10. Hypertension in pregnancy-2.pptx
Transcript
Hypertension in pregnancy-2 Dr Sathisha Nayak Learning objectives • Major Complications • Management principles • Management of Eclampsia Emergency protocol Control of convulsions Control of hypertension Definitive management • Prevention Major complications • Eclampsia • Abruptio placenta •...
Hypertension in pregnancy-2 Dr Sathisha Nayak Learning objectives • Major Complications • Management principles • Management of Eclampsia Emergency protocol Control of convulsions Control of hypertension Definitive management • Prevention Major complications • Eclampsia • Abruptio placenta • Renal failure • Cerebral hemorrhage • DIC • Cardiac failure • Retinal detachment Investigations • CBC-Platelet count • Coagulation profile • Urine analysis • RFT • LFT • Fundoscopy • Ultrasound scan Management principles • Definitive treatment for Gestational hypertension/re eclampsia/eclampsia is DELIVERY • Prevention/control of convulsions by Magnesium sulphate. • Control of blood pressure by IV Labetolol • Monitoring Vital chart BP Chart Input output chart Monitoring for coagulation failure Management of Eclampsia • Shout for help/alert team • Remove from danger • Protect airway-Left lateral position, suction and airway/tongue protecter • IV Access-Blood for investigations • IV Magnesium sulphate:4g IV over 4 min and 1g/hour till 24 hours after delivery or consultations which ever is later. • IV Labetolol 25-50 mg stat and sos • Bladder catheterization • Assess and plan immediate delivery • Monitor and follow up Mgso4 Regimens • Pitchard regimen Loading dose 4G IV over 4 minites, and 10 gm 1M stat and 5 gm 4th hourly for 24 hours • Zuspan regimen  4Gm 1V 20% over 20 min following 1g m /hour IV infusion for 24 hours • Dhaka Regimen 4gm IV stat+6gm im and 2.5gm IM 4th hourly for 24 hours Check for(Every 4 hours before next dose) Respiratory rate: >16/min Urine output:>30ml/hr Deep tendon reflex: present Complications: Respiratory depression, Cardiac arrest Anti dote: Calcium Gluconate 10% IV 10ML Antihypertensive in Eclampsia • Goal is to prevent severe increase in BP leading to cerebral hemorrhage etc. • To keep Bp below 140/90 mm of Hg. • Choices: Labetolol:20-40 mg IV stat and repeat as required. Hydralazine 5-10 mg IV stat Nifedipine 5-10 mg sublingual /oral DEFINITIVE MANAGEMNT: DELIVER at the earliest!!..LSCS unless patient in advanced labour. Monitoring and follow up • Vital chart: BP,RR • BP Chart • Input output chart • Coagulation profile • RFT/LFT • Check for bleeding
