The document discusses pre-eclampsia, a pregnancy complication characterized by high blood pressure, protein in urine, and edema. It begins by defining pre-eclampsia and describing its signs and symptoms. It then covers risk factors, classifications of mild versus severe pre-eclampsia, pathophysiology, pathological changes, signs and symptoms, investigations, and management approaches including monitoring and delivering at term for mild cases and early delivery for severe cases.
This document discusses fetal positioning and presentations during labor and delivery. It begins by defining non-vertex presentations including breech, face, brow, transverse, and compound. It then discusses the causes of non-vertex presentations and describes the different positions including occiput posterior. The document provides details on assessing various positions through abdominal and vaginal exams. It concludes by outlining the management of different non-vertex positions, including allowing natural rotation, augmentation of labor, operative vaginal delivery, or caesarean section if needed.
The third stage of labour involves the delivery of the placenta and membranes after childbirth. It normally lasts 5-15 minutes but can take up to 30 minutes without significant bleeding. The main risks include postpartum hemorrhage from uterine atony, retained placenta, or genital tract trauma. Active management with controlled cord traction and uterotonics after delivery reduces the risk of PPH compared to expectant management. Complications are treated by uterine massage, additional uterotonics, exploration for trauma, or surgery in severe cases of hemorrhage.
The document discusses two conditions that can cause bleeding in late pregnancy - abruptio placenta and placenta previa. Abruptio placenta involves the separation of the placenta from the uterus prior to delivery and common risk factors include hypertension and trauma. Placenta previa occurs when the placenta implants in the lower uterine segment over the cervical os. Management of both conditions involves monitoring for maternal and fetal stability and either emergency c-section or planned c-section depending on gestational age and severity of bleeding. Complications can include disseminated intravascular coagulation for abruptio placenta or placenta accreta if placenta previa occurs over a previous c-section
This document defines HELLP syndrome as preeclampsia associated with hemolytic anemia, elevated liver enzymes, and low platelet count. It describes the HELLP triad of hemolysis, elevated liver enzymes, and low platelet count. Risk factors include age over 34, multiparity, and white race. HELLP syndrome ranges from severe to mild based on platelet count and liver enzyme levels. Conservative management focuses on blood pressure control, preventing seizures, corticosteroids, and fluid therapy, with termination of pregnancy for severe cases.
This document discusses pregnancy induced hypertension, which includes chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension. It defines each condition and describes their causes, risk factors, management during pregnancy, and criteria for delivery. Chronic hypertension is high blood pressure before or early in pregnancy, while gestational hypertension develops after 20 weeks without other complications. Preeclampsia involves hypertension and proteinuria. Management depends on severity and gestational age, ranging from observation to medical treatment and delivery.
Threatened abortion by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
Threatened abortion is associated with bleeding and/or uterine cramping while the cervix is closed. This stage of abortion may progress to spontaneous incomplete or complete abortion. While this event may be considered a part of the quality control process in human reproduction, it is important to know the possible etiologies and when therapy might prevent pregnancy loss. The World Health Organization estimated that 15% of all clinically recognizable pregnancies and in spontaneous abortion, 50-60% of which are due to chromosomal abnormalities. Apart from the fetal factors, several maternal and probably paternal factors contribute to the causes of spontaneous abortion. The maternal factors that may be responsible for abortion include both local and systemic conditions such as infections, maternal disease states, genital tract abnormalities, endocrine factors and other miscellaneous causes (antiphospholipid antibodies, maternal-fetal histocompatibility, excessive smoking and other environmental toxicants, etc.). This review focuses on the management of threatened abortion, but it should be emphasized that the management to maintain pregnancy is reasonable only in those cases, in which the fetus is not seriously affected. It would not be beneficial to provide treatment that would permit chromosomally and anatomically abnormal embryos to survive to term. Treatment is feasible first of all in cases with maternal factors. Surgical procedures may precede pregnancy (correction of septate uterus, removal of a submucous leiomyomata) or may be performed usually in the second trimester (cervical cerclage). Maternal general diseases (diabetes, hypothyroidism) and infections should be treated accordingly. The most common entity to be treated in this category is luteal phase deficiency. Progesterone is the most important hormone for the maintenance of an early human pregnancy. Besides progesterone administration, human chorionic gonadotropin (hCG) also is the logical endocrine treatment of choice. In the pregnant woman hCG stimulates and optimizes hormonal production in the corpus luteum and may also influence the fetoplacental unit. The contribution of environmental, physical and chemical agents to the incidence of spontaneous abortion is controversial. They may be abortifacient even if they are not teratogenic. Exposure to environmental toxicants should be avoided. Paternal leukocyte immunotherapy has been associated with successful outcome in patients with unexplained repeated spontaneous abortion. This therapeutic approach is considered experimental, as there may be some significant risks. Associating maternal antiphospholipid antibodies with reproductive failure is a rapidly developing field. Administration of corticosteroids with low doses of aspirin has resulted in fetal salvage in women in whom antiphospholipid antibodies are present.
This document discusses fetal distress, which is now referred to as non-reassuring fetal status. It describes the pathophysiology of fetal distress as being caused by chronic placental insufficiency and hypoxia, leading to lactic acid buildup and changes in fetal heart rate and meconium passage. It distinguishes between acute and chronic fetal distress and lists various causes. Diagnosis is made based on abnormal fetal heart rate patterns, meconium staining, low pH, and low Apgar scores. Management involves oxygen, monitoring the mother, addressing hypotension, and immediate delivery.
006 management of the third stage of laborHummd Mdhum
The third stage of labor involves the period from delivery of the baby to delivery of the placenta. It normally takes 5-10 minutes and is divided into four phases: latent phase, contraction phase, detachment phase, and expulsion phase. The major risk is postpartum hemorrhage. Active management, including a uterotonic drug before delivery of the placenta and controlled cord traction, reduces blood loss and risk of retained placenta compared to expectant management. Complete placental separation is confirmed when the cord stops pulsing and cannot be pulled into the uterus.
This document discusses fetal positioning and presentations during labor and delivery. It begins by defining non-vertex presentations including breech, face, brow, transverse, and compound. It then discusses the causes of non-vertex presentations and describes the different positions including occiput posterior. The document provides details on assessing various positions through abdominal and vaginal exams. It concludes by outlining the management of different non-vertex positions, including allowing natural rotation, augmentation of labor, operative vaginal delivery, or caesarean section if needed.
The third stage of labour involves the delivery of the placenta and membranes after childbirth. It normally lasts 5-15 minutes but can take up to 30 minutes without significant bleeding. The main risks include postpartum hemorrhage from uterine atony, retained placenta, or genital tract trauma. Active management with controlled cord traction and uterotonics after delivery reduces the risk of PPH compared to expectant management. Complications are treated by uterine massage, additional uterotonics, exploration for trauma, or surgery in severe cases of hemorrhage.
The document discusses two conditions that can cause bleeding in late pregnancy - abruptio placenta and placenta previa. Abruptio placenta involves the separation of the placenta from the uterus prior to delivery and common risk factors include hypertension and trauma. Placenta previa occurs when the placenta implants in the lower uterine segment over the cervical os. Management of both conditions involves monitoring for maternal and fetal stability and either emergency c-section or planned c-section depending on gestational age and severity of bleeding. Complications can include disseminated intravascular coagulation for abruptio placenta or placenta accreta if placenta previa occurs over a previous c-section
This document defines HELLP syndrome as preeclampsia associated with hemolytic anemia, elevated liver enzymes, and low platelet count. It describes the HELLP triad of hemolysis, elevated liver enzymes, and low platelet count. Risk factors include age over 34, multiparity, and white race. HELLP syndrome ranges from severe to mild based on platelet count and liver enzyme levels. Conservative management focuses on blood pressure control, preventing seizures, corticosteroids, and fluid therapy, with termination of pregnancy for severe cases.
This document discusses pregnancy induced hypertension, which includes chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension. It defines each condition and describes their causes, risk factors, management during pregnancy, and criteria for delivery. Chronic hypertension is high blood pressure before or early in pregnancy, while gestational hypertension develops after 20 weeks without other complications. Preeclampsia involves hypertension and proteinuria. Management depends on severity and gestational age, ranging from observation to medical treatment and delivery.
Threatened abortion by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
Threatened abortion is associated with bleeding and/or uterine cramping while the cervix is closed. This stage of abortion may progress to spontaneous incomplete or complete abortion. While this event may be considered a part of the quality control process in human reproduction, it is important to know the possible etiologies and when therapy might prevent pregnancy loss. The World Health Organization estimated that 15% of all clinically recognizable pregnancies and in spontaneous abortion, 50-60% of which are due to chromosomal abnormalities. Apart from the fetal factors, several maternal and probably paternal factors contribute to the causes of spontaneous abortion. The maternal factors that may be responsible for abortion include both local and systemic conditions such as infections, maternal disease states, genital tract abnormalities, endocrine factors and other miscellaneous causes (antiphospholipid antibodies, maternal-fetal histocompatibility, excessive smoking and other environmental toxicants, etc.). This review focuses on the management of threatened abortion, but it should be emphasized that the management to maintain pregnancy is reasonable only in those cases, in which the fetus is not seriously affected. It would not be beneficial to provide treatment that would permit chromosomally and anatomically abnormal embryos to survive to term. Treatment is feasible first of all in cases with maternal factors. Surgical procedures may precede pregnancy (correction of septate uterus, removal of a submucous leiomyomata) or may be performed usually in the second trimester (cervical cerclage). Maternal general diseases (diabetes, hypothyroidism) and infections should be treated accordingly. The most common entity to be treated in this category is luteal phase deficiency. Progesterone is the most important hormone for the maintenance of an early human pregnancy. Besides progesterone administration, human chorionic gonadotropin (hCG) also is the logical endocrine treatment of choice. In the pregnant woman hCG stimulates and optimizes hormonal production in the corpus luteum and may also influence the fetoplacental unit. The contribution of environmental, physical and chemical agents to the incidence of spontaneous abortion is controversial. They may be abortifacient even if they are not teratogenic. Exposure to environmental toxicants should be avoided. Paternal leukocyte immunotherapy has been associated with successful outcome in patients with unexplained repeated spontaneous abortion. This therapeutic approach is considered experimental, as there may be some significant risks. Associating maternal antiphospholipid antibodies with reproductive failure is a rapidly developing field. Administration of corticosteroids with low doses of aspirin has resulted in fetal salvage in women in whom antiphospholipid antibodies are present.
This document discusses fetal distress, which is now referred to as non-reassuring fetal status. It describes the pathophysiology of fetal distress as being caused by chronic placental insufficiency and hypoxia, leading to lactic acid buildup and changes in fetal heart rate and meconium passage. It distinguishes between acute and chronic fetal distress and lists various causes. Diagnosis is made based on abnormal fetal heart rate patterns, meconium staining, low pH, and low Apgar scores. Management involves oxygen, monitoring the mother, addressing hypotension, and immediate delivery.
006 management of the third stage of laborHummd Mdhum
The third stage of labor involves the period from delivery of the baby to delivery of the placenta. It normally takes 5-10 minutes and is divided into four phases: latent phase, contraction phase, detachment phase, and expulsion phase. The major risk is postpartum hemorrhage. Active management, including a uterotonic drug before delivery of the placenta and controlled cord traction, reduces blood loss and risk of retained placenta compared to expectant management. Complete placental separation is confirmed when the cord stops pulsing and cannot be pulled into the uterus.
This document summarizes information about post-term pregnancy and induction of labor. It defines post-term pregnancy as beyond 42 weeks gestation, which increases risks of complications. Induction of labor is commonly recommended between 41-42 weeks to reduce risks. Common methods of induction include amniotomy, prostaglandins like misoprostol, and oxytocin infusion. Risks of induction include greater pain, uterine hyperstimulation, and potential need for C-section if induction fails. Accurate dating and fetal surveillance are important aspects of managing post-term pregnancies.
Dr. Rupa Rajshekar presents information on abruptio placentae (AP), or premature separation of the placenta from the uterine wall. AP has an incidence of 1 in 75 to 1 in 225 births and can recur in subsequent pregnancies. Risk factors include increased age, preeclampsia, smoking, and prior AP. AP is classified as revealed, concealed, or mixed based on whether bleeding is visible. Complications for both mother and baby can be severe, including hemorrhage, shock, renal failure, and fetal death. Diagnosis is based on symptoms and ultrasound may show placental separation. Management depends on gestational age and maternal stability, and may involve resuscitation, monitoring, steroids
Toxemia of pregnancy: Definition,risk factors,Clinical features,management of pre-eclampsia. Nursing students will understand toxemia of pregnancy .Jasleen Kaur
This document discusses hypertensive disorders in pregnancy. It begins by noting that hypertensive disorders complicate about 10% of pregnancies and are a major cause of maternal and infant morbidity and mortality. The document then defines various types of hypertensive disorders like gestational hypertension, preeclampsia, eclampsia, and chronic hypertension. It discusses risk factors, pathogenesis, clinical features, maternal and fetal effects, diagnostic criteria and differential diagnosis of these conditions. The multi-organ pathophysiology and maternal syndrome are explained through placental hypoxia and endothelial dysfunction.
Antepartum haemorrhage is defined as bleeding from or into the genital tract after 28 weeks of pregnancy but before birth. Placenta previa, where the placenta implants over the cervix, is a leading cause, accounting for about one-third of cases. With placenta previa, bleeding is typically sudden, painless, and recurrent. Management depends on gestational age and severity of bleeding, ranging from bed rest and monitoring to emergency cesarean delivery.
1) Abnormal lie and presentation occur when the fetus is positioned in the uterus with something other than its head facing downward toward the birth canal.
2) The document defines abnormal lie and presentation and identifies types such as transverse, oblique, breech, face, brow, and shoulder.
3) Causes of abnormal lie and presentation include cephalopelvic disproportion, preterm delivery, small baby size, fetal anomalies, and uterine or abdominal wall issues. Diagnosis involves assessing dates, history, physical exam including palpation and ultrasound, and may require caesarean section or external cephalic version for breech presentations.
This document provides information on the classification, definition, management, and treatment of hypertensive disorders during pregnancy including pre-eclampsia and eclampsia. It classifies hypertensive disorders based on onset and characteristics, defines pre-eclampsia as new hypertension with proteinuria after 20 weeks of gestation, and eclampsia as seizures occurring in pre-eclampsia or pregnancy-induced hypertension. It outlines protocols for magnesium sulfate treatment of seizures, antihypertensive treatment, fluid management, and delivery decisions.
Antepartum haemorrhage is defined as bleeding from or into the genital tract after 28 weeks of pregnancy. The main causes are placental bleeding (70%), unexplained bleeding (25%), and extraplacental bleeding (5%). Placenta praevia, where the placenta implants over the lower uterine segment, is a common cause and accounts for 35% of cases. It can be diagnosed using ultrasound and risks include preterm birth, fetal distress, postpartum hemorrhage, and increased need for operative delivery. Management involves bed rest, monitoring for bleeding and fetal wellbeing, blood transfusions if needed, and potential early delivery by caesarean section.
This document discusses the diagnosis and management of hypertensive disorders in pregnancy. It defines various types of hypertension including gestational hypertension, preeclampsia, and eclampsia. It covers the signs and symptoms, potential complications, risk factors, diagnostic tests, and treatment approaches including antihypertensive medications and magnesium sulfate administration. Treatment involves controlling blood pressure, preventing seizures, administering steroids to promote fetal lung maturity, and carefully monitoring fluid balance, with the goal of optimizing outcomes for both the mother and baby.
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
This document discusses hypertension in pregnancy, including gestational hypertension. It defines gestational hypertension as blood pressure of 140/90 or higher after 20 weeks of pregnancy without proteinuria, with blood pressure returning to normal within 12 weeks postpartum. It notes that early onset of gestational hypertension and higher blood pressure are risk factors for progression to preeclampsia. Treatment for gestational hypertension focuses on monitoring and controlling severe high blood pressure, with delivery occurring between 37-38 weeks.
Antepartum haemorrhage (APH) is bleeding from or into the genital tract occurring between 24 weeks of pregnancy until birth. The most common causes are placenta praevia and placental abruption. APH complicates 3-5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide. Management of APH involves assessing the severity of bleeding and signs of shock, investigating the cause, monitoring the fetus, and considering conservative management or delivery depending on gestational age and stability of the mother and fetus. Definitive treatment depends on the specific cause and can involve induction, vaginal delivery, or caesarean section.
Preeclampsia in pregnancy etiopathogenesis and management Deepti Daswani
This document discusses the etiopathogenesis and management of preeclampsia. It begins by outlining recommendations for blood pressure measurement in pregnancy. It then covers the classification of hypertension in pregnancy and risk factors for preeclampsia. The document discusses the etiology of preeclampsia involving poor placentation leading to placental oxidative stress and endothelial dysfunction. Predictors of preeclampsia and the role of ultrasound are described. Management involves termination of pregnancy, with timing based on gestational age and severity of symptoms. Antihypertensive therapy aims to control blood pressure without dropping it too low.
This document summarizes preeclampsia, including its classification, etiology, epidemiology, risk factors, symptoms, complications, prevention, and conclusion. Preeclampsia is a pregnancy complication characterized by hypertension and proteinuria. It remains a leading cause of maternal and infant mortality. The pathophysiology involves poor placentation leading to placental ischemia and release of factors causing maternal endothelial dysfunction. Risk factors include previous preeclampsia, age under 18 or over 40, family history, chronic hypertension, diabetes, and obesity. Symptoms may include edema, headaches and nausea. Complications can include eclampsia, HELLP syndrome, stroke and death. Prevention focuses on delivery, and treatment involves blood pressure management
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the uterus, usually in the fallopian tubes. It can be life-threatening because it may cause internal bleeding. The document discusses the definition, incidence, risk factors, types (acute, unruptured, chronic), clinical presentation, investigations, and management approaches for ectopic pregnancies, including expectant, medical, and surgical options depending on the individual case. The goal of treatment is to preserve fertility when possible through conservative approaches like salpingostomy or systemic methotrexate administration.
Eclampsia is a life-threatening condition characterized by seizures in pregnant or postpartum women. It is caused by severe preeclampsia leading to high blood pressure and organ damage. Management involves preventing further seizures with magnesium sulfate. Delivery of the baby is usually required to fully resolve the condition since it is caused by pregnancy. The baby must be closely monitored during treatment for signs of distress.
This document provides an overview of preterm labor and abnormal uterine action. It begins by defining preterm labor as labor starting between 24-28 weeks and before 37 weeks of pregnancy. The prevalence of preterm labor is reported to range between 5-10%. Risk factors for preterm labor are then discussed, along with potential maternal and fetal complications. Diagnosis and management of preterm labor focuses on preventing onset, arresting labor if possible, and providing appropriate neonatal care. The document then discusses various types of abnormal uterine action including hypertonic, hypotonic, dyscoordinate, and tonic contractions. Causes, signs, and management are described for each type. Cervical dystocia is also reviewed, distinguishing between primary
This document discusses hypertensive emergencies in pregnancy. It begins by classifying the four main categories of hypertensive disorders in pregnancy according to the American College of Obstetricians and Gynecologists. It then discusses the epidemiology, pathophysiology, diagnosis, and pharmacologic treatment options for hypertensive emergencies in pregnancy. The document emphasizes that treatment is recommended for severe hypertension persisting over 15 minutes to prevent end-organ damage, and that intravenous labetalol, intravenous hydralazine, and oral nifedipine are commonly recommended first-line medications.
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.
This document summarizes information about post-term pregnancy and induction of labor. It defines post-term pregnancy as beyond 42 weeks gestation, which increases risks of complications. Induction of labor is commonly recommended between 41-42 weeks to reduce risks. Common methods of induction include amniotomy, prostaglandins like misoprostol, and oxytocin infusion. Risks of induction include greater pain, uterine hyperstimulation, and potential need for C-section if induction fails. Accurate dating and fetal surveillance are important aspects of managing post-term pregnancies.
Dr. Rupa Rajshekar presents information on abruptio placentae (AP), or premature separation of the placenta from the uterine wall. AP has an incidence of 1 in 75 to 1 in 225 births and can recur in subsequent pregnancies. Risk factors include increased age, preeclampsia, smoking, and prior AP. AP is classified as revealed, concealed, or mixed based on whether bleeding is visible. Complications for both mother and baby can be severe, including hemorrhage, shock, renal failure, and fetal death. Diagnosis is based on symptoms and ultrasound may show placental separation. Management depends on gestational age and maternal stability, and may involve resuscitation, monitoring, steroids
Toxemia of pregnancy: Definition,risk factors,Clinical features,management of pre-eclampsia. Nursing students will understand toxemia of pregnancy .Jasleen Kaur
This document discusses hypertensive disorders in pregnancy. It begins by noting that hypertensive disorders complicate about 10% of pregnancies and are a major cause of maternal and infant morbidity and mortality. The document then defines various types of hypertensive disorders like gestational hypertension, preeclampsia, eclampsia, and chronic hypertension. It discusses risk factors, pathogenesis, clinical features, maternal and fetal effects, diagnostic criteria and differential diagnosis of these conditions. The multi-organ pathophysiology and maternal syndrome are explained through placental hypoxia and endothelial dysfunction.
Antepartum haemorrhage is defined as bleeding from or into the genital tract after 28 weeks of pregnancy but before birth. Placenta previa, where the placenta implants over the cervix, is a leading cause, accounting for about one-third of cases. With placenta previa, bleeding is typically sudden, painless, and recurrent. Management depends on gestational age and severity of bleeding, ranging from bed rest and monitoring to emergency cesarean delivery.
1) Abnormal lie and presentation occur when the fetus is positioned in the uterus with something other than its head facing downward toward the birth canal.
2) The document defines abnormal lie and presentation and identifies types such as transverse, oblique, breech, face, brow, and shoulder.
3) Causes of abnormal lie and presentation include cephalopelvic disproportion, preterm delivery, small baby size, fetal anomalies, and uterine or abdominal wall issues. Diagnosis involves assessing dates, history, physical exam including palpation and ultrasound, and may require caesarean section or external cephalic version for breech presentations.
This document provides information on the classification, definition, management, and treatment of hypertensive disorders during pregnancy including pre-eclampsia and eclampsia. It classifies hypertensive disorders based on onset and characteristics, defines pre-eclampsia as new hypertension with proteinuria after 20 weeks of gestation, and eclampsia as seizures occurring in pre-eclampsia or pregnancy-induced hypertension. It outlines protocols for magnesium sulfate treatment of seizures, antihypertensive treatment, fluid management, and delivery decisions.
Antepartum haemorrhage is defined as bleeding from or into the genital tract after 28 weeks of pregnancy. The main causes are placental bleeding (70%), unexplained bleeding (25%), and extraplacental bleeding (5%). Placenta praevia, where the placenta implants over the lower uterine segment, is a common cause and accounts for 35% of cases. It can be diagnosed using ultrasound and risks include preterm birth, fetal distress, postpartum hemorrhage, and increased need for operative delivery. Management involves bed rest, monitoring for bleeding and fetal wellbeing, blood transfusions if needed, and potential early delivery by caesarean section.
This document discusses the diagnosis and management of hypertensive disorders in pregnancy. It defines various types of hypertension including gestational hypertension, preeclampsia, and eclampsia. It covers the signs and symptoms, potential complications, risk factors, diagnostic tests, and treatment approaches including antihypertensive medications and magnesium sulfate administration. Treatment involves controlling blood pressure, preventing seizures, administering steroids to promote fetal lung maturity, and carefully monitoring fluid balance, with the goal of optimizing outcomes for both the mother and baby.
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
This document discusses hypertension in pregnancy, including gestational hypertension. It defines gestational hypertension as blood pressure of 140/90 or higher after 20 weeks of pregnancy without proteinuria, with blood pressure returning to normal within 12 weeks postpartum. It notes that early onset of gestational hypertension and higher blood pressure are risk factors for progression to preeclampsia. Treatment for gestational hypertension focuses on monitoring and controlling severe high blood pressure, with delivery occurring between 37-38 weeks.
Antepartum haemorrhage (APH) is bleeding from or into the genital tract occurring between 24 weeks of pregnancy until birth. The most common causes are placenta praevia and placental abruption. APH complicates 3-5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide. Management of APH involves assessing the severity of bleeding and signs of shock, investigating the cause, monitoring the fetus, and considering conservative management or delivery depending on gestational age and stability of the mother and fetus. Definitive treatment depends on the specific cause and can involve induction, vaginal delivery, or caesarean section.
Preeclampsia in pregnancy etiopathogenesis and management Deepti Daswani
This document discusses the etiopathogenesis and management of preeclampsia. It begins by outlining recommendations for blood pressure measurement in pregnancy. It then covers the classification of hypertension in pregnancy and risk factors for preeclampsia. The document discusses the etiology of preeclampsia involving poor placentation leading to placental oxidative stress and endothelial dysfunction. Predictors of preeclampsia and the role of ultrasound are described. Management involves termination of pregnancy, with timing based on gestational age and severity of symptoms. Antihypertensive therapy aims to control blood pressure without dropping it too low.
This document summarizes preeclampsia, including its classification, etiology, epidemiology, risk factors, symptoms, complications, prevention, and conclusion. Preeclampsia is a pregnancy complication characterized by hypertension and proteinuria. It remains a leading cause of maternal and infant mortality. The pathophysiology involves poor placentation leading to placental ischemia and release of factors causing maternal endothelial dysfunction. Risk factors include previous preeclampsia, age under 18 or over 40, family history, chronic hypertension, diabetes, and obesity. Symptoms may include edema, headaches and nausea. Complications can include eclampsia, HELLP syndrome, stroke and death. Prevention focuses on delivery, and treatment involves blood pressure management
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the uterus, usually in the fallopian tubes. It can be life-threatening because it may cause internal bleeding. The document discusses the definition, incidence, risk factors, types (acute, unruptured, chronic), clinical presentation, investigations, and management approaches for ectopic pregnancies, including expectant, medical, and surgical options depending on the individual case. The goal of treatment is to preserve fertility when possible through conservative approaches like salpingostomy or systemic methotrexate administration.
Eclampsia is a life-threatening condition characterized by seizures in pregnant or postpartum women. It is caused by severe preeclampsia leading to high blood pressure and organ damage. Management involves preventing further seizures with magnesium sulfate. Delivery of the baby is usually required to fully resolve the condition since it is caused by pregnancy. The baby must be closely monitored during treatment for signs of distress.
This document provides an overview of preterm labor and abnormal uterine action. It begins by defining preterm labor as labor starting between 24-28 weeks and before 37 weeks of pregnancy. The prevalence of preterm labor is reported to range between 5-10%. Risk factors for preterm labor are then discussed, along with potential maternal and fetal complications. Diagnosis and management of preterm labor focuses on preventing onset, arresting labor if possible, and providing appropriate neonatal care. The document then discusses various types of abnormal uterine action including hypertonic, hypotonic, dyscoordinate, and tonic contractions. Causes, signs, and management are described for each type. Cervical dystocia is also reviewed, distinguishing between primary
This document discusses hypertensive emergencies in pregnancy. It begins by classifying the four main categories of hypertensive disorders in pregnancy according to the American College of Obstetricians and Gynecologists. It then discusses the epidemiology, pathophysiology, diagnosis, and pharmacologic treatment options for hypertensive emergencies in pregnancy. The document emphasizes that treatment is recommended for severe hypertension persisting over 15 minutes to prevent end-organ damage, and that intravenous labetalol, intravenous hydralazine, and oral nifedipine are commonly recommended first-line medications.
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.
Pregnancy-induced hypertension (PIH) is a condition characterized by new onset hypertension after 20 weeks of gestation without prior chronic hypertension. It can range from mild to severe preeclampsia and eclampsia. Severe PIH is associated with multiple organ involvement and risks to both mother and baby. Care involves careful monitoring, controlling blood pressure, delivering the baby when term, and preventing and treating seizures with magnesium sulfate. Anesthetic management focuses on regional techniques like epidural anesthesia to control blood pressure, while preparing for potential difficulties like airway edema during general anesthesia if needed.
This document discusses hypertensive disorders in pregnancy including preeclampsia. It begins by defining and classifying pre-existing hypertension, gestational hypertension, and preeclampsia. Preeclampsia is characterized by new onset hypertension and proteinuria after 20 weeks of gestation. The pathogenesis of preeclampsia is then explained in detail, involving incomplete trophoblast invasion of spiral arteries leading to placental hypoxia and endothelial dysfunction. Risk factors, clinical signs, screening, and management of preeclampsia are also outlined. Complications for both mother and baby are described if preeclampsia is not well-managed.
This document discusses renal disease and pregnancy. It begins by outlining the normal physiological changes that occur in the kidney during pregnancy, including increased renal plasma flow, GFR, and dilatation of the collecting system. It then covers pregnancy-induced hypertension, including gestational hypertension, chronic hypertension, preeclampsia, and chronic hypertension with superimposed preeclampsia. The document also discusses acute kidney injury in pregnancy and chronic kidney disease and pregnancy. It provides details on diagnosis and management of various conditions.
This document provides an overview of hypertension in pregnancy. It begins with classifications of hypertensive disorders in pregnancy and risk factors. The pathophysiology involves placental insufficiency causing endothelial dysfunction and an imbalance of vasoactive substances. Clinical manifestations involve multiple organ systems due to failure of autoregulation from high blood pressure. Management involves monitoring, prevention of complications, and delivery when indicated to resolve the condition.
This document summarizes hypertensive disorders of pregnancy. It defines hypertension and proteinuria in pregnancy and classifies hypertensive disorders into four categories: gestational hypertension, preeclampsia, pre-existing chronic hypertension, and chronic hypertension superimposed by preeclampsia. It discusses the definition, risk factors, maternal and fetal effects, complications, and management including antihypertensive treatment, magnesium sulfate for seizures, induction or C-section for delivery, and postpartum care. The goal of management is to minimize risks to the mother and fetus until delivery is safest for the baby.
Preeclampsia is a pregnancy complication characterized by high blood pressure and protein in the urine. It affects over 5-8% of pregnancies worldwide and is a leading cause of maternal and infant illness and death. The condition is caused by poor development of the placenta, which fails to properly remodel the mother's uterine arteries. This results in reduced blood flow to the placenta and release of factors that cause damage to other organs. Risk factors include first pregnancy, obesity, diabetes, and family history. Symptoms range from mild to severe, including headaches, visual issues, pain, and seizures in severe cases. Management involves monitoring and delivery of the baby if the condition worsens. Ongoing research is
hypertensive-disorder-of-pregnancy775.pptRenjini R
This document summarizes hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and eclampsia. It defines hypertension in pregnancy and proteinuria. It discusses risk factors, complications, and management approaches for these conditions, including antihypertensive treatment, induction of labor, magnesium sulfate treatment for eclampsia, and delivery of the fetus as the definitive treatment. The goal of management is to minimize risks to both the mother and fetus.
Pregnancy complications can include pregnancy-induced hypertension (PIH), preeclampsia, and gestational hypertension. Preeclampsia is characterized by high blood pressure and excess protein in the urine after 20 weeks of pregnancy. It can threaten the health of both mother and baby. Risk factors include a personal or family history of preeclampsia, obesity, young or advanced maternal age, multiple gestation, and certain genetic factors. Treatment focuses on delivering the baby to resolve preeclampsia, along with controlling blood pressure and monitoring for serious complications.
Toxemia in pregnancy, now called preeclampsia, is a condition characterized by high blood pressure and protein in the urine that affects 3-8% of pregnancies. It can threaten the health of the mother and baby. Symptoms include swelling, headaches, vision changes, and abdominal pain. Risk factors include first pregnancies, obesity, chronic high blood pressure, and a family history of preeclampsia. Treatment focuses on delivering the baby to resolve the condition, with close monitoring until then. Untreated preeclampsia can lead to serious maternal complications like seizures or organ damage and threaten the baby's growth and development.
Hypertensive disorders in pregnancy are a leading cause of maternal and fetal morbidity and mortality in India. It is characterized by new onset hypertension and proteinuria after 20 weeks of gestation. The disorder includes gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension. Symptoms include headaches, visual disturbances, and right upper quadrant pain. Management involves hospitalization, bed rest, blood pressure monitoring, magnesium sulfate administration to prevent seizures, and often early delivery. Untreated hypertensive disorders can lead to serious maternal complications like eclampsia and organ damage as well as fetal growth restriction and death.
Define hypertension in pregnancy.
Give a simple classification of the hypertensive disorders of pregnancy.
Diagnose pre-eclampsia and chronic hypertension.
Explain why the hypertensive disorders of pregnancy must always be regarded as serious.
List which patients are at risk of developing pre-eclampsia.
List the complications of pre-eclampsia.
Differentiate pre-eclampsia from pre-eclampsia with severe features.
Give a practical guide to the management of pre-eclampsia.
Provide emergency management for eclampsia.
Manage gestational hypertension and chronic hypertension during pregnancy.
This document discusses features of pregnancy and childbirth management in women with extragenital pathology. It notes that only 20% of pregnancies proceed without complications, while 30-40% involve extragenital pathology (EGP) such as cardiovascular, kidney, or blood diseases. Pregnancy termination risks are 12% and can affect fetal development. The most common EGP in women ages 21-29 is cardiovascular disease, observed in 7% of cases. Management of pregnancy involves frequent hospitalizations and selecting delivery methods based on the severity of the woman's condition.
Preeclampsia is a pregnancy complication characterized by new onset hypertension and proteinuria after 20 weeks of gestation. It can range from mild to severe, with severe preeclampsia presenting risks to both mother and baby like organ damage or failure. Risk factors include primigravidity and preexisting conditions. The cause is unknown but may involve placental factors. Treatment depends on severity but generally involves bed rest, blood pressure medication, fetal monitoring, and often delivery of the baby and placenta as this resolves the condition. Complications can be serious so careful management in hospital is important.
Preeclampsia is a multiple system disorder characterized by new onset hypertension and proteinuria after 20 weeks of gestation. It is caused by unknown etiological factors and includes gestational hypertension, pre-eclampsia, and eclampsia. Risk factors include primigravidity, family history, and pre-existing conditions. Clinical features range from mild to severe. Management involves monitoring, controlling blood pressure, preventing complications, and timely delivery.
This document summarizes the normal physiological changes that occur in various maternal body systems during pregnancy. It describes how the cardiovascular, respiratory, renal, hematologic, gastrointestinal and reproductive systems adapt to accommodate the growing fetus. Key changes include increased blood volume, heart rate and kidney function as well as common symptoms like nausea and backache. Understanding these changes is important for identifying complications and educating patients about normal pregnancy.
This document summarizes key points about managing cardiac disease in pregnancy, specifically congenital heart disease. It discusses how pregnancy physiologically impacts the cardiovascular system and increases risks. Women with congenital heart disease should have planned pregnancies managed by a multidisciplinary team. Important considerations include pre-pregnancy counseling and risk assessment, close monitoring during pregnancy, developing a delivery plan, and postpartum surveillance. Different cardiac lesions carry specific maternal and fetal risks that depend on current status and history.
This document outlines the Nurses and Midwives Act of 2019 in Zambia. It continues the existence of the General Nursing Council and renames it the Nursing and Midwifery Council of Zambia. The Act regulates the education, training, registration, practice and professional conduct of nurses and midwives. It also provides for the licensing of nursing and midwifery facilities. Key aspects include continuing the Nursing Council, setting its functions, regulating nurse and midwife registration, education/training, scope of practice, disciplinary matters, and licensing facilities.
This document provides 20 examples of different defense mechanisms people may use to cope with anxiety or uncomfortable feelings, such as repression, rationalization, projection, and fantasy. Repression involves being unable to remember unpleasant events, while rationalization means providing logical excuses to justify irrational behavior. Projection refers to attributing one's own undesirable feelings or behaviors to others. Fantasy involves imagining scenarios that are not real to fulfill wishes or deal with problems.
This document discusses fluid therapy and fluid balance. It begins with definitions of key terms like electrolyte, osmolarity, and body fluid compartments. It then explains the regulation and assessment of fluid balance, types of intravenous fluids, and how to calculate infusion rates. Fluid balance charts are described as an essential tool to monitor intake, output, and a patient's hydration status. The document provides examples of completing a fluid balance chart and emphasizes the importance of careful recording and monitoring of fluid therapy.
This document discusses urinary and fecal elimination. It provides details on:
1) The normal urinary elimination process involving the kidneys, ureters, bladder, and urethra. Urine is normally produced and stored in the bladder until voiding occurs.
2) Common alterations in urinary elimination including increased or decreased urine output, painful urination, incontinence, and retention.
3) Factors that can affect bowel elimination such as age, diet, fluid intake, medications, and physical or psychological conditions.
4) Common bowel problems include constipation, impaction, diarrhea, and incontinence. Nursing interventions are aimed at promoting normal elimination habits.
The document discusses the assessment and management of unconscious patients. It defines unconsciousness as a state of reduced awareness and responsiveness. Causes can include head injuries, tumors, overdoses, infections, and more. Levels of consciousness are assessed using scales like the Glasgow Coma Scale. Nursing priorities for unconscious patients include airway maintenance, skin care, range of motion exercises to prevent contractures, and careful monitoring for any changes in condition.
This document outlines the process and techniques for conducting a physical examination. It defines a physical exam as collecting observable data using inspection, palpation, percussion, and auscultation. The key techniques are explained in detail, including inspection using the senses of vision, hearing and smell; palpation to feel for pulses, temperature, and consistency; percussion to elicit sounds that vary with tissue density; and auscultation using a stethoscope to listen to internal sounds. Proper equipment, patient positioning, and exam sequencing are also reviewed to thoroughly assess the skin, head, neck, chest, abdomen, extremities, and other body systems.
The document discusses the importance of communication and interaction between nurses and patients. It states that the nurse is always interacting with patients and healthcare team members. Effective communication helps the nurse build relationships and collaborate to achieve health goals. The document outlines different types of communication including intrapersonal, interpersonal, small group, and public. It emphasizes that both verbal and nonverbal communication are important and discusses elements like appearance, eye contact, and body language. Throughout the nursing process, open communication between the nurse and patient allows ongoing identification of health problems.
This document discusses pain from a nursing perspective. It defines pain, explains the physiology of pain including pain receptors and signal transmission, and outlines the types of pain such as acute, chronic, idiopathic, and psychogenic pain. The document also discusses pain assessment and management in nursing, including using pain scales, relieving pain through measures like rest, relaxation, analgesia, and diversional therapy.
The document discusses vital signs, which are important measurements that reflect essential body processes for life. They include temperature, pulse, respiration, and blood pressure. Vital signs provide information about the body's response to stress and can reveal sudden or gradual changes in a patient's condition. They are routinely taken for baseline data and to monitor a patient before, during, and after procedures or changes in their condition. The four components of vital signs are described in detail, including how they are assessed, normal ranges, and factors that can influence them.
Vital signs, including temperature, pulse, respiration and blood pressure, reflect essential body processes and can indicate changes in a patient's condition. They are important baseline measurements that are taken routinely during assessments and when a patient's status may be affected. Temperature, pulse and respiration are regulated by the hypothalamus, heart and respiratory functions, respectively, and can be impacted by environmental and psychological stressors. Abnormal vital signs may reveal sudden or gradual deterioration and should be reported promptly.
The document discusses various ways of classifying families and groups. It describes how families can be classified based on marriage structure (monogamous, polygamous, etc.), residence (matrilocal, patrilocal), ancestry (matrilineal, patrilineal) and size (nuclear, extended). Groups are characterized by interaction, structure, size and cohesiveness. Groups typically progress through forming, storming, norming, performing and terminating stages. Ethnic groups are defined by shared language, culture, history and self-identity.
The document discusses vital signs, which are temperature, pulse, respiration, and blood pressure. These reflect essential body processes and are important indicators of a patient's condition. Temperature, pulse, respiration are measured routinely for baseline data and to monitor for changes. Normal ranges are provided for each vital sign. Factors that influence the vital signs and techniques for accurately measuring them are described.
The document discusses the importance of communication and interaction between nurses and patients. It states that nurse-patient interaction is a professional relationship where meaningful exchange of ideas and problem-solving can occur. Through open communication, nurses can work with patients to continuously identify health problems and achieve health-related goals. The core elements of trust, respect, confidentiality, empathy and appropriate use of power are essential to ensuring a therapeutic relationship.
Fluid, electrolyte, and acid-base balances must be maintained for health. Imbalances can occur from factors like dehydration or diarrhea. Fluids are distributed intracellularly and extracellularly, and electrolytes like sodium, potassium, and chloride are regulated between these compartments. Fluid intake, output, and hormones like ADH work to maintain balance. Intravenous fluids include crystalloids like saline that distribute between compartments, and colloids that remain intravascular.
The document describes the process of conducting a physical examination. It defines physical examination and outlines the basic techniques used, including inspection, palpation, percussion, and auscultation. It provides examples of common equipment used and examines different body systems. The document also discusses ensuring patient privacy and comfort during the examination.
This document discusses fundamentals of nursing and the nurse's role in the healthcare system. It defines key nursing terms and describes nursing practice. It also outlines the healthcare delivery system in Zambia, including different provider levels and factors that influence healthcare delivery such as policies, economics, disease burden and technology. Challenges in providing care are noted as well as the organization and functions of various hospital levels.
The document discusses fundamentals of nursing palliative care. Nursing and palliative care are natural partners, as all nurses should have palliative care skills. Palliative care aims to improve quality of life for terminally ill patients and their families by preventing and relieving suffering. It involves an interdisciplinary team approach to address physical, psychosocial and spiritual needs. The role of nurses in palliative care focuses on symptom management, especially pain management, and providing 24-hour support.
This document discusses pain from a nursing perspective. It defines pain, explains the physiology of pain including pain receptors and signal transmission, and outlines the types of pain such as acute, chronic, idiopathic, and psychogenic pain. The document also discusses pain assessment and management in nursing, including using pain scales, relieving pain through measures like rest, relaxation, analgesia, and diversional therapy.
The document discusses the importance and purposes of documentation in nursing. Effective documentation allows nurses to communicate about patient care, promotes good nursing practices, and supports meeting legal and professional standards. It should provide an accurate account of assessments, interventions, and patient outcomes. The SOAP format is commonly used to document patient encounters and ensure comprehensive yet concise notes.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
2. PRE-ECLAMPSIA
Pre-eclampsia is a condition specific to pregnancy occurring
after the 20th week of gestation characterised by hypertension,
proteinuria and/or oedema.
Pre-eclampsia is a complication of pregnancy in which a
pregnant woman has high blood pressure, protein in urine and
oedema, and may develop other symptoms and problems.
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3. The more severe the pre-eclampsia, the greater the risk of
serious complications to both mother and baby.
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4. CLASSIFICATION
MILD/ MODERATE PRE-ECLAMPSIA
Blood pressure is 140/90mmHg to 150/100mmHg.
Oedema up to 2+ (may be generalised).
Proteinuria of up to 2+ (in the absence of UTI).
SEVERE PRE-ECLAMPSIA
Blood pressure exceeds 160/110mmHg
Increase in proteinuria
Oedema 3+ (generalised).
Frontal headache and visual disturbances are usually present.
Upper abdominal pain or epigastric pain with or without vomiting.
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5. RISK FACTORS
Maternal personal risk factors for preeclampsia
First pregnancy
New partner/paternity
Age younger than 18 years or older than 35 years
History of preeclampsia
Family history of preeclampsia
Black race
Obesity
Interpregnancy interval less than 2 years or more than 10 years
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6. Maternal medical risk factors for preeclampsia
Chronic hypertension,
Preexisting diabetes (type 1 or type 2),
Renal disease
Systemic lupus erythematosus
Obesity
Thrombophilia
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8. PATHOPHYSIOLOGY
Pre-eclampsia has been called a disease of theory because the
true mechanism behind the pathogenesis is unknown.
Women who develop pre-eclampsia become more sensitive to
pressor agents (substances that increase blood pressure) rather
than less sensitive to them as in normal pregnancy.
This response has been linked to the ratio between prostacyclin,
prostaglandins and thromboxane.
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9. Prostacyclin, a vasodilator produced by endothelial cells,
decreases blood pressure, prevents platelet aggregation and
promotes uterine blood flow.
Thromboxane produced by platelets, causes vessels to constrict
and platelets to clump together.
In Pre-eclampsia, prostacyclin is decreased allowing the potent
vaso-constrictor and platelet aggregating effects of
thromboxane to dominate.
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10. These hormones are produced partially by the placenta which
would help explain the reversal of the condition when the
placenta is removed and why the incidence is increased when
there is a larger than normal placental mass such as in hydrops,
multiple pregnancy or hydatidiform mole.
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11. There is another theory which suggests that women who
develop preeclampsia have been found to have an increased
cardiac output and an associated endothelial damage.
The vasodilation acts as a compensatory mechanism allowing a
normal blood pressure in spite of the high cardiac output.
The body responds to the endothelial damage with platelet
aggregation and adherence to the damaged sites.
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12. The combination of these events will cause vaso-spasms and
increased blood pressure, abnormal coagulation and thrombosis
and increased permeability of the endothelium leading to
oedema, proteinuria and hypovolaemia (blood seeps out in the
tissue).
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13. PATHOLOGICAL CHANGES
Blood; High blood pressure combined with endothelial cell
damage affect capillary permeability leading to plasma proteins
leak from the damaged blood vessels.
This will cause decrease in the plasma colloid pressure and an
increase in edema within the intracellular space.
It will further cause hypovolemia and hemo concentration due
to reduced intravascular plasma volume and this will be
reflected in an elevated hematocrit level.
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14. Kidneys; Hypertensive disorders in pregnancy can also disrupt
renal function.
The detectable presence of proteins within the urine
(proteinuria) may indicate that larger molecules than normal are
being forced into the Bowman’s capsule.
This is caused by increased blood pressure resulting in abnormal
ultra filtration.
As the condition worsens, oliguria develops as well signifying
kidney damage and severe preeclampsia.
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15. Liver; There will be hypoxia and edema of the liver cells due to
vasoconstriction of the hepatic vascular bed and this may lead
to epigastric pain with intra capsular hemorrhages in severe
cases.
Rarely does rupture of the liver occur, however, there will be
altered liver enzyme and albumin levels.
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16. Brain; The combination of hypertension and cerebral vascular
endothelial dysfunction leads to increased permeability of the
blood-brain barrier.
This will result in cerebral edema and micro hemorrhaging
leading to characteristics such as headaches, visual disturbances
and convulsions. Excessive increase in blood pressure may lead
to hypertensive encephalopathy.
8/27/2019 JONES H.M-MBA 16
17. Fetal Placental; There will be vascular lesions in the placental
bed due to reduced uterine blood flow and this may result in
placental abruption.
Blood flow to the chorio decidual spaces will also reduce thereby
diminishing oxygen diffusion into the fetal circulation within the
placenta leading to fetal growth restriction.
Hormonal output is also impaired due to reduced placental
function hence compromising survival of the fetus.
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18. SIGNS AND SYMPTOMS
The signs of pre-eclampsia do not occur before the 20th week of
pregnancy and seldom after the 30th week, however the earlier
they occur the more serious the condition becomes.
If the signs are found before 20th week of pregnancy, it is usually
an indication of the underlying pathological conditions e.g.
trophoblastic diseases like hydatidiform mole or
choriocarcinoma, chronic hypertension, chronic renal disease
etc.
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19. Hypertension- a rise in blood pressure of above 140/90 or rise by
10-15 mmHg in two or more subsequent readings is suggestive
of pre-eclampsia or PIH in a normo-tensive mother.
Proteinuria- develops as reduced blood flow damages the
kidneys.This damage allows the protein to leak into the urine.
8/27/2019 JONES H.M-MBA 19
20. Oedema- occurs because the fluid leaves the blood vessels (due
to hypoproteinaemia) and enters the tissues.
Sudden excessive weight gain is a first sign of fluid retention.
Visible oedema of the legs and feet is common during
pregnancy, but oedema above the waist is suggestive of
pregnancy induced hypertension.
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21. GRADES OF OEDEMA:
Grade 1 (1+) - Ankle oedema
Grade 2 (2+) oedema of the lower limbs to knees
Grade 3 (3+) Generalized oedema
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22. • Visual disturbances -These disturbances are presumed to be due to
cerebral vasospasm.
• Headache is of new onset and may be described as frontal,
throbbing, or similar to a migraine headache.
• Epigastric pain is due to hepatic swelling and inflammation, with
stretch of the liver capsule.
• Pain may be of sudden onset, is typically constant, and may be
moderate-to-severe in intensity.
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23. INVESTIGATIONS
Hypertension and proteinuria are not the only signs of pre-
eclampsia, or necessarily the most important; they constitute
evidence of end organ damage within on going process.
8/27/2019 JONES H.M-MBA 23
24. Diagnostic tests to assess renal function, cardiovascular changes
and liver enzymes are necessary to diagnose the extent to which
the maternal system is affected. And these include:
Blood urea and creatinine are raised, and a high level indicates a
late stage of renal involvement.
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25. Platelet count is reduced
Packed cell volume is increased
Hb and haematocrit levels are raised
Urinalysis-24 hour specimen will reveal protein > 0.3g
Liver function test especially transaminase should be carried out
to determine liver function
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26. Ultra sound scan- For the Bio-physical profile of the fetus and
fetal movements, breathing and liquor volume
Fetal maturity Test- Pulmonary surfactant (Lecithin
sphingomyelin ratio, normal 2:1).
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27. MANAGEMENT OF PRE- ECLAMPSIA
AIMS
The ultimate aim is to prolong pregnancy until the baby is
sufficiently mature to survive while safeguarding the mother’s
life.
To monitor the disease and prevent it from getting worse
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28. ANTENATALLY
MILD PRE-ECLAMPSIA
Treatment of pre-eclampsia is symptomatic because the cause is
unknown.
Usually the patient with mild pre-eclampsia will be nursed at
home (Out patient).
The patient is given the following advice;
8/27/2019 JONES H.M-MBA 28
29. Rest- The patient should have adequate bed rest at home to
ensure improved blood flow to the heart and therefore to the
placenta.
A doctor might order mild sedatives to promote restful sleep at
home.
Diet- The patient is advised to take diet rich in proteins and
vitamins but low in carbohydrates and no extra salt.
The patient is advised not to gain excess weight.
The proteins and the vitamins are needed to nourish the
growing foetus and prepare the woman for lactation.
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30. Antenatal visits- The woman is advised to make frequent visits to
the health facility to ensure frequent monitoring of the
condition.
She is advised to report to the health facility if she is feeling very
unwell (headache, oedema etc).
Foetal well being –The patient is advised to maintain the “kick
chart” to monitor any foetal movements.
Usually the woman is admitted at 37 weeks if condition has
remained stable so as to deliver in hospital.
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31. MODERATE TO SEVERE PRE-ECLAMPSIA
Patients with moderate and severe pre-eclampsia need to be
hospitalized till delivery.
The patient should be admitted in the quiet room since she will
be anxious about her condition
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32. Establish good midwife -patient relationship
Explain condition to the patient to allay anxiety
Allow significant others to visit when appropriate but give her
time to rest
Assign a nurse to attend to her constantly
8/27/2019 JONES H.M-MBA 32
33. REDUCTION OF BLOOD PRESSURE
The treatment is aimed at reducing blood pressure as soon as
possible and this is achieved by the following:
Putting the woman on bed rest in order to rest the heart, reduce
demands of blood by other organs and improve placental
perfusion.
Record blood pressure 1 -2 hourly to detect any sudden rise or
sudden drop which should be reported to the doctor.
Give the ordered drugs
Fluid intake and output is monitored and fluids may restricted if
there is severe kidney damage.
8/27/2019 JONES H.M-MBA 33
34. MONITORING OF OEDEMA
Weigh patient daily
Encourage bed rest
Monitor fluid intake and output
Do daily physical examinations to assess the amount of oedema
present
No extra salt is allowed
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35. DIET
High protein and vitamins to nourish the growing foetus
Low salt diet to avoid water retention
Low carbohydrate diet to avoid gaining of excess weight
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36. OBSERVATIONS
Since the foetus is at risk of intra uterine growth retardation
because of placenta insufficiency, frequent and efficient
monitoring is essential.The following should be done;
Check the foetal heart rate 4 hourly depending on the condition
of the mother
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37. Use cardiotocography machine.
Continuously monitor the well being of the foetus especially if
the patient is on antihypertensive drugs or where patient’s
condition is not satisfactory.
Ultra sound can be done to assess the foetal well being, the
foetal movements, the amount of liquor and the foetal
breathing pattern.
8/27/2019 JONES H.M-MBA 37
38. Vital signs are done 4 hourly to monitor maternal well being.
Abdominal examinations are done twice daily and in this case
compare the height of fundus with the gestation age to rule out
intrauterine growth retardation
8/27/2019 JONES H.M-MBA 38
39. Note for any abdominal pains as presence of abdominal pains
may denote abruptio placenta, onset of labour and deteriorating
condition.
Watch out for epigastric pain as this may be a sign of imminent
eclampsia.
Never leave the woman alone if shows signs of imminent
eclampsia
8/27/2019 JONES H.M-MBA 39
40. MEDICAL MANAGEMENT
The following drugs may be ordered;
Antihypertensives - May be ordered if B/P exceeds
150/100mmHg in an effort to reduce it, prevent CVA and
eclampsia and therefore prolong pregnancy, maternal well
being and foetal survival rate.
When lowering blood pressure with medication it is vitally
important to monitor the fetal heart in order to detect whether
the lowered maternal BP is affecting the utero-placental blood
flow and fetal oxygenation.
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41. Methyldopa (Aldomet) - 250-500mg 8hrly.
It is a long term treatment until the fetus is more mature (35-36
weeks)
This medication takes 24 hours to be effective
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42. Hydralizine
Given when diastolic pressure is above 110 mmHg
Given intravenously slowly
25mg 8hrly or 12hrly or 5mg iv bolus initially followed by an
infusion of 2-20mg/hour according to the patient’s response.5
mg to 20 mg
8/27/2019 JONES H.M-MBA 42
43. Neprosol - 6.25mg IV slowly over 4minutes for acute
hypertension.
Nefidipine - 10-20mg subliqually used for acute lowering of B/P
Steroids- When pre-eclampsia develops late in gestation,
steroids maybe given to reduce the risk of RDS e.g.
Dexamethasone 4 mg, 12 hourly for 48 hours.
8/27/2019 JONES H.M-MBA 43
44. Aspirin- It is thought to inhibit production of platelet
aggregating agent thromboxane A2, therefore low dose of
aspirin maybe beneficial for women at high risk of pre-
eclampsia.
8/27/2019 JONES H.M-MBA 44
45. In imminent eclampsia, it is important to reduce the excitement
of the central nervous system and the following measures
should be taken:
Phernobarbitone may be used in small amounts in mild
eclampsia when patient is not going into labour early.
Note that it has a depressive effect on the foetus and the
maternal respiration system.
Magnesuim Sulphate 5g (mgSo4) in 200mls of 5% dextrose
over 20minutes and then 5mg i.m start 6hrly for 2/7 only if
diastolic pressure is above 90mmHg.
8/27/2019 JONES H.M-MBA 45
46. Diazepam can be used for transporting the patient with
imminent eclampsia
Diuretics are not used as they aggravate haemoconcentration
and may lead to haemorrhagic pancreatitis in the mother.
Manitol 200mls iv 6hrly can only be used when there is cerebral
oedema and mainly this is in eclempsia.
8/27/2019 JONES H.M-MBA 46
47. OBSTETRIC MANAGEMENT
The obstetrician decides the optimum time for the delivery of
the baby.
This depends on the maternal and foetal well being and not on
the period of gestation.
If patient responds well to treatment in mild and moderate pre-
eclampsia the pregnancy is usually allowed to continue and
usually labour is induced before term to reduce effects of
placental insufficiency.
8/27/2019 JONES H.M-MBA 47
48. If patient does not respond to treatment and has moderate or
severe pre-eclampsia, then an induction of labour is usually
commenced after 24hrs
Indications for induction are:
Foetal intrauterine growth retardation
Uncontrolled rising blood pressure
Poor renal function
8/27/2019 JONES H.M-MBA 48
49. NURSING CARE DURING LABOUR
Labour is induced by an IV oxytocics being administered
together with the rupture of membranes.
Episiotomy and forceps or vacuum extraction is frequently used
to prevent exhaustion by the patient as this may lead to
eclampsia.
Caesarian section may be performed where labour is
detrimental to the maternal and foetal condition.
8/27/2019 JONES H.M-MBA 49
50. The following measures should be done:
Do not leave patient alone
Inform the doctor immediately of any change in the patients
condition
Check blood pressure half hourly or quarter hourly and foetal
heart rate quarter hourly or CTC machine can be useful to
monitor the foetal heart
8/27/2019 JONES H.M-MBA 50
51. When necessary put up intravenous fluid line but careful not to
overload the patient
Keep the patient sedated and you can even give her epidural
anesthesia
Continue with medication the patient is on
Keep a record of all drugs during labour and delivery to be
reported to a pediatrician
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52. Prepare the patient for episiotomy/forceps delivery/vacuum
extraction
Note: Ergometrine and syntometrine are never useful in the
third stage of labour.These cause peripheral vascular spasms
and increase the blood pressure
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53. NURSING CARE DURING
PUERPERIUM
Convulsions can occur soon after delivery for the first time and
therefore, the first 24 hours is the most critical period. The
patient should be nursed as follows:
Continue with the sedation of the patient
Constantly monitor the patient’s condition from delivery to 24
hours.
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54. Check the blood pressure hourly for 6 hours and then if
decreasing 4 hourly for 24 hours and if stable blood pressure can
be done twice daily.
Monitor fluid balance until it is normal
Continue with urinalysis for proteins till negative and repeat on
disc
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55. Continue with urinalysis for proteins till negative and repeat on
discharge
Note: Patient will only be discharged when blood pressure is
normal and urine is free of proteins.
NEONATAL CARE
These babies are always small for dates and premature,
therefore give them care accordingly.
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56. COMPLICATIONS
Eclampsia
Placenta abruptio
Renal failure
Subcapsular hemorrhage or rapture of the liver
Disseminated intravascular coagulation (DIC)
Cardiovascular accident
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57. HELLP syndrome- a syndrome of Haemolysis Elevated Liver
enzyme and Low Platelet count. It represents a variant of pre-
eclampsia/eclampsia syndrome.
Pregnancies complicated with this syndrome have been
associated with significant maternal and perinatal morbidity and
mortality.
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