tags:
- o&g/obsHTN in Pregnancy
Before 20w - chronic HTN
After 20w - gestational HTN
Primigravida
Multiple pregnancy
Molar pregnancy
Maternal obesity
Family history of HTN
Abnormal placentation -> abnormal invasion of trophoblast to spiral artery
Lead to inflammatory cytokines -> systemic symptoms
BP > 140/90 mmHg
Proteinuria?
24hr urine for protein quantification - "Ada dpt botol besar utk collect urine tk?"
Significant proteinuria - 300 mg/24hr
Glycosuria? - DM increased risk of HTN
Ultrasound - IUGR? AFI? "Air ketuban cukup tk?" "Size baby normal tk?"
Obs: primid, h/o preeclampsia
Alertness
Body built
Leg edema
Facial puffiness
Hyperreflexia, clonus
SFH & CFH - IUGR, oligohydramnios
FHR
Bishop's score
Head - facial puffiness, frontal headache, blurred vision, nausea & vomiting
Abdomen - Epigastric pain, SOB, crepitation, uterus smaller than date
Leg - bilateral pitting edema, PV bleed (abruptio)
HELLP syndrome - hemolysis, elevated LFT, low platelet
AKI
Eclampsia & intracranial hemorrhage
Acute pulmonary edema
Placental insufficiency
Oligohydramnios
IUGR
Placenta abruptio
FBC - Hb, platelet
LFT - increase AST & ALT, increased LDH (hemolysis)
RP - increased urea & creatinine (AKI), uric acid (reduced GFR)
Coag profile - to look for synthetic failure of liver
Dipstick urine test & 24hr urine sample
Doppler ultrasound of umbilical artery
BP stabilization - Labetalol, Nifedipine, Hydralazine, MgSO4 (prevent seizure)
Timing of birth - before 34w in severe PE
Indications for early delivery
Mode of delivery
Postpartum
A disorder characterized by hypertension >140/90 mmHg with proteinuria after 20th week of pregnancy in previously normotensive and nonproteinuric woman.
i. Hypertension - absolute rise of BP ≥140/90 mmHg
ii. Proteinuria - presence of protein ≥ 2+ (1.0 g/L)
iii. Edema - pitting edema over the ankles