
patient
• No h/o headache, blurring of vision, epigastric pain or tightening of rings
• No h/o itching
• 2nd Trimester

6. • Regular intake of iron, folic acid and calcium supplements
• USG done in 8th month, reports of which were normal according to patient
• BP was raised on her last visit, for which she was given medications
• Urine sample was taken and was sent for further investigations
• Patient was diagnosed with hypothyroidism in the 9th month for which she is taking
Thyronorm 25mcg
• No h/o blurring of vision, pedal edema, headache, epigastric pain or tightening of
rings
• No h/o bleeding or discharge
• 3rd Trimester

7. MENSTRUAL HISTORY
• LMP- 19th September 2022
• POG- 37 weeks + 1 day
• Menarche at 13 yrs
• Regular periods
• Bleeding lasts for 3 days with 2 pads used per day
• No h/o dysmenorrhoea

8. OBSTETRIC HISTORY
• She is married for 12 yrs and it was a non-consanguineous marriage
• She is G-3 P-2 L-2 A-0
1st Child
• She conceived 4 months after marriage
• She went into spontaneous labour and delivered a baby girl 11 yrs back
• It was a pre-term (7 months) vaginal delivery
• The baby girl weighed 1.9 kg, cried immediately after birth and was kept in NICU for
2 days
• Breastfeeding was initiated after 2 days and was continued till 2 yrs of age
• The child is fully immunised till date

9. • It was a term normal vaginal delivery
• The baby girl weighed 3kg and cried immediately after birth
• Breastfeeding was initiated after 1 hour and continued till 2 yrs of age
• Antepartum, intrapartum and postpartum period were uneventful
• The baby is 7 yrs old, presently alive and well
2nd Child

10. PAST HISTORY
• No h/o diabetes, hypertension, tuberculosis or cardiovascular problems
• No h/o blood transfusion
• No past surgical history
FAMILY HISTORY
• Patient has a family history of diabetes mellitus and hypertension
• No h/o tuberculosis, cardiovascular problems in the family
• No h/o any congenital disease in the family

11. DIETARY HISTORY
• Patient takes a mixed diet
• According to 24 hour recall method
PERSONAL HISTORY
• No h/o smoking or alcohol consumption
• No sleep disturbance
• Adequate appetite
• Normal bowel and bladder habits
• No h/o allergy
Intake Ideal Intake Deficit
Calorie 1995 Kcal 1660+350=2010Kcal 15 Kcal (0.7%)
Protein 53 gm 46+22= 68 gm 15 gm (22%)
CONTRACEPTIVE HISTORY
• No h/o use of contraception

12. EXAMINATION
• Consent was taken and the procedure was explained to the patient
• The patient is lying comfortably in bed in supine position with empty bladder
• She is conscious, well oriented to time, place and person and has average built
• Height: 155 cm ; Pre pregnancy weight: 65 kg ; BMI: 27.1 kg/m2
Vitals and GPE
• Pulse: 84 bpm, regular in rate and rhythm, good in volume and equal in both sides
in sitting position
• Blood pressure: 138/98 mm Hg in sitting position in right brachial artery
• Respiratory rate: 20 breaths/min
• Temperature: afebrile
• Pallor present
• Icterus, cyanosis, clubbing, lymphadenopathy absent
• Orodental hygiene adequate
• Thyroid not palpable on examination
• Pedal edema absent

13. BREAST EXAMINATION
• Breast were soft, bilaterally symmetrical
• Nipples erect
• No scar marks
• No dilated veins
• No discharge
• No tenderness
• No palpable mass

14. SYSTEMIC EXAMINATION
• Normal heart sounds S1, S2 heard
• No murmur present
CVS
Respiratory
• Trachea centrally placed
• Normal breath sounds heard
• No added sounds heard
• B/L air entry present
• Tachypnea absent

15. ABDOMINAL EXAMINATION
Inspection
• Abdomen is distended, longitudinal in shape
• Linea nigra present
• Stria gravidarum present
• Stria albicans present
• Umbilicus flat and central
• Scar marks absent
• Hernial orifices intact
Palpation
• Symphysiofundal height: 35 cm
• Abdominal girth: 41.5 inches

16. LEOPOLD’S MANEUVERS
• 1st grip: Fundal grip
• Soft, broad, irregular, non ballotable structure was felt, suggestive of buttocks
• 2nd grip: Lateral grip
• Firm, smooth, hard, resistant structure suggestive of back (on left side)
• Small, knobby structures suggestive of limbs (on right side)
• 3rd grip: Superficial pelvic grip
• Head was not ballotable
• 4th grip: Deep pelvic grip
• Fingers were diverging, suggestive of engagement of head

17. AUSCULTATION
• Fetal heart sound heard on auscultation

18. DIAGNOSIS
• On the basis of history and examination, Mrs Shaheen Fatima, 37 yrs old female,
multigravida with G3 P2 L2 A0 presented to the hospital at 37+1 weeks of gestation
with single live fetus, admitted in view of increased blood pressure and for further
workup
• Provisional diagnosis is Gestational Hypertension

19. Systolic BP≥140 and/or
Diastolic BP≥90
On 2 occasions 4 hrs
apart
POG less than 20
weeks
Chronic Hypertension
POG more than 20
weeks
Pregnancy Induced
Hypertension
CLASSIFICATION OF HYPERTENSIVE DISORDERS

20. Pregnancy
Induced
Hypertension
Proteinuria and/or
signs of end
organ damage
present
PRE-ECLAMPSIA
Proteinuria and
signs of end
organ damage
absent
GESTATIONAL
HYPERTENSION

21. Pre-Eclampsia
Non severe
Severe
(BP≥160/110
mm Hg)
New Onset Generalised Tonic
Clonic Seizures OR Coma
Eclampsia

22. PROTEINURIA
OR
Screening by
Dipstick Test
24 hr urine
protein (Gold
Standard)
Proteinuria
Spot urine
Protein
Creatinine
ratio
Protein reading ≥ 2+
≥ 300 mg
≥ 0.3

23. SIGNS OF END ORGAN DAMAGE
• Platelet count < 1 lakh/μL
• Liver enzymes twice of normal
• Serum creatinine > 1.1 mg/dL
• Pulmonary edema
• Headache
• Epigastric pain
• Visual symptoms
• Scotoma
• Blurring of vision
• Diplopia
• Blindness
SIGNS OF IMPENDING ECLAMPSIA
• Severe headache not resolving on analgesics
• Severe epigastric pain
• Severe visual disturbances

24. APPROACH
■NST
■BPP
■USG
Fetal Well
Being
■Platelet count
■Serum
creatinine
■Liver enzymes
Severity of
Disease
■Test for
proteinuria
■Urine
microscopy
If red cell casts
seen;
underlying
renal pathology
If granular
casts;
suggestive of
pre eclampsia
Nature of
Disease
•■Done in ALL
pregnant
women on
EACH
antenatal visit.
■If SBP≥140
and/or DBP≥90
on 2 occasions
4 hrs apart,
check POG for
chronic or
pregnancy
induced
hypertension
BP
Documentation

28. MANAGEMENT OBJECTIVES
• To stabilize hypertension and prevent its progression to
severe pre-eclampsia.
• To prevent complications.
• To prevent eclampsia.
• Delivery of a healthy baby in optimal time.
• Restoration of the health of the mother in puerperium.

29. MANAGEMENT OF GESTATIONAL HYPERTENSION