![\"036d0b4c-3a56-446f-8aa4-6bbf53c691f7\"](\"https:\/\/scribblingsofamedic.files.wordpress.com\/2018\/10\/036d0b4c-3a56-446f-8aa4-6bbf53c691f7.jpg?w=307&h=409\")
<\/p>\nDr. Sandamali Perera<\/p>\n<\/div>\n
Dr. Sandamali Perera is currently an RHO in Obstetrics and Gynaecology (OBGYN) working in Sri Lanka. After completing a hectic internship in obgyn, she was quickly chosen to advance her training in the same department and one day hopes to pursue a career in OBGYN despite its\u2019 trials and challenges. She loves to travel and uses her time off work to explore the many wonders that Sri Lanka has to offer.<\/p>\n
One of the most common presentations in obstetrics is pregnancy-induced hypertension and pre-eclampsia. Diagnosing these conditions is crucial and quick management is essential! Read on below as she shares her experience in tackling this condition.<\/p>\n
Sandamali and I both began our internship in Sri Lanka together and became quick friends. In addition to her sense of humour, her love of travelling is something we share and you may have seen her pop up in my instagram stories when we do our monthly trips around Sri Lanka. Once we get talking there is no stopping and I truly will miss her once our work period together ends!<\/em><\/p>\n A brief clinical picture<\/strong><\/p>\n A 35 year old mother in her second pregnancy (G2P1C1) came in\u00a0for her routine antenatal clinic follow up at 32weeks of gestation. At the clinic she complained of a mild headache persisting over 2-3 days with an associated cough. On further questioning she also complained of some upper abdominal cramping and lethargy.\u00a0Foetal movements were felt as normal.<\/p>\n Her SFH was appropriate on examination, but her blood pressure was 150\/90mmhg. Rest of the examination was normal, with no hyper-reflexia, pitting oedema or visual disturbances. Quick investigation found her urine albumin to be (1+) and her full blood count had a platelet count of 238,000.<\/p>\n As an OBGYN RHO for almost a year, I believe that sometimes we tend to get set into a routine of ignoring minor complaints made by pregnant mothers as a majority of them are not significantly harmful to either the mother or the baby (trust me pregnancy is no easy task as a whole bunch of aches and pains with other minor ailments are a given). However,\u00a0we could also miss certain important diseases such as pregnancy induced hypertension or gestational hypertension which can have many harmful complications.<\/p>\n Introduction<\/strong><\/p>\n Hypertension is a common medical complication of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality.<\/p>\n Definitions<\/em><\/p>\n Pre-eclampsia (gestational hypertension with proteinuria) is a multi system disorder of unknown aetiology (thought to be of vascular endothelium malfunction) characterized by the development of hypertension to the extent of 140\/90mmhg or more with proteinuria after the 20th week, in a previously normotensive and non-proteinuric woman.<\/em><\/p>\n Diagnostic criteria<\/em><\/p>\n 1. Absolute rise of blood pressure of at-least 140\/90mmhg \u2013 a rise of 20mmhg of MAP or when\u00a0the MAP is 105mmhg or more, it is considered to be significant. Blood pressure should be checked on the right arm of the mother when she is in a seated position.<\/p>\n 2. Pitting oedema of the ankle not settling with 12 hours of bed rest<\/p>\n 3. Total protein in urine over 24 hours \u2013 if more than 0.3 grams on atleast 2 random clean-catch urine\u00a0samples tested 4 hours apart in the absence of an urinary tract infection<\/p>\n Impaired hepatic function, thrombocytopenia, pulmonary oedema, visual disturbances or renal sufficiency indicates severe features or pre-eclampsia.<\/p>\n Risk factors<\/strong><\/p>\n Symptoms<\/strong><\/p>\n Mild : slight swelling of the ankles gradually extending to face, abdominal wall, vulva and even the whole body<\/p>\n Moderate: headache over occipital or frontal region, disturbance of sleep, reduced urine output, epigastric pain, vomiting with blurring of vision, scotomata (partial loss of vision or a blind spot) or dimness of vision with flashes of light.<\/p>\n Signs to look for<\/strong><\/p>\n Investigations\u00a0<\/strong><\/p>\n Complications<\/strong><\/p>\n Hypertension cause a number of complications \u2013 not just for the mother but also for the baby.<\/p>\n Maternal<\/em><\/p>\n Fetal<\/em><\/p>\n Management<\/strong><\/p>\n Prophylactic measures to prevent pre-eclampsia<\/em><\/p>\n Conservative management<\/em><\/p>\n Oral medication<\/em><\/p>\n Intravenous medication<\/em><\/p>\n Furthermore definitive treatment would be delivery of the fetus either by induction of labour or caesarian section. Delivery is indicated especially if the foetus is more than 34 weeks (remember to give prophylactic IV steroids to improve lung maturity), if there is ruptured membranes, uncontrolled BP, doppler changes or severe IUGR. Eclampsia, placental abruption, and develop of severe signs are also indications.<\/p>\n Remember that Magnesium sulphate is given prophylactically if features of severe pre-eclampsia and is first line to treat active eclamptic seizures. Seizure prophylaxis should also be continued 24 hours post partum.<\/p>\n I hope this helps any junior doctor or intern and is a reminder to always check the blood pressure of pregnant women who come to clinic for check ups.<\/p>\n","protected":false},"excerpt":{"rendered":" Obstetrics and gynaecology is one of the most stressful departments […]<\/p>\n","protected":false},"author":3,"featured_media":906,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0},"categories":[7],"tags":[59,24,60,75,78,104,153,23,21,163,134,22],"_links":{"self":[{"href":"https:\/\/scribblingsofamedic.com\/index.php\/wp-json\/wp\/v2\/posts\/1000"}],"collection":[{"href":"https:\/\/scribblingsofamedic.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/scribblingsofamedic.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/scribblingsofamedic.com\/index.php\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/scribblingsofamedic.com\/index.php\/wp-json\/wp\/v2\/comments?post=1000"}],"version-history":[{"count":2,"href":"https:\/\/scribblingsofamedic.com\/index.php\/wp-json\/wp\/v2\/posts\/1000\/revisions"}],"predecessor-version":[{"id":1002,"href":"https:\/\/scribblingsofamedic.com\/index.php\/wp-json\/wp\/v2\/posts\/1000\/revisions\/1002"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/scribblingsofamedic.com\/index.php\/wp-json\/wp\/v2\/media\/906"}],"wp:attachment":[{"href":"https:\/\/scribblingsofamedic.com\/index.php\/wp-json\/wp\/v2\/media?parent=1000"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/scribblingsofamedic.com\/index.php\/wp-json\/wp\/v2\/categories?post=1000"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/scribblingsofamedic.com\/index.php\/wp-json\/wp\/v2\/tags?post=1000"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"72c411d9-378c-485b-ba34-9291324355a5\"](\"https:\/\/scribblingsofamedic.files.wordpress.com\/2018\/10\/72c411d9-378c-485b-ba34-9291324355a5.jpg?w=311&h=234\")
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