Preeclampsia is a pregnancy complication characterized by new onset hypertension and either proteinuria or other maternal organ dysfunction after 20 weeks of gestation. The cause is believed to involve abnormal placentation leading to placental ischemia and release of anti-angiogenic factors, causing widespread maternal endothelial dysfunction. Women with preeclampsia are monitored closely and delivery is often indicated if maternal or fetal complications develop. Management may involve expectant monitoring, antihypertensive treatment, and delivery depending on gestational age and severity of features.
1. Bleeding in early pregnancy can be caused by miscarriage, ectopic pregnancy, or rare conditions like cervical cancer or polyps.
2. Miscarriage is the most common cause, and it is defined as the natural or spontaneous end of a pregnancy before 24 weeks. Early pregnancy assessment using transvaginal ultrasound and serum hCG levels can help diagnose the cause.
3. Ectopic pregnancies, which occur when a fertilized egg implants outside the uterus, should also be considered and ruled out as they can be life-threatening if ruptured. Transvaginal ultrasound and serial hCG measurements are used to diagnose ectopic pregnancies.
This document discusses pregnancy induced hypertension (PIH), also known as preeclampsia. PIH is a multisystem disorder characterized by high blood pressure and protein in the urine that develops during pregnancy. It can lead to serious complications for both the mother and baby if untreated. The document covers the definition, classification, signs and symptoms, risk factors, pathogenesis, diagnosis, and management of mild and severe cases of PIH.
This document discusses hypertension in pregnancy, including definitions of gestational hypertension and preeclampsia. It describes potential complications affecting the cardiovascular, neurological, renal and hepatic systems in the mother, as well as fetal growth restriction and preterm birth. Diagnosis involves blood pressure monitoring and urine testing. Management includes antihypertensive treatment, fluid management, magnesium therapy, and timely delivery. Regional anesthesia is preferred for labor and c-section, though general anesthesia may be required in emergencies. Post-delivery, close monitoring is needed as preeclampsia can worsen for up to 6 weeks.
Hypertensive disorders of pregnancy (HDP) are among the top 3 causes of maternal mortality, responsible for 10-15% of deaths. The new classification of HDP defines it as hypertension in pregnancy and removes eclampsia from the major classification. Prediction of preeclampsia is important because the risk of recurrence can be as high as 35% and it is associated with maternal and neonatal complications. However, current screening tests are not reliable enough for clinical use as they lack specificity and predictive value. Treatment aims to control blood pressure and prevent complications like eclampsia.
This document discusses induction and augmentation of labor. It defines induction as stimulating contractions before spontaneous labor onset and augmentation as stimulating inadequate spontaneous contractions. It reviews evaluation and indications for induction, including absolute indications like preeclampsia and relative indications. Risks of induction like cesarean delivery and chorioamnionitis are presented. Cervical ripening, a process of softening and dilating the cervix before labor, is described. The Bishop score is introduced as a system to assess cervical status and likelihood of successful induction.
This document summarizes information about preeclampsia. It discusses that preeclampsia is a serious complication of pregnancy characterized by hypertension, proteinuria, and edema. The cause is unknown but theories include immunological, genetic, and hormonal factors. Symptoms usually present after 20 weeks of gestation. Management involves monitoring for severity and delivering the baby if conditions worsen or reach term. Outcomes can be improved with early detection and treatment but preeclampsia remains a major cause of maternal and fetal complications.
Protocol for MANAGEMENT OF SEVERE PRE-ECLAMPSIA/ ECLAMPSIA Green top guideli...Aboubakr Elnashar
This document provides guidelines for the management of severe pre-eclampsia and eclampsia. It outlines protocols for maternal monitoring, fetal assessment, controlling blood pressure, preventing and treating seizures, fluid balance, delivery, and postpartum care. The guidelines recommend close monitoring of vitals and lab work. Antihypertensives like nifedipine and hydralazine are used to control blood pressure. Magnesium sulfate is the treatment of choice for preventing and treating seizures. Delivery is recommended after 34 weeks gestation once the mother is stabilized. Postpartum monitoring and follow up is also advised.
1. Bleeding in early pregnancy can be caused by miscarriage, ectopic pregnancy, or rare conditions like cervical cancer or polyps.
2. Miscarriage is the most common cause, and it is defined as the natural or spontaneous end of a pregnancy before 24 weeks. Early pregnancy assessment using transvaginal ultrasound and serum hCG levels can help diagnose the cause.
3. Ectopic pregnancies, which occur when a fertilized egg implants outside the uterus, should also be considered and ruled out as they can be life-threatening if ruptured. Transvaginal ultrasound and serial hCG measurements are used to diagnose ectopic pregnancies.
This document discusses pregnancy induced hypertension (PIH), also known as preeclampsia. PIH is a multisystem disorder characterized by high blood pressure and protein in the urine that develops during pregnancy. It can lead to serious complications for both the mother and baby if untreated. The document covers the definition, classification, signs and symptoms, risk factors, pathogenesis, diagnosis, and management of mild and severe cases of PIH.
This document discusses hypertension in pregnancy, including definitions of gestational hypertension and preeclampsia. It describes potential complications affecting the cardiovascular, neurological, renal and hepatic systems in the mother, as well as fetal growth restriction and preterm birth. Diagnosis involves blood pressure monitoring and urine testing. Management includes antihypertensive treatment, fluid management, magnesium therapy, and timely delivery. Regional anesthesia is preferred for labor and c-section, though general anesthesia may be required in emergencies. Post-delivery, close monitoring is needed as preeclampsia can worsen for up to 6 weeks.
Hypertensive disorders of pregnancy (HDP) are among the top 3 causes of maternal mortality, responsible for 10-15% of deaths. The new classification of HDP defines it as hypertension in pregnancy and removes eclampsia from the major classification. Prediction of preeclampsia is important because the risk of recurrence can be as high as 35% and it is associated with maternal and neonatal complications. However, current screening tests are not reliable enough for clinical use as they lack specificity and predictive value. Treatment aims to control blood pressure and prevent complications like eclampsia.
This document discusses induction and augmentation of labor. It defines induction as stimulating contractions before spontaneous labor onset and augmentation as stimulating inadequate spontaneous contractions. It reviews evaluation and indications for induction, including absolute indications like preeclampsia and relative indications. Risks of induction like cesarean delivery and chorioamnionitis are presented. Cervical ripening, a process of softening and dilating the cervix before labor, is described. The Bishop score is introduced as a system to assess cervical status and likelihood of successful induction.
This document summarizes information about preeclampsia. It discusses that preeclampsia is a serious complication of pregnancy characterized by hypertension, proteinuria, and edema. The cause is unknown but theories include immunological, genetic, and hormonal factors. Symptoms usually present after 20 weeks of gestation. Management involves monitoring for severity and delivering the baby if conditions worsen or reach term. Outcomes can be improved with early detection and treatment but preeclampsia remains a major cause of maternal and fetal complications.
Protocol for MANAGEMENT OF SEVERE PRE-ECLAMPSIA/ ECLAMPSIA Green top guideli...Aboubakr Elnashar
This document provides guidelines for the management of severe pre-eclampsia and eclampsia. It outlines protocols for maternal monitoring, fetal assessment, controlling blood pressure, preventing and treating seizures, fluid balance, delivery, and postpartum care. The guidelines recommend close monitoring of vitals and lab work. Antihypertensives like nifedipine and hydralazine are used to control blood pressure. Magnesium sulfate is the treatment of choice for preventing and treating seizures. Delivery is recommended after 34 weeks gestation once the mother is stabilized. Postpartum monitoring and follow up is also advised.
MANAGEMENT OF GESTATIONAL DIABETES MELLITUS BY DR SHASHWAT JANIDR SHASHWAT JANI
This document contains information from Dr. Shashwat Jani regarding gestational diabetes mellitus (GDM). It discusses the increasing prevalence of GDM in India and its associated risks for both mother and baby. It provides details on screening and diagnostic protocols, management through medical nutrition therapy, glycemic control, fetal monitoring and delivery planning. The importance of a multidisciplinary approach and glycemic control for optimizing maternal and neonatal outcomes is emphasized.
This document contains information from Dr. Shashwat Kamal Jani on fever during pregnancy. It discusses the definition of fever, periods of prenatal development and their susceptibility to fever, physiological changes during pregnancy that increase infection risk, common causes of fever like URTI and UTI, and complications of fever for both mother and baby such as preterm birth and fetal anomalies. Treatment of common infections involves antibiotics while ensuring the fever resolves before delivery.
This document discusses hypertension in pregnancy and preeclampsia. It begins by outlining normal blood pressure changes during pregnancy, then defines pregnancy-induced hypertension and chronic hypertension. It distinguishes between gestational hypertension, preeclampsia, and eclampsia. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. Risk factors, incidence rates, causes, pathophysiology, complications, classification, diagnosis, and management of preeclampsia are then summarized. Indications for delivery are outlined for both mild and severe preeclampsia cases based on maternal and fetal stability and gestational age.
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 provides an overview of the management of hypertensive disorders in pregnancy. It discusses the differences between gestational hypertension and chronic hypertension, how to assess proteinuria, prevention strategies, recommendations for various stages of mild to severe hypertension during pregnancy and postpartum, which antihypertensive medications to use and avoid, risk factors for preeclampsia, and conclusions about early diagnosis and treatment improving outcomes for both mother and baby. The conclusions recommend labetolol and methyldopa as first-line drugs, watching high risk women closely for preeclampsia, using urine protein to creatinine ratio for proteinuria screening, and aspirin as the only proven primary prevention method.
This document discusses hypertensive disorders of pregnancy, including definitions, classifications, signs, symptoms, risk factors, investigations, complications and management of conditions like pre-eclampsia and eclampsia. It defines pre-eclampsia as hypertension with proteinuria developing after 20 weeks in a previously normotensive woman. Eclampsia is defined as pre-eclampsia with seizures. Management involves controlling blood pressure, preventing seizures, monitoring the patient closely, and timely delivery of the baby. Magnesium sulfate is the primary treatment for preventing and treating seizures.
Preeclampsia is a disorder that is unique to human pregnancy, and the only known cure for this complication is delivery. Preeclampsia affects approximately 4% to 5% of pregnancies . The Preeclampsia Foundation states that: “Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.” As is evident from the statement that, preeclampsia is a major contributor to maternal and fetal morbidity and mortality worldwide. In India, the incidence of preeclampsia is reported to be 8-10% among the pregnant women. According to a study, the prevalence of hypertensive disorders of pregnancy was 7.8% with preeclampsia in 5.4% of the study population in India
Heart disease occurs in approximately 1% of pregnancies and can be caused by rheumatic heart disease, congenital heart defects, or other conditions like ischemic heart disease. Diagnosis involves taking a medical history and performing a physical exam, chest X-ray, electrocardiogram, and echocardiogram. Pregnancy places additional strain on the heart and can exacerbate existing heart conditions or lead to heart failure. Management involves rest, diet, infection prevention, hospitalization if decompensation occurs, and possibly medical treatments like diuretics, beta blockers, or surgical treatments such as cardiac surgery or therapeutic abortion in severe cases. During labor, vaginal delivery is preferred if possible but induction is not recommended if acute heart
Hypertension is a common complication of pregnancy that can lead to increased maternal and neonatal morbidity and mortality if not properly managed. It includes conditions like chronic hypertension, pre-eclampsia, and gestational hypertension. Pre-eclampsia affects 5-15% of pregnancies and is characterized by new onset hypertension and proteinuria developing after 20 weeks of gestation. Risk factors include primigravidas, family history, chronic hypertension, and obesity. Treatment involves monitoring, medication to control blood pressure, delivery after 36 weeks gestation, and magnesium sulfate in severe pre-eclampsia to prevent eclampsia. Close antenatal surveillance and multidisciplinary care are important to optimize outcomes.
This document presents a case of a 29-year-old woman who is 3 months pregnant and experiencing bleeding and abdominal pain. On examination, she is found to have an incomplete miscarriage. The document then discusses manual vacuum aspiration (MVA) as a procedure to evacuate the uterine contents in cases of incomplete miscarriage. It covers the advantages, indications, contraindications, equipment, precautions, procedure steps, and potential complications of MVA. MVA is described as a safe, affordable option for uterine evacuation that is easy to learn and use without requiring electricity.
Pre-Eclampsia and Hypertensive Disease in Pregnancymeducationdotnet
This document discusses pre-eclampsia and hypertensive disease in pregnancy. It begins by outlining normal blood pressure changes during pregnancy and then defines different types of hypertension including chronic hypertension, pregnancy-induced hypertension, and pre-eclampsia. Pre-eclampsia is described as a multi-system disorder specific to pregnancy caused by placental dysfunction. The document details diagnostic criteria, clinical features, complications, investigations, and stepwise management of pre-eclampsia including delivery timing and postpartum care. Management involves treating hypertension, preventing eclampsia with magnesium sulfate if needed, and delivery to cure the condition, balancing risks of preterm birth.
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 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.
This document discusses chorioamnionitis (intra-amniotic infection), including its pathogenesis, risk factors, clinical findings, diagnosis, and evaluation. Chorioamnionitis occurs when pathogens ascend from the vagina and infect the amniotic fluid and fetal membranes. It complicates 40-70% of preterm births and 1-4% of term births. Diagnosis is based on maternal fever and may include leukocytosis, fetal tachycardia, and uterine tenderness. Evaluation of amniotic fluid can confirm infection through culture, Gram stain, or glucose/white blood cell counts. Histologic examination after birth also helps diagnosis.
Gestational diabetes (GDM) is glucose intolerance that begins or is first recognized during pregnancy. It can be caused by either pre-existing type 2 diabetes or a new onset of diabetes during pregnancy. The document discusses screening, diagnosis and management of both pre-existing diabetes and GDM during pregnancy. It aims to provide optimal glucose control to support fetal growth while avoiding risks of hyper- and hypoglycemia. Treatment involves medical nutrition therapy, glucose monitoring and may require insulin therapy in some cases. Close monitoring is needed throughout pregnancy and postpartum to support maternal and fetal health.
Eclampsia is a complication of preeclampsia defined by the occurrence of seizures. It is caused by severe vasospasm and damage to the vascular endothelium in the brain. Convulsions typically occur in late pregnancy or early postpartum. Management involves controlling seizures with magnesium sulfate, controlling blood pressure, and delivering the baby to ultimately cure the condition. Complications can be serious for both mother and baby if not properly managed.
This document discusses hypertensive disorders in pregnancy. It classifies hypertension into pre-existing (chronic) hypertension, pregnancy-induced hypertension (PIH), and superimposed pre-eclampsia/eclampsia. PIH includes transient hypertension, pre-eclampsia, and eclampsia. The document explores various theories of causation and provides details on pathological changes, diagnosis, screening tests, types of pre-eclampsia, complications, and treatment including prophylactic low-dose aspirin.
This document defines hypertension in pregnancy as a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher on more than one occasion. Preeclampsia is a multifactorial condition affecting 3% of pregnancies that is characterized by poor placentation leading to endothelial dysfunction and clinical manifestations including hypertension and proteinuria after 20 weeks of gestation. Magnesium sulfate is the drug of choice for preventing seizures in women with moderate to severe preeclampsia, given either as a continuous intravenous infusion or intermittent intramuscular injections to control blood pressure and prevent complications.
Hyperemesis Gravidarum (HG) is diagnosed when there is intractable nausea and vomiting of pregnancy associated with weight loss, dehydration, and electrolyte imbalance. Guidelines recommend outpatient management for mild cases using antihistamines and phenothiazines as first-line antiemetics. Hospitalization is indicated for HG with continued vomiting and signs of dehydration or ketosis. Inpatient treatment involves IV hydration with normal saline and potassium, supplementation with thiamine, and thromboprophylaxis with low molecular weight heparin. Second-line therapies include metoclopramide, ondansetron, corticosteroids, and ginger may be used as complementary therapy.
This document discusses hypertensive disorders in pregnancy, which remain a leading cause of maternal mortality in Uganda. It defines various hypertensive disorders including chronic hypertension, gestational hypertension, preeclampsia, and HELLP syndrome. Risk factors, pathogenesis, clinical features, investigations, and management are described. Severe preeclampsia is treated with antihypertensive drugs like hydralazine to control blood pressure and delivery of the baby to resolve the condition. Hypertensive disorders continue to have high mortality and morbidity rates in Uganda.
This document discusses hypertension in pregnancy. It defines hypertension as a systolic blood pressure over 140 mmHg or a diastolic over 90 mmHg, documented on two occasions at least 6 hours apart. It classifies hypertensive disorders into categories including gestational hypertension, preeclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension. Preeclampsia is a significant health concern that can lead to maternal and fetal complications like preterm delivery. The pathophysiology involves reduced placental perfusion in early pregnancy followed by maternal symptoms of endothelial dysfunction later in pregnancy.
MANAGEMENT OF GESTATIONAL DIABETES MELLITUS BY DR SHASHWAT JANIDR SHASHWAT JANI
This document contains information from Dr. Shashwat Jani regarding gestational diabetes mellitus (GDM). It discusses the increasing prevalence of GDM in India and its associated risks for both mother and baby. It provides details on screening and diagnostic protocols, management through medical nutrition therapy, glycemic control, fetal monitoring and delivery planning. The importance of a multidisciplinary approach and glycemic control for optimizing maternal and neonatal outcomes is emphasized.
This document contains information from Dr. Shashwat Kamal Jani on fever during pregnancy. It discusses the definition of fever, periods of prenatal development and their susceptibility to fever, physiological changes during pregnancy that increase infection risk, common causes of fever like URTI and UTI, and complications of fever for both mother and baby such as preterm birth and fetal anomalies. Treatment of common infections involves antibiotics while ensuring the fever resolves before delivery.
This document discusses hypertension in pregnancy and preeclampsia. It begins by outlining normal blood pressure changes during pregnancy, then defines pregnancy-induced hypertension and chronic hypertension. It distinguishes between gestational hypertension, preeclampsia, and eclampsia. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. Risk factors, incidence rates, causes, pathophysiology, complications, classification, diagnosis, and management of preeclampsia are then summarized. Indications for delivery are outlined for both mild and severe preeclampsia cases based on maternal and fetal stability and gestational age.
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 provides an overview of the management of hypertensive disorders in pregnancy. It discusses the differences between gestational hypertension and chronic hypertension, how to assess proteinuria, prevention strategies, recommendations for various stages of mild to severe hypertension during pregnancy and postpartum, which antihypertensive medications to use and avoid, risk factors for preeclampsia, and conclusions about early diagnosis and treatment improving outcomes for both mother and baby. The conclusions recommend labetolol and methyldopa as first-line drugs, watching high risk women closely for preeclampsia, using urine protein to creatinine ratio for proteinuria screening, and aspirin as the only proven primary prevention method.
This document discusses hypertensive disorders of pregnancy, including definitions, classifications, signs, symptoms, risk factors, investigations, complications and management of conditions like pre-eclampsia and eclampsia. It defines pre-eclampsia as hypertension with proteinuria developing after 20 weeks in a previously normotensive woman. Eclampsia is defined as pre-eclampsia with seizures. Management involves controlling blood pressure, preventing seizures, monitoring the patient closely, and timely delivery of the baby. Magnesium sulfate is the primary treatment for preventing and treating seizures.
Preeclampsia is a disorder that is unique to human pregnancy, and the only known cure for this complication is delivery. Preeclampsia affects approximately 4% to 5% of pregnancies . The Preeclampsia Foundation states that: “Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.” As is evident from the statement that, preeclampsia is a major contributor to maternal and fetal morbidity and mortality worldwide. In India, the incidence of preeclampsia is reported to be 8-10% among the pregnant women. According to a study, the prevalence of hypertensive disorders of pregnancy was 7.8% with preeclampsia in 5.4% of the study population in India
Heart disease occurs in approximately 1% of pregnancies and can be caused by rheumatic heart disease, congenital heart defects, or other conditions like ischemic heart disease. Diagnosis involves taking a medical history and performing a physical exam, chest X-ray, electrocardiogram, and echocardiogram. Pregnancy places additional strain on the heart and can exacerbate existing heart conditions or lead to heart failure. Management involves rest, diet, infection prevention, hospitalization if decompensation occurs, and possibly medical treatments like diuretics, beta blockers, or surgical treatments such as cardiac surgery or therapeutic abortion in severe cases. During labor, vaginal delivery is preferred if possible but induction is not recommended if acute heart
Hypertension is a common complication of pregnancy that can lead to increased maternal and neonatal morbidity and mortality if not properly managed. It includes conditions like chronic hypertension, pre-eclampsia, and gestational hypertension. Pre-eclampsia affects 5-15% of pregnancies and is characterized by new onset hypertension and proteinuria developing after 20 weeks of gestation. Risk factors include primigravidas, family history, chronic hypertension, and obesity. Treatment involves monitoring, medication to control blood pressure, delivery after 36 weeks gestation, and magnesium sulfate in severe pre-eclampsia to prevent eclampsia. Close antenatal surveillance and multidisciplinary care are important to optimize outcomes.
This document presents a case of a 29-year-old woman who is 3 months pregnant and experiencing bleeding and abdominal pain. On examination, she is found to have an incomplete miscarriage. The document then discusses manual vacuum aspiration (MVA) as a procedure to evacuate the uterine contents in cases of incomplete miscarriage. It covers the advantages, indications, contraindications, equipment, precautions, procedure steps, and potential complications of MVA. MVA is described as a safe, affordable option for uterine evacuation that is easy to learn and use without requiring electricity.
Pre-Eclampsia and Hypertensive Disease in Pregnancymeducationdotnet
This document discusses pre-eclampsia and hypertensive disease in pregnancy. It begins by outlining normal blood pressure changes during pregnancy and then defines different types of hypertension including chronic hypertension, pregnancy-induced hypertension, and pre-eclampsia. Pre-eclampsia is described as a multi-system disorder specific to pregnancy caused by placental dysfunction. The document details diagnostic criteria, clinical features, complications, investigations, and stepwise management of pre-eclampsia including delivery timing and postpartum care. Management involves treating hypertension, preventing eclampsia with magnesium sulfate if needed, and delivery to cure the condition, balancing risks of preterm birth.
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 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.
This document discusses chorioamnionitis (intra-amniotic infection), including its pathogenesis, risk factors, clinical findings, diagnosis, and evaluation. Chorioamnionitis occurs when pathogens ascend from the vagina and infect the amniotic fluid and fetal membranes. It complicates 40-70% of preterm births and 1-4% of term births. Diagnosis is based on maternal fever and may include leukocytosis, fetal tachycardia, and uterine tenderness. Evaluation of amniotic fluid can confirm infection through culture, Gram stain, or glucose/white blood cell counts. Histologic examination after birth also helps diagnosis.
Gestational diabetes (GDM) is glucose intolerance that begins or is first recognized during pregnancy. It can be caused by either pre-existing type 2 diabetes or a new onset of diabetes during pregnancy. The document discusses screening, diagnosis and management of both pre-existing diabetes and GDM during pregnancy. It aims to provide optimal glucose control to support fetal growth while avoiding risks of hyper- and hypoglycemia. Treatment involves medical nutrition therapy, glucose monitoring and may require insulin therapy in some cases. Close monitoring is needed throughout pregnancy and postpartum to support maternal and fetal health.
Eclampsia is a complication of preeclampsia defined by the occurrence of seizures. It is caused by severe vasospasm and damage to the vascular endothelium in the brain. Convulsions typically occur in late pregnancy or early postpartum. Management involves controlling seizures with magnesium sulfate, controlling blood pressure, and delivering the baby to ultimately cure the condition. Complications can be serious for both mother and baby if not properly managed.
This document discusses hypertensive disorders in pregnancy. It classifies hypertension into pre-existing (chronic) hypertension, pregnancy-induced hypertension (PIH), and superimposed pre-eclampsia/eclampsia. PIH includes transient hypertension, pre-eclampsia, and eclampsia. The document explores various theories of causation and provides details on pathological changes, diagnosis, screening tests, types of pre-eclampsia, complications, and treatment including prophylactic low-dose aspirin.
This document defines hypertension in pregnancy as a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher on more than one occasion. Preeclampsia is a multifactorial condition affecting 3% of pregnancies that is characterized by poor placentation leading to endothelial dysfunction and clinical manifestations including hypertension and proteinuria after 20 weeks of gestation. Magnesium sulfate is the drug of choice for preventing seizures in women with moderate to severe preeclampsia, given either as a continuous intravenous infusion or intermittent intramuscular injections to control blood pressure and prevent complications.
Hyperemesis Gravidarum (HG) is diagnosed when there is intractable nausea and vomiting of pregnancy associated with weight loss, dehydration, and electrolyte imbalance. Guidelines recommend outpatient management for mild cases using antihistamines and phenothiazines as first-line antiemetics. Hospitalization is indicated for HG with continued vomiting and signs of dehydration or ketosis. Inpatient treatment involves IV hydration with normal saline and potassium, supplementation with thiamine, and thromboprophylaxis with low molecular weight heparin. Second-line therapies include metoclopramide, ondansetron, corticosteroids, and ginger may be used as complementary therapy.
This document discusses hypertensive disorders in pregnancy, which remain a leading cause of maternal mortality in Uganda. It defines various hypertensive disorders including chronic hypertension, gestational hypertension, preeclampsia, and HELLP syndrome. Risk factors, pathogenesis, clinical features, investigations, and management are described. Severe preeclampsia is treated with antihypertensive drugs like hydralazine to control blood pressure and delivery of the baby to resolve the condition. Hypertensive disorders continue to have high mortality and morbidity rates in Uganda.
This document discusses hypertension in pregnancy. It defines hypertension as a systolic blood pressure over 140 mmHg or a diastolic over 90 mmHg, documented on two occasions at least 6 hours apart. It classifies hypertensive disorders into categories including gestational hypertension, preeclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension. Preeclampsia is a significant health concern that can lead to maternal and fetal complications like preterm delivery. The pathophysiology involves reduced placental perfusion in early pregnancy followed by maternal symptoms of endothelial dysfunction later in pregnancy.
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.
Tăng huyết áp thai kỳ và tiền sản giật ACOG 2019Võ Tá Sơn
This document provides guidelines for diagnosing and managing gestational hypertension and preeclampsia. It defines key terms like gestational hypertension, preeclampsia, and severe features. Preeclampsia is a disorder of pregnancy associated with new-onset hypertension and often proteinuria. It can occur with or without severe features affecting organs. Risk factors include nulliparity, obesity, chronic hypertension, and diabetes. Diagnosis requires new hypertension and proteinuria or other severe features after 20 weeks. The guidelines aim to help practitioners identify and monitor these conditions to improve outcomes.
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.
Management of Pre-eclampsiaand eclampsia Case discussionsMouafak Alhadithy
The document discusses the management of pre-eclampsia and eclampsia, defining the conditions and outlining diagnostic criteria and treatment approaches. It provides case studies of patients presenting with hypertension in pregnancy and describes how to evaluate and treat the patients, including through antihypertensive medication, magnesium sulfate administration, and decisions around delivery timing and method. The goal of management is to terminate the pregnancy safely while restoring the health of both the mother and newborn.
This document provides guidelines for the management of hypertensive disorders during pregnancy, including pre-eclampsia. It discusses the epidemiology, risks, classification, pathophysiology, and management based on NICE guidelines. Key points include: hypertension complicates 10% of pregnancies, pre-eclampsia 2-8%; it is a leading cause of maternal death; risks include prematurity, fetal growth restriction, and maternal organ damage; treatment involves hospitalization, blood pressure monitoring, antihypertensive medications, timing of birth depending on gestational age and severity of symptoms.
PRE-ECLAMPSIA SUPERIMPOSED ON CHRONIC HTN.pptxByamugishaJames
Superimposed pre-eclampsia is diagnosed when a woman with chronic hypertension develops new-onset proteinuria or other signs of worsening pre-eclampsia after 20 weeks of gestation. It carries increased risks for both mother and baby compared to chronic hypertension alone. The pathophysiology likely involves abnormal placentation exacerbating existing vascular dysfunction. Management includes close monitoring, antihypertensive treatment, corticosteroids if delivery is premature, and delivery once the fetus is mature unless maternal or fetal conditions indicate earlier delivery. Risks include maternal organ damage and preterm birth or stillbirth for the baby.
Hypertensive Disorders of Pregnancy .pdfNenyiGhartey1
This document provides an overview of hypertensive disorders in pregnancy (HDPs). It defines HDPs and classifies the main types as chronic hypertension, gestational hypertension, preeclampsia, and superimposed preeclampsia. Preeclampsia is the most dangerous type and can cause multiple maternal organ complications as well as fetal growth restriction. Accurate blood pressure measurement and assessment of proteinuria are key to diagnosis. Treatment involves monitoring for preeclampsia symptoms and delivery of the baby if indicated.
This document discusses hypertension in pregnancy and preeclampsia. It begins with definitions and classifications of hypertension in pregnancy. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. Risk factors for preeclampsia are discussed. The pathogenesis involves placental ischemia leading to endothelial dysfunction. Clinical manifestations in the mother can include issues in cardiovascular, respiratory, neurological, renal and hepatic systems. Management involves controlling blood pressure, preventing seizures with magnesium sulfate, and timely delivery of the baby.
This document discusses various medical illnesses that can occur during pregnancy including hematological disorders like anemia, heart disease, diabetes, thyroid dysfunction, jaundice, and viral infections. It provides details on the symptoms, effects, and management of conditions like anemia, heart disease, gestational diabetes, thyroid dysfunction, hypertension during pregnancy, and pre-eclampsia. High risk factors for complications are discussed. The summary concludes with references used in compiling the information.
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.
1) The document discusses pregnancy induced hypertension, its classification, diagnosis, and management. It defines four types of hypertensive disorders in pregnancy: gestational hypertension, preeclampsia-eclampsia (mild and severe), superimposed preeclampsia-eclampsia, and chronic (preexisting) hypertension.
2) For diagnosis of hypertension in pregnancy, blood pressure must exceed 140/90 mmHg. Diagnosis of mild or severe preeclampsia depends on blood pressure levels and presence of proteinuria.
3) Management of mild preeclampsia can involve outpatient monitoring with regular visits or inpatient monitoring with maternal and fetal monitoring and treatment if signs worsen.
This document discusses hypertensive disorders of pregnancy including gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome. Key points:
1. Preeclampsia affects 10-12% of pregnancies and is a leading cause of maternal death worldwide. It involves new onset hypertension and proteinuria after 20 weeks.
2. Diagnosis, monitoring, and management involves frequent blood pressure monitoring, urine and blood tests. Delivery is usually indicated for worsening conditions or after 37 weeks.
3. Magnesium sulfate is used for seizure prophylaxis in preeclampsia patients and blood pressure control is important for reducing maternal risks while allowing further fetal growth.
1. Hypertension in pregnancy can manifest as gestational hypertension, preeclampsia, or eclampsia. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation.
2. The pathophysiology of preeclampsia involves abnormal placentation leading to placental ischemia and endothelial dysfunction. This causes widespread effects including vasoconstriction and signs/symptoms affecting multiple organ systems.
3. Diagnosis of preeclampsia is based on new hypertension and proteinuria developing after 20 weeks of gestation. Evaluation of patients involves assessment of signs/symptoms and laboratory/imaging tests to determine severity and monitor for complications affecting maternal/fetal health.
Introduction to Assisted reproductive technology.pptxAhmed Mowafy
Infertility is defined as the failure to achieve a clinical pregnancy after 12 months of regular unprotected intercourse. It affects approximately 9-15% of reproductive-aged couples worldwide. The main causes of infertility include female factors like PCOS, endometriosis, and tubal damage; male factors like low sperm count or quality; and unexplained infertility. Treatments for infertility include ovulation induction, intrauterine insemination, in vitro fertilization, and others. Religious views on assisted reproduction vary between religions, with some being more accepting than others.
Update management of postpartum haemorrhage.pdfAhmed Mowafy
Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, responsible for over 80,000 deaths in 2015. PPH can be primary (within 24 hours of delivery) or secondary (within 12 weeks) and is classified by blood loss volume. The causes of PPH are commonly referred to as the "four Ts": tone (uterine atony), trauma, tissue (retained placenta), and thrombin (coagulopathies). Early recognition through monitoring vital signs and blood loss estimation is important. Treatment involves resuscitation, hemostatic measures like uterotonics to address the underlying cause, and consideration of surgical interventions if conservative options fail.
The document discusses luteinizing hormone (LH) structure and function, as well as its role in assisted reproduction. It summarizes evidence from multiple publications on using recombinant human LH (r-LH) as an adjuvant to recombinant FSH (r-FSH) in ovarian stimulation. The evidence is conflicting, but there is consensus that r-LH may benefit women with hypogonadotropic hypogonadism, those aged 35-39, those with a suboptimal response to r-FSH, and in reducing ovarian hyperstimulation syndrome risk. However, the optimal dose, timing and patient groups require more clarification.
Assessment and preparation of infertile couples before icsiAhmed Mowafy
This document provides information about infertility, its causes and treatments. It defines infertility as the failure to achieve pregnancy after 12 months of regular unprotected sex. It discusses infertility as a disability according to the WHO. It also defines terms like subfertility, assisted reproductive technology (ART), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and their procedures. The document discusses the evaluation process for infertility including history, examination, ovarian reserve testing and semen analysis. It provides details about the IVF/ICSI cycle steps and frequently asked questions about success rates, costs, bed rest after embryo transfer and religious aspects.
This document defines infertility and its causes. It discusses male and female factors of infertility in detail. For male factors, it covers pre-testicular, testicular, and post-testicular causes and evaluates male factor infertility through history, examination, semen analysis, and assessment of sperm function. For female factors, it discusses ovarian causes of anovulation including physiological and pathological causes. It also describes the treatment of ovulatory disorders, focusing on clomiphene citrate as a first-line induction of ovulation treatment.
The Diagnostic Value of Saline Infusion Sonohysterography Versus Hysteroscopy...Ahmed Mowafy
This study evaluated the diagnostic value of saline infusion sonohysterography (SIS) compared to hysteroscopy for detecting uterine abnormalities in 161 women with infertility or recurrent pregnancy loss. SIS had slightly lower sensitivity and specificity than hysteroscopy, particularly for detecting intrauterine adhesions and congenital anomalies. However, SIS has advantages of being non-invasive, cheaper, faster, and more comfortable for patients compared to hysteroscopy. While hysteroscopy remains the gold standard, SIS is an effective initial screening tool for evaluating the uterine cavity.
In vitro fertilization and embryo transfer "IVF"; Overview on the Story FRO...Ahmed Mowafy
The document discusses the history and development of in vitro fertilization (IVF). It mentions:
- Aldous Huxley predicted IVF techniques in his 1931 novel "Brave New World".
- The first reported pregnancies from IVF occurred in the late 1950s and early 1960s involving animals.
- The first reported human pregnancy from IVF was in 1973, though it resulted in miscarriage.
- The first successful human birth from IVF, Louise Brown, occurred in 1978 in the UK from the work of Steptoe and Edwards.
HELLP syndrome is a severe form of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets. It occurs in 0.5-0.9% of pregnancies and is diagnosed based on evidence of hemolysis, elevated liver enzymes, and low platelet count. Management of HELLP syndrome depends on disease severity and gestational age, ranging from termination of pregnancy for severe cases to conservative management including blood pressure control, magnesium sulfate to prevent seizures, and corticosteroids to improve platelet and liver function for mild to moderate cases before 34 weeks gestation.
Antiphospholipid antibody syndrome is a condition characterized by the presence of antibodies that cause an increased risk of blood clots, pregnancy complications such as miscarriage, and preeclampsia. These antibodies interfere with prostacyclin and thromboxane, leading to vasoconstriction and thrombosis. Diagnosis requires at least one clinical criteria of vascular events, pregnancy morbidity, or autoimmune disease plus a positive test for antiphospholipid antibodies. Management involves pre-conception counseling, low-dose aspirin, anticoagulation with heparin, prevention and monitoring of complications during pregnancy, and postpartum care including continued anticoagulation.
The Diagnostic value of saline infusion sonohysterography and hysteroscopy in...Ahmed Mowafy
Hysteroscopy is more sensitive and has a higher negative predictive value than saline infusion sonohysterography (SIS) in detecting intracavitary abnormalities, according to a study comparing the two techniques. The study of 80 women found hysteroscopy had a sensitivity of 96.3% versus 89.3% for SIS. Hysteroscopy also had a higher negative predictive value of 92.3% compared to 76.9% for SIS. However, SIS has advantages of being non-invasive, cheaper, faster, and less discomfortable for patients. Both techniques had few complications, with bleeding being most common for SIS. The study concludes hysteroscopy is superior for diagnosis but S
Venous thromboembolism during pregnancyAhmed Mowafy
Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, can occur during pregnancy. The risk of VTE is highest during the antepartum period and with cesarean delivery. Risk factors include prior VTE, thrombophilia, older age, obesity, multiparity, bed rest, and certain medical conditions. Treatment involves anticoagulants like heparin and warfarin, with heparin preferred in early pregnancy due to risks of warfarin exposure to the fetus. Patients are classified as very high, high, moderate, or low risk, with treatment strategies varying based on risk level.
Cardiotocography monitors the fetal heartbeat and uterine contractions during pregnancy and labor. It involves measuring the fetal heart rate, uterine contractions, fetal movement and heart rate accelerations. Abnormal findings include bradycardia, tachycardia, minimal heart rate variability, and late decelerations which can indicate fetal distress requiring interventions like oxygen supplementation or emergency delivery. The NST and CST (oxytocin challenge test) are used to assess fetal wellbeing by observing fetal heart rate patterns in response to movement or induced contractions.
Single port laparoscopic hysterectomy is a new minimally invasive surgical technique that uses only one small incision in the belly button to remove the uterus through the vagina, compared to traditional laparoscopic hysterectomy which uses multiple small incisions. This new technique aims to reduce pain, scarring and recovery time for patients undergoing hysterectomy.
1) Pregnancy places significant demands on the cardiovascular system due to increases in blood volume, cardiac output, heart rate and changes in blood pressure and chemistry.
2) Women with preexisting heart conditions like rheumatic heart disease may experience worsening symptoms during pregnancy due to these demands. Care during pregnancy involves monitoring, activity restriction, medication and potential termination if risk is too high.
3) Delivery requires close supervision by obstetricians and cardiologists due to risks of heart failure from labor and postpartum blood loss. Overall maternal mortality is low for mild conditions but can be over 7% for severe illnesses if not properly managed.
retract the wound edges laterally using self-retaining
retractors to expose the peritoneal cavity
Operative Techniques
IV.Abdominal wall incision
Sub-umblical vertical midline incision
Disadvantages:
1. Poor cosmetic results
2. Higher incidence of incisional hernia
3. Limited exposure of adnexae
4. More pain in the postoperative period
5. Difficult to close the incision in obese patients
So Pfannenstiel incision is preferred in elective cases and midline
incision in emergency cases or when good exposure is needed.
The choice depends on the obstetrician preference and the
clinical situation.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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).
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Update management of preeclampsia
1.
2.
3.
4.
5.
6. “Toxemia of pregnancy” Eclampsia and preeclampsia were originally
attributed to “toxins” or “poisons” believed to enter the maternal
circulation—hence, the term toxemia of pregnancy.
The search for the toxins responsible for preeclampsia and eclampsia
has lasted for more than a century
Bell, M.J., 2010.
7. Preeclampsia is one of the most enigmatic complications of pregnancy,
and it is considered a pregnancy-specific disorder cured only by
delivery.
It has been estimated that preeclampsia complicates 2–8% of
pregnancies globally.
ACOG practice bulletin no. 202: 2019
Eclampsia complicates about 1 in 3000 (0.03%) pregnancies in the
United Kingdom and Europe. In some developing countries, the
incidence reaches 1%. and about 1% of women with pre-eclampsia in
developed countries
Hypertension accounts for 12%–25% of all antenatal admissions
(Nelson-Piercy C. Handbook of obstetric medicine. CRC press; 2020 Aug 26.)
8. Hypertensive disorders of pregnancy is one of the leading causes of
maternal and perinatal mortality worldwide.
16% of maternal deaths can be attributed to hypertensive disorders:
• 26% In Latin America and the Caribbean
• 9% in Africa and Asia
• maternal mortality is much lower in high-income countries than
in developing countries
ACOG practice bulletin no. 202: 2019
9.
10.
11. preeclampsiais defined as a systolic blood pressure 140 mm Hg or
more or a diastolic blood pressure of 90 mm Hg or more, or both, on
two occasions at least 4 hours apart after 20 weeks of gestation, in a
woman with a previously normal blood pressure and frequently near
term. Although often accompanied by new-onset proteinuria,
symptoms of preeclampsia may present in the absence of proteinuria.
ACOG practice bulletin no. 202: 2019
12. Gestational hypertension is defined as a systolic blood pressure 140
mm Hg or more or a diastolic blood pressure of 90 mm Hg or more, or
both, on two occasions at least 4 hours apart after 20 weeks of
gestation, in a woman with a previously normal blood pressure without
proteinuria or severe features with levels return to normal in the
postpartum period.
Gestational hypertension is considered severe when the systolic level
reaches 160 mm Hg or the diastolic level reaches 110 mm Hg.
ACOG practice bulletin no. 202: 2019
13. • women diagnosed as hypertensive prior to pregnancy
• If diagnosed for the first time in the first trimester, it is likely a
chronic, pre-existing hypertension, since pregnancy-induced
hypertension (including pre-eclampsia) usually, but not invariably,
appears in the second half of pregnancy
• Diagnosis of pre-existing hypertension may, on occasion, only be
made retrospectively, i.e., 3 to 6 months after delivery when the
blood pressure has not returned to normal
(Nelson-Piercy C. Handbook of obstetric medicine. CRC press; 2020)
14.
15.
16. ➢ General factors
▪ Age: Women over the age of 40 have double the risk of pre-
eclampsia
▪ body mass index greater than 30
➢ Genetic predisposition
▪ Women whose mothers had pre-eclampsia have a 20%–25% risk
of developing pre-eclampsia.
▪ In women with a sister with a history of pre-eclampsia, the risk
may be as high as 35%–40%.
17. ➢ Obstetric factors
▪Primiparity (two- to threefold risk)
▪Multiple pregnancy (twofold risk for twins)
▪Previous pre-eclampsia (sevenfold risk)
▪Long birth interval (two- to threefold if 10 years)
▪ In vitro fertilization especially with donor eggs
▪Hydrops with a large placenta
▪Hydatidiform mole
▪Triploidy (particular association with very early-onset [before 24
weeks’ gestation] pre-eclampsia)
Although pre-eclampsia is more common in primiparous women,
it is more severe in multiparous women with higher morbidity and
mortality rates.
18. ➢ Medical factors
▪ Pre-existing hypertension
▪ Chronic kidney disease (even without renal impairment)
▪ Diabetes (pre-existing or gestational)
▪ Antiphospholipid syndrome
▪ Systemic lupus erythematosus
▪ Sickle cell disease
(Nelson-Piercy C. Handbook of obstetric medicine. CRC press; 2020)
19.
20.
21. • The exact cause of preeclampsia remains unknown
• A fundamental task of medicine is establishing the causes of
diseases. Preeclampsia is an enigmatic and elusive disorder of
pregnancy and has been labeled the “disease of theories.”
• This condition is one of the “great obstetrical syndromes” in which
multiple and sometimes overlapping pathologic processes activate
a common pathway that leads to their clinical recognition.
22. Theories tried to explain preeclampsia are the following:
• Abnormal trophoblastic invasion and placental hypoxia (the most
accepted theory)
• Immunologic phenomena
• Vascular endothelial damage
• Cardiovascular maladaptation
• Inflammation and oxidative stress
• Genetic predisposition
• Coagulation abnormalities
• Dietary deficiencies or excesses
Khalil, G. and Hameed, A., 2017
23. It is generally accepted that abnormal placentation resulting in the
release of soluble antiangiogenic factors, coupled with increased
oxidative stress and inflammation, leads to systemic endothelial
dysfunction and the clinical manifestations of the disease.
Rana, S., Burke, S.D. and Karumanchi, S.A., 2020
24. Stage 1: Abnormal placentation
• During embryo implantation in early pregnancy, the extravillous
cytotrophoblast from the placenta invade and remodel the uterine
spiral arteries in the myometrium.
• This creates a high-flow, low resistance blood supply to the
maternal compartment that can adequately perfuse the placenta
and sustain the pregnancy.
• Poor cytotrophoblast invasion that leads to poor placental
implantation is the initial pathogenic event that gives rise to
preeclampsia
25. Stage 1: Abnormal placentation
• uteroplacental ischaemia develops whether due to poor
implantation in underlying microvascular disease or underperfusion
McElwain, C.J et al. 2020
26. Stage 2: Maternal response
• Normal pregnancy is associated with a systemic inflammatory
response, and this is exacerbated in pre-eclampsia. The maternal
features of preeclampsia include metabolic disturbance including
high levels of triglycerides, an exaggerated inflammatory response
with higher levels of pro-inflammatory cytokines associated with
endothelial dysfunction.
• Endothelial cell activation leads to increased capillary permeability,
increased endothelial expression of cell adhesion molecules and
pro-thrombotic factors, platelet activation and increased vascular
tone.
27. Stage 2: Maternal response
• In preeclampsia there is a decrease in prostacyclin synthesis and
an increase in thromboxane A2 (TXA2) synthesis. This contributes to
the platelet activation and vasoconstriction.
• These factors cause widespread microvascular damage and
dysfunction, which lead to the clinical manifestations of the
maternal syndrome such as hypertension, proteinuria and hepatic
disturbance.
McElwain, C.J et al. 2020
28.
29. Antiangiogenic factors in preeclampsia:
During normal pregnancy, vascular endothelial growth factor (VEGF)
and transforming growth factor (TGF-β1) maintain endothelial health
by interacting with their endogenous endothelial receptors.
In Preeclampsia placentally derived soluble factors include
antiangiogenic factors, such as:
▪ soluble fms-like tyrosine kinase-1 (sFlt-1)
▪ soluble endoglin (sEng).
These factors bind and neutralize the actions of proangiogenic factors,
such as vascular endothelial growth factor (VEGF) and transforming
growth factor beta.
McElwain, C.J et al. 2020
30.
31.
32. Antiangiogenic factors in preeclampsia:
The soluble factors from the placenta can reduce the production of
important vasoactive molecules (including the vasodilator, nitric oxide)
and cause the local release of endothelially derived factors that
further exacerbate the endothelial dysfunction.
These include thromboxane and endothelin-1 (ET-1) (both induce
vasoconstriction) and proinflammatory cytokines.
McElwain, C.J et al. 2020
33.
34.
35.
36.
37.
38.
39. ➢ Blood pressure:
▪ Systolic blood pressure of 140 mm Hg or more or diastolic blood
pressure of 90 mm Hg or more on two occasions at least 4 hours
apart after 20 weeks of gestation in a woman with a previously
normal blood pressure
▪ Systolic blood pressure of 160 mm Hg or more or diastolic blood
pressure of 110 mm Hg or more. (Severe hypertension can be
confirmed within a short interval (minutes) to facilitate timely
antihypertensive therapy).
40. ➢ Proteinuria
▪ 300 mg or more per 24 hour urine collection (or this amount
extrapolated from a timed collection) or
▪ Protein/creatinine ratio of 0.3 mg/dL or more or
▪ Dipstick reading of +2 (used only if other quantitative methods not
available)
41. ➢ Or in the absence of proteinuria, new-onset hypertension with the
new onset of any of the following:
▪ Thrombocytopenia: Platelet count less than 100,000 per µl
▪ Renal insufficiency: Serum creatinine concentrations greater than
1.1 mg/dL or a doubling of the serum creatinine concentration in
the absence of other renal disease
▪ Impaired liver function: Elevated blood concentrations of liver
transaminases to twice normal concentration
▪ Pulmonary edema
42. ➢ Or in the absence of proteinuria, new-onset hypertension with the
new onset of any of the following:
▪ New-onset headache unresponsive to medication and not
accounted for by alternative diagnoses or visual symptoms
46. ➢ Assessment of Proteinuria:
• Before the Task Force on Hypertension in 2013, proteinuria was an
essential part of the diagnosis of preeclampsia.
• The amount of protein was previously related to the severity of
the disease. >5 g.
• After the publication of the new guidelines, limited data are
available on whether preeclampsia with or without proteinuria
will have different outcomes.
47. ➢ Assessment of Proteinuria:
• Urine dipsticks
Based on the current available data, the accuracy of dipstick
urinalysis in pregnancy with 1+ threshold for predicting
proteinuria of 300 mg/day is poor with a positive likelihood ratio
of 3.48 (95% CI, 1.66e7.27), a negative likelihood ratio of 0.6 (95%
CI, 0.45e0.8), sensitivity of 59% (95% CI, 37%e79%), and specificity
of 28% (95% CI, 18% to 41%.
Waugh, J.J et al., 2004.
49. ➢ Assessment of Proteinuria:
• 24-hour urine collection
300 mg or more per 24 hour urine collection (or this amount
extrapolated from a timed collection) is considered positive
The reference standard for measuring urinary protein excretion is
a 24-hour urine collection
Not practical for women need rapid diagnosis
50. ➢ Assessment of Proteinuria:
• Protein/creatinine ratio
A value of of 0.3 mg/dL or more is considered positive
52. ➢ Warning symptoms of preeclampsia: (signs precedes symptoms)
• Persistent headache
• Blurring of vision and flashing lights
• Epigastric Pain
• right upper quadrant pain
• Nausea and vomiting
• Rapidly increasing swelling of face, fingers or legs
• Rapid weight gain
54. ➢ Investigations:
• 24-hour urinary protein excretion >0.3 g
• Protein creatinine ratio ; albumin creatinine ratio (
• Complete blood count CBC
• Prolonged clotting times (if concomitant DIC in HELLP syndrome)
• Renal fuvction test ; creatinine
• Liver function tests, particularly raised transaminases
55. ➢ Investigations:
• Reduced fetal growth and oligohydramnios
• Abnormal uterine artery Doppler (bilateral notches and increased
resistance ; pulsatility index at 24 weeks predict pre-eclampsia)
• Abnormal umbilical artery Doppler (reduced, absent or reversed
end diastolic flow indicating fetal compromise)
• Low placental growth factor (PlGF) (reduced in pre-eclampsia and
predictive of delivery for pre-eclampsia within 2 weeks)
60. ➢ Antepartum management:
• Maternal evaluation at the initial evaluation, a complete blood
count with platelet estimate, serum creatinine, LDH, AST, ALT, and
testing for proteinuria should be obtained in parallel with a
comprehensive clinical maternal and fetal evaluation.
• Fetal evaluation should include ultrasonographic evaluation for
estimated fetal weight and amount of amniotic fluid, as well as
fetal antepartum testing.
• Subsequent management will depend on the results of the
evaluation and gestational age.
• The decision to deliver must balance the maternal and fetal risks.
61. ➢ Antepartum management:
• Continued observation is appropriate for a woman with a preterm
fetus if she has gestational hypertension or preeclampsia without
severe features.
ACOG practice bulletin no. 202: 2019
63. ➢ Conditions Precluding Expectant Management:
• Maternal
1. Uncontrolled severe-range blood pressures (persistent systolic
blood pressure 160 mm Hg or more or diastolic blood pressure
110 mm Hg or more not responsive to antihypertensive
medication .
2. Persistent headaches, refractory to treatment .
3. Epigastric pain or right upper pain unresponsive to repeat
analgesics
4. Visual disturbances, motor deficit or altered sensorium.
5. Stroke
6. Myocardial infarction
64. ➢ Conditions Precluding Expectant Management:
• Maternal
7. HELLP syndrome
8. New or worsening renal dysfunction (serum creatinine greater
than 1.1 mg/dL or twice baseline)
9. Pulmonary edema
10. Eclampsia
11. Suspected acute placental abruption or vaginal bleeding in the
absence of placenta previa
65. ➢ Conditions Precluding Expectant Management:
• Fetal:
1. Abnormal fetal testing
2. Fetal death
3. Fetus without expectation for survival at the time of maternal
diagnosis (eg, lethal anomaly, extreme prematurity)
4. Persistent reversed end-diastolic flow in the umbilical artery
ACOG practice bulletin no. 202: 2019
66. ➢ Inpatient Versus Outpatient management:
Ambulatory management at home is an option only for women with
gestational hypertension or preeclampsia without severe features
and requires frequent fetal and maternal evaluation.
Hospitalization is appropriate for women with severe features and
for women in whom adherence to frequent monitoring is a concern.
ACOG practice bulletin no. 202: 2019
67. ➢ Management of mild cases with no evidence of pre-eclampsia:
managed as outpatients. National Institute for Care and Excellence
(NICE) recommends that admission is not mandatory for pre-
eclampsia and that individual risk assessment regarding place of care
is appropriate
(Nelson-Piercy C.; 2020 & NICE guidelines 2019)
68. ➢ Management of pre-eclampsia:
• Monitoring for pre-eclampsia:
1.Regular checks of serum creatinine, haemoglobin, platelet count
(and if thrombocytopenia is present and platelet count <100 ×
109/L, a coagulation screen and liver function.
2. Regular urinalysis, and if proteinuria (≥1+) is detected, PCR or
ACR.
3.Uterine artery Doppler blood flow examination at 20–24 weeks’
gestation, looking particularly for the presence of a prediastolic
‘notch’ or a persistent high-resistance waveform is predictive of
subsequent pre-eclampsia, FGR and placental abruption.
69. ➢ Management of pre-eclampsia:
• Monitoring for pre-eclampsia:
4. NICE recommends offering PlGF-based testing if pre-eclampsia
is suspected at <35 weeks and commercial tests are now
available.
(Nelson-Piercy C.; 2020 & NICE guidelines 2019)
70. ➢ Management of pre-eclampsia:
• Monitoring for pre-eclampsia:
71. ➢ Management of pre-eclampsia:
• Treatment of hypertension:
Treatment of pre-existing hypertension in pregnancy reduces the
risk of severe hypertension
Good control of blood pressure is important, and decreases the
complications; maternal (e.g. in HELLP syndrome or another crisis)
or fetal (e.g. with severe growth restriction).
(Nelson-Piercy C.; 2020 & NICE guidelines 2019)
72. ➢ Management of pre-eclampsia:
• Treatment of hypertension:
Drug treatment:
(Nelson-Piercy C.; 2020 & NICE guidelines 2019)
73. ➢ Management of pre-eclampsia:
• Treatment of hypertension:
Drug treatment:
o First-line drug : Labetalol
Labetalol, a combined α- and β-adrenergic blocker, is the
recommended first-line drug. initial regimen of labetalol at 200
mg orally every 12 hours and dose may be increased up to 800
mg orally every 8–12 hours as needed (maximum 2,400 mg/ d).
few side effects, two to four times daily and should be avoided in
women with asthma.
Parenteral labetalol can be used in the intrapartum management
of acute severe hypertension
74. ➢ Management of pre-eclampsia:
• Treatment of hypertension:
Drug treatment:
o Second-line drugs: Nifedipine
Calcium antagonists (e.g. slow-release nifedipine or amlodipine)
can be used alone or in conjunction with labetalol in women who
fail to respond to monotherapy or to replace labetalol in women
who are unable to tolerate it or in whom it is contraindicated.
Side effects include headache, facial flushing and oedema, and
may necessitate withdrawal in some patients.
75. ➢ Management of pre-eclampsia:
• Treatment of hypertension:
Drug treatment:
o Third-line drugs : Methyldopa
Methyldopa has been used for many years without any reports of
serious adverse effects on the fetus or on children.
side effects include depression, sedation and postural
hypotension. liver function test abnormalities, and hemolytic
anemia necessitate a change to an alternative drug.
76. ➢ Management of pre-eclampsia:
• Treatment of hypertension:
Drug treatment:
o Fourth-line drugs:
α-adrenergic blockers (e.g. doxazosin) which are safe and well
tolerated and other vasodilators such as oral hydralazine.
(Nelson-Piercy C.; 2020 & NICE guidelines 2019)
77. ➢ Management of pre-eclampsia:
• Treatment of hypertension:
Drug treatment:
o Other drugs:
Diuretics: avoided in pregnancy, cause further depletion of a
reduced intravascular volume only for heart failure, pulmonary
oedema and idiopathic intracranial hypertension
β-Blockers: used in cardiac disease, migraine prophylaxis and
thyrotoxicosis rather than for hypertension. May affect fetal
growth when used in large doses, may cause neonatal
hypotension and hypoglycemia others. β-Blockers should not be
given to women with a history of asthma.
78. ➢ Management of pre-eclampsia:
• Treatment of hypertension:
Drug treatment:
o Other drugs:
Angiotensin-converting enzyme inhibitors
should not be used in pregnancy because they are teratogenic,
increasing the risk of cardiovascular and neurological
malformations.
(Nelson-Piercy C.; 2020 & NICE guidelines 2019)
80. ➢ Intrapartum Management:
• Prevention of seizures
Magnesium Sulfate
▪ A strong evidence prove that the efficacy of magnesium
sulfate to prevent seizures in women with preeclampsia with
severe features and eclampsia.
▪ Reduced the risk of eclampsia (RR, 0.41; 95% CI, 0.29– 0.58).
▪ Reduced the risk of placental abruption (RR, 0.64; 95% CI,
0.50–0.83).
▪ Reduced the risk of maternal mortality (RR, 0.54; 95% CI, 0.26–
1.10).
81. ➢ Intrapartum Management:
• Prevention of seizures
Magnesium Sulfate
▪ United States regimen : (intravenous administration of a 4–6 g
loading dose over 20–30 minutes, followed by a maintenance
dose of 1–2 g/hour).
▪ For women requiring cesarean delivery (before onset of labor),
the infusion should ideally begin before surgery and continue
during surgery, as well as for 24 hours afterwards.
▪ For women who deliver vaginally, the infusion should continue
for 24 hours after delivery.
82. ➢ Intrapartum Management:
• Prevention of seizures
Magnesium Sulfate
▪ In case of difficulties with establishing venous access,
magnesium sulfate can be administered by intramuscular (IM)
injection, 10 g initially as a loading dose , followed by 5 g every
4 hours.
85. ➢ Intrapartum Management:
• Control of hypertension:
Although parenteral antihypertensive therapy may be needed
initially for acute control of blood pressure, oral medications can be
used as expectant management is continued.
Oral labetalol and calcium channel blockers are commonly used
If the maximum dose is inadequate to achieve the desired blood
pressure goal, or the dosage is limited by adverse effect, then
short-acting oral nifedipine can be added gradually
ACOG practice bulletin no. 202: 2019
87. ➢ Mode of Delivery :
• The mode of delivery in women with gestational hypertension or
preeclampsia (with or without severe features) should be
determined by routine obstetric considerations.
• The decision to perform cesarean delivery should be
individualized, based on anticipated probability of vaginal
delivery and on the nature and progression of preeclampsia
disease state.
ACOG practice bulletin no. 202: 2019
88.
89.
90. ➢ Low dose aspirin:
• The rationale for the use of low-dose aspirin is that it inhibits
platelet cyclooxygenase and therefore TXA2 synthesis.
• NICE recommends aspirin 75–150 mg in women at increased risk
of pre-eclampsia.
• aspirin should be started before 12 weeks’ gestation and be
continued throughout pregnancy. There is some evidence that the
reduction in risk of pre-eclampsia is greater if the aspirin is taken
later in the day (at bedtime)
(Nelson-Piercy C.; 2020 & NICE guidelines 2019)
92. ➢ Calcium and vitamin D:
• Meta-analysis of 13 randomized trials comparing at least 1 g daily
of calcium during pregnancy with placebo showed a greater than
50% reduction in the risk of pre-eclampsia.
• The World Health Organization recommends calcium 1.5–2 g daily
for pregnant women with low dietary calcium intake.
• Low maternal serum 25(OH)D (25-hydroxyvitamin D)
concentrations increase pre-eclampsia risk, and vitamin D
supplementation lowers this risk.
(Nelson-Piercy C.; 2020 & NICE guidelines 2019)
99. There has been an increasing amount of literature studying the
relationship between ART and pregnancy and perinatal outcomes over
the past decade, but there is also a lack of clinical practice guidelines
for women who conceived through ART.
Cryopreservation has led to the rise of frozen embryo transfer (FET),
which expands the scope of treatment and decreases the risk of
ovarian hyperstimulation syndrome
100. While ART continues to benefit many couples around the world, it may
be associated with adverse outcomes, including hypertensive
disorders of pregnancy.
Several metanalyses was done to find relationship between ART and
hypertensive disorders ( Quin et al 2015 Chich et al 2021)
There is strong relationship but further studies with randomized
controlled trials are needed.
101. ➢ Frozen transfer
In recent studies , there is increased risk of hypertensive disorders in
frozen embryo transfer compared to fresh transfer (Maheshwari et al
2018)
Programmed cycles with absence of corpus luteum were associated
with higher risk (Hoynk et al 2019)
104. ➢ Frozen transfer
In an attempt to explain the mechanism(s) underlying the increased
risk of preeclampsia after FET, some hypotheses were formulated:
• Vitrification and warming process might affect the developing
trophoblast, resulting in abnormal Placentation.
• Estradiol rise
• Epigenetic changes by vitrification.
• Protocol used (absence or presence of Corpus luteum)