Counseling: Pre-eclampsia.
(BP: systolic >30 and diastolic >20 over booking BP or BP >160/100 or BP 140/90 with proteinuria).
Good morning Mrs. Smith I am Dr. Munagapati senior house officer in the department obstetrics and gynecology. You are now 30 weeks pregnant and we have been monitoring your BP closely over the last 2 weeks. I am sorry to say that your BP is still high. This condition is called Pre-eclampsia or pregnancy induced hypertension. This condition needs to be managed very carefully to prevent any complications to you or your baby. I am afraid that we will have to admit you to the hospital to control your BP. You need to take bed rest. We'll also start you on medication to lower your BP. It is important to test your urine and blood regularly. We'll also check the well being of the baby by CTG and scan. We hope that your BP will be controlled by these measures.
If how ever there is a problem we might need to deliver the baby early.
Pre-eclampsia: PIH with proteinuria + oedema. The arterial wall doesn't distend enough to allow sufficient blood flow to the placenta in late pregnancy, and increasing BP is a mechanism, which partially compensates for this.
Symptoms: headache, fever, chest pain, epigastric pain, vomiting and visual disturbance. There may be tachycardia, shaking, hyperreflexia, irritability and papilloedema.
Effects: plasma volume is reduced, increased peripheral resistance. If BP is >180/140 microaneurysms develop in the arteries. DIC may develop. Uric acid level is increased.
Management: admit, measure BP 2-4 hourly. Weigh daily, test urine for protein, monitor fluid balance, check uric acid, renal, liver and platelet function. Do regular CTG and USG to check growth and biophysical profiles.
Methyldopa to reduce BP. If signs worsen delivery is the only cure (give H2-blockers if they go into labour).
Symptomatic pre-eclampsia and eclampsia: diazepam + hydralazine. Labetalol provides an alternative. Visual symptoms, twitching or ankle clonus indicate that the baby must be delivered urgently (by caesarean section).
Ergometrine should not be used for the third stage. Syntocinon may be used. Ergometrine further increases BP so would risk stroke.