Hypertension in the commonest problem encountered in pregnancy.
When the woman develops high BP for the first time in pregnancy, then she has gestational HTN.
When the BP becomes uncontrolled and when patient has proteinurea then it is called as pre-eclampsia.
Severe PE is the 2nd commonest cause of maternal mortality in India. WHICH TRIMESTER GEST HTN PRESENTS :
Usually it is in the 2nd is > 20 weeks or the third trimester. WHO IS AT RISK :
Pregnancy in a mother whose age is less than 20 years or more than 40 years.
Previous history of HTN in pregnancy.
Family history of HTN. WARNING SIGNS OF HYPERTENSION :
Odema/swelling of legs, abdomen, hands, face.
Persistant heart burn, or pain under the rib cage.
Vomiting. VISUAL DISTURBANCES : Such as blurring of vision seeing dark spots etc.
Decrease in your baby' s movements.
It is very important to tell your gynecologist if you have any above symptoms. Your doctor will look for certain signs when assessing you for pre-eclampsia, including.
Protein in your urine
Abnormal blood tests-tests done to assess
how well your kidneys-liver are functioning and how well your blood is clotting.
Gynecologist will assess how your baby is coping by
Monitoring of the baby using CTG (NST machine).
An ultrasound to assess your baby's growth,
liquor / fluid content around the baby. And how the blood is supplying to the baby. TREATMENT OF HYPERTENSION : Admission to the hospital : admission to the hospital should be done, and it is done usually to monitor the BP, lab investigations and timing of the medications. Because pre-eclampsia can get worsen if it is not controlled, and at times lead to eclampsia, i.e., seizures due to high BP. Treatment of Hypertension : there are medication for pre-eclampsia which are very safe for pregnancy but at times if BP is uncontrolled then medication can be given through IV drip. Definitive treatment of hypertension : Delivery of the baby is the only definitive treatment for pre-eclampsia. Early delivery may be needed if there is a progression to severe PE or eclampsia with worsening of either the maternal or the fetal condition. Eclampsia and its complications : Eclampsia is a very serious condition and a dread complication of hypertension, which causes convulsions (fits) in pregnant woman. Complications of eclampsia :
Death of the patient Ante natal Care : The care of the pregnant woman with the aim of achieving a healthy pregnancy and delivery of a normal baby are the main perspective of antenatal care. Good antenatal care helps a woman face labor in good health and in optimum condition. When to consult your gynecologist :
Consult your doctor as early as possible,
preferably when you miss your periods.
It is better to consult in the pre
conceptional period i.e., before getting pregnant. What is pre-conceptional counseling :
The woman who is planning to conceive must consult a gynecologist wherein she will have her weight, blood pressure and few blood tests like Hb%, blood sugar, thyroid and rubella status checked. These tests are essential because if she needs any corrective measures, she can undergo them, before she conceives. General advice in preconception :
Folic acid intake to prevent neural tube
Rubella and hepatitis B vaccination in the
Weight reduction in obesity
Cessation of smoking and alcohol.
Advice regarding drug intake. How often should you visit the hospital in pregnancy :
Monthly up to 28 weeks (7 months)
Two weekly between 28-36 weeks
(in uncomplicated pregnancy)
More frequent visits will be advised if any
complicated pregnancies. What to expect in each ANC visit :
Meet your doctor as soon as you know that
you are pregnant, because there can be a chances of ectopic pregnancies which has to be attended immediately.
Monthly weight check.
BP checkup in every visit.
Daily fetal kick count.
Fetal heart beat monitoring after 24 weeks. Investigations :
Complete blood count.
Glucose Tolerance Test (GTT)
Blood grouping and Rh typing
Urine routine Tetanus Toxid (TT) Injection: 2 Injections
given at booking visit or at 16-24 weeks followed by another dose 6 weeks later.
One booster dose in women who have taken
TT within 3 years.
Fetal monitoring with NST after 32 weeks.
Counselling will be provided regarding the :
Activity and exercise
Care of breasts
Travelling during pregnancy
Dental care Travel safe in pregnancy :
Air or train travel is not contraindicated but
certain precautions may be needed. Prolonged air travel can lead to venous thrombosis and so mobilsation, hydration and using compressor stocking may help.
Women at risk of preterm delivery or
having abruptio placenta/placenta previa are prohibited from travelling. Ultra-sound in Pregnancy :
1st scan as soon as possible to confirm
A scan between 11-13 weeks to look for the
Nuchal translucency and look for any major congenital anomalies.
Anomaly scan done between 18-24 weeks is
mandatory to look for anomalies in fetus.
Interval growth scan in third trimester is
not routine, but indicated in complaints of IUGR and in high risk pregnancies. Diabetes in Pregnancy :
If a women gets diabetes or high blood sugar when she is pregnant, but she never had before, then she has gestational diabetes. Who is at risk ?
Your Body Mass Index (BMI) is 30 or
You have previously given birth to a large baby weighing 4.5kgs or more.
You have had gestational diabetes before.
You have a parent, sibling or child with
You have a family history of diabetes.
Bad obstetric history
Polycystic ovary syndrome. When does it occur :
During 2nd trimester (24-28 weeks) How to diagnose GDM :
The test done to diagnose GDM is called
as 75gm GTT(Glucose Tolerance Test)
Done between 24-28 weeks of pregnancy.
Your doctor will ask you to come to the
hospital empty stomach (i.e., early morning) when a fasting blood sample is taken.
Then you will have to drink a 75gm
glucose mixed in water, after which another blood sample is taken which will be after 2 hours.
Further testing is required depending on 75gm GTT, results. Complications of GDM : In Mother :
Infections : Urinary Infection
Vulvo vaginal infection
Purpural sepsis and wound infection Fetal Complications :
Abortion in uncontrolled DM.
Unexplained intrauterine fetal death