【高血压英文ppt课件】妊高症 Hypertensive Disorders with Pregnancy.pptVIP

Diagnosis (cont.) Investigations ?? CBC: ↑ PCV and thrombocytopenia ?? SGOT, SGPT: Elevated liver enzymes ?? Creatinine clearance, serum creatinine, uric acid, total protein in urine, and blood urea: impaired ?? Coagulation profile: PT, PTT, clot. and bleed. time → in DIC. Fibrinogen and FDP to diagnose DIC ?? Fetal Surveillance Diagnosis (cont.) Indicators of severity of pre-eclampsia ?? Presence of symptoms Persistent headache or other cerebral or visual disturbances Persistent epigastric pain ?? Diastolic BP ≥ 110 mmHg ?? Proteinuria of 2+ or more by urine dipstick or a total protein level of ≥2 gm/liter in a 24-hour urine sampling Diagnosis (cont.) ?? Abnormal laboratory findings ?? Obvious fetal growth restriction ?? Neurological effects: ? Scotomata, hyperreflexia ? Eclamptic convulsions Indications to terminate pregnancy in pre-eclampsia Maternal Indications ?? Completed 37 weeks ?? Abnormal liver/ renal functions ?? Severe preeclampsia/ eclampsia regardless of the gestational age ? In selected cases of severe PET, where the expertise and equipment are available, expectant management may be undertaken for fetal indications Indications to terminate pregnancy in pre-eclampsia (cont.) Fetal Indications ?? Obvious IUGR ?? Oligohydramnios, IUFD ?? The presence of congenital fetal malformations incompatible with life Management of pre-eclampsia ?? Convulsion prophylaxis ?? Treatment of hypertension ?? Timing of delivery ?? Fluid management ?? Supportive care for various end organ complications Management of Mild Pre-eclampsia ?? Completed 37 weeks gestation: Termination of pregnancy yields better fetal and maternal outcomes ?? 34–37 weeks: Expectant management ?? Gestation 34 weeks: Expectant management and administration of glucocorticoids Management of severe pre-eclampsia Severe pre-eclampsia usually requires prompt delivery Mana