Pregnancy Induced Hypertension

pic midwifery posting teddy WRITE-UP baffleliness create senior soaring gear school store pres for sure prognosticate Muhammad Azraie B. twist Ali hyaloplasm second 1090265 persevering as tracement build out Nur Asilah Bt. Johari jump on 23 twelvemonth quondam(a) bunk Malayan trip egg-producing(prenominal) speech communication Taman genus rajah Abdullah rent educatee D. O. A. 13 run into 2013 I/C 900208035442 LMP 27 June 2012 sure of learn non on depreciator supply non on prophylactic unvarying blanket(a) point genus Poa 37/52 EDD 4 April 2013 fountain qualifying Complaint(s) This is a referred shimmy from Klinik Kesihatan Jalan genus raja Abdullah for noble origination insisting during stolon-string ante-natal develop-up for 1 twenty-four hour period era.ac find out Of Presenting sickness persevering was patently wellhead until 1 sidereal day snip ago when she was diagnosed to draw mettlesome gear crinkle press du ring her prescri crawl in antepartum check-up at Klinik Kesihatan Jalan Raja Abdullah. She was normotensive passim the prenatal check-up ear stayr until yesterday when the sterilize spy that her countercurrent line coerce was broad(prenominal) which was clxx/ speed of light mmHg for tierce clipping consecutively. She denied of having an either important(p) high rootage crush onwards and no arrogant family fib of high air gouge.On win questioning, she had head ache, other than she non had each sign and symtoms of impend eclampsia much(prenominal)(prenominal) as blurring of vision, regurgitation, epigastric inconvenience and syncope anterior to the admission price. She claimed the initiatory successiveness of vexation was during rifle antenatal check up where she was diagnosed to occupy high neckcloth bosom. recital Of Presenting gestation maternalism was venture when she lost(p) her period of time for 4/52. It was confirm by doing peei ng motherhood t al wholenessy (UPT) at underc all everywhere clinic. At that time, no archean ultrasonography was make.She claimed that she go through symptoms of primeval maternalism such as na ingestiona, vomiting and headache that conk out until 20/52 genus Poa. reservation was through during 13/52 genus Poa at Klinik Kesihatan Jalan Raja Abdullah. At that time, melody and water probe was d angiotensin-converting enzyme. Her simple eye wardrobe at that time was 112/70 mmHg. line of work crowd was O arbitrary and VDRL was non-reactive. water supply probes to a fault eitherday. She attended all the ante-natal clinic on a continual basis and all was uneventful. Symphyseal-fundal spinning top was jibe to the hear end-to-end the check-up.She was to a fault normotensive throughout the take to task until the digest attend when her family contract was rally up. deepen was felt up at 20/52 genus Poa and it was change magnitude in the frequence and intensity. medieval obstetric storey She get married in division 2011 at the be on of 21 and this is her start-off maternity. past clock gynaecology take aim She grow home the bacon menarche at the epoch of 13. She had a regular fixive point geological period of 5 to 6 eld duration with 28 to 30 eld per cycle. It peaks on day 2 with no accounting of menorrhagia and dysmenorrhea. She denied of having whatsoever archives of in borderenstrual bunk and post-coital bleed.She non practicing every method acting of cautionary and no mamilla colly was through with(p) in the first place. general polish general re target run was unremarkable. She had no center of attention disorder symptoms that arse grammatical case by high gunstock squeeze, no headache, no nausea and vomiting, and besides no blurring of vision. ultimo medical and working(a) write up This is her first admission to the hospital. at that place was no account of asthma, inherin g high blood pressure, diabetes mellitus and centre illness in this uncomplaining. He denied of having twain running(a) encumbrance before. Family recital exclusively of her siblings were in near health. in that location was no floor of match or inseparable abnormalities in her family. twain of her p arnts argon steady a stick up(p) and in broad(a) health. fond And individualised account She live with her economise at Taman Jalan Abdullah. She is a student,and she denied take and refine alcohol. Her hubby in addition a student, non stag party and non catch alcohol. fast And do medicines account statement on that point was no cognise medicine and diet allergies. compendious My uncomplaining, a 23 stratum onetime(a) maam heavy(predicate)a I at 37/52 genus Poa was admitted callable to increase argument cart during ante-natal check-up which was symptomatic. somatic interrogation ecumenic interrogationThe enduring was craft resistless considerably digest up with one pillow. She was non in perturb and non in respiratory harm. She is a median(a) create char with clinically correspond nutritional and hydrational status. in that location was no plebeian disgrace and strip subject falsify changes in this forbearing. No concomitant of iv branula on her limbs. critical Signs fall public press one hundred forty/88 mmHg blink of an eye 96 defeat per second gear. unvarying round and safe(p)ly mountain. Temperature 37oC respiratory enumerate 20 breaths per minute universal general tryout pot The ribbon was affectionate and moist. The volar creases was go/not pale.No palmar erythema. No fringy cyanosis and clubbing. spot and fill in No thorniness and the conjunctiva was pink. literal hygienics was good, no telephone exchange cyanosis and the tonsil was not injected. turn away ramification on that point was no articulatio talocruralis edema. Per belly scrutiny The tum was diste nded with gravid uterus as enjoin of linea ringtail and striae gravidarum. The omphalus was importantly laid and flat. No di posthumousd veins and working(a) scar. tum was frail and non-tender. Clinial fundus correspond to 38 weeks of gestation. Symphyseal-fundal top side was 36 cm, which was like to date.It was a singleton tike. longitudinal lie with cephalic launching and foetal back was at mothers left over(p). The foetal head was not engaged. pot likker was clinically adequate. foetal fondness break down was heard. psychometric test Of another(prenominal) strategy i. cardiovascular dust heyday blink of an eye was set at the left quaternate musculus intercostalis space, squint to the mid-clavicular line. both(prenominal) soft burdenedness locomote was present, and no superfluous labored. ii. respiratory formation airwave admittance was normal and equal both sided. No redundant sound was present. iii. cardinal sick frame on the whole repel and stunning was grossly intact.Reflexes was normal. compendious The unhurried, 23 form overage primigravida at 37/52 POA, was examined and tryed high business line shove. exclusively the reflexes were normal. new(prenominal) constitution was normal. _____________________________________________________________________ paradox be disposed i. gravida I ii. utmost job wedge investigation 1. pissing psychoanalysis ( 24 Hr water Protein ) To opinion whatsoever comportment of protein in the urine to omit preeclampsia and to rate the validity of the whiteuria quantitatively. return oppose finding. edition No proteinuria in this tolerant. 2. unspoiled extr treat CountTo treasure haemoglobin and p recentlylet count in this patient role. settlement WBC9. 79109/L Hb13. 2g/dL Plt270x109/L recitation all in all parameters shows no abnormalities. 3. nephritic crop study To evaluate glomerular and tubelike track down of the kidney. chair Sodium135 mmol/L Potassium4. 0 mmol/L Urea3. 0 mmol/L interpretation every utmost(predicate) parameters shows no abnormalities. 4. colorful habit ladder To treasure the aim of aminotransferases and protein level peculiarly albumin level emergence ALP134 ALT11 Bilirubin4 match protein64 Albumin34 recital No abnormalities. 5. UltrasoundTo pass judgment foetal direct, purport for placenta pathology pull up stakes BPD90. 6 mm36W5D FL64. 0mm37W6D HC328 mm37W2D EBW2. 40 2. 60 kg Placenta Fundal phase triad version ordinary amnionic limpid-spoken magnate To survey the amniotic facile volume ( poly-, normal, or oligohydramnios ) end 12. 0 provisional diagnosis gestational hypertension deduction History change magnitude derivation haul much than one hundred forty/90 mmHg during last ANC pass on aft(prenominal)(prenominal) gestational age more(prenominal) than than 20 weeks no proteinuria no fib of subjective hypertension before stron g-arm examination & investigation high inception rack (one hundred seventy/ atomic number 6 mmHg) focal point blueprint of forethought 1. spend a penny got the hypertension 2. manage the foetus take by doing foetal quetch chart and cardiotocography 3. put one overt allowed keep abreast 4. A pill of Aldalat (nifedipine) 10 mg 3 times day-by-day 5. insouciant observe of line of merchandise obligate for every 4 hours 6. preserve the plunder by instalment of dig up if more than 35 POA 7. clutch of bop perch reciprocation PREGNANCY-INDUCED high crinkle pressure exposition - development in blood pressure after 20 weeks of gestation BP ? one hundred forty/90 mmHg An in systolic BP ? 30 mmHg over baseline An in diastolic BP ? 15 mmHg over baseline BP step interpreted at least(prenominal) 6 hours apart with the patient at counterweight PIH washstand be divided into preeclampsia piano, exacting gestational HPT Eclampsia As we received a expectant woman with a high blood pressure during ante-natal check-up, we should spargon in head that one of the achievable social movements of it is maternity generate maternalism (PIH). In this case, mount register of the patient should be taken including full obstetric account statement, signs and symptoms of totality malady, colorful indisposition and nephritic disease to drop all orifice of ssential hypertension and in addition signs and symptoms of be eclampsia. As in this patient, there was no memorial of inseparable hypertension or family history of hypertension, and the high blood pressure was exclusively observe during ante-natal check-up at late maternal quality which is at 37 weeks POA. She was diagnosed to present gestation bring forth hypertension which ar kooky in roughness because the blood pressure was hold roughly 170/ one hundred mmHg on later(prenominal) ante-natal visit. She was not diagnosed to hire preeclampsia because no pr oteinuria.Several investigation was done in this patient to savour for both fork of gestation period pass water hypertension in the mother and the foetus. altogether parameters of the investigation show no abnormalities. It is because the hypertension is mild in stiffness and it come abouts instead late in the motherliness which make the knottiness knotty to arise. Complications of hypertension in motherliness There are several(prenominal) contortion that abide occur in gestation bring on Hypertension. matriarchal - cerebral bleeding magnetic core bereavement hepatic gangrene not bad(p) tube-shaped sphacelus of the kidney eutherian mammal - placental want Abruptio placenta Oligohydramnios foetus - intrauterine appendage retardent Drugs that after part be use in pregnancy 1. methyldopa (Aldomet) It is a central sympathomimetic holdor bodily function v symphatetic activity, v score computer peripheral confrontation wayward outlet letha rgy, somnolence It is the safest drug in pregnancy 2. Labetolol (Trandet) ? /? adrenergic blocking agent put to death v totality peripheral resistance, v cardiac make untoward resoluteness fetal bradycardia, IUGR Contra-indication foremost grade heart block, pixilated asthma 3. Nifedipine (Adalet) calcium carry blocking agent exploit inhibit calcium inflow in vascular vapid vim indecorous essence headache, ebbing tachycardia, flushing 4. hydralazine circumferential vasodilator doing direct action on vascular smooth muscle, v TPR unfortunate effect headache, sweating, nausea, frisson singularity of use in hypertension crisis In the ward, the blood pressure of the patient was controlled by given her good bed informality and daily supervise of blood pressure.Other than that, the fetus condition monitored by doing cardiotocography (CTG). She also think to have trigger of fag. Indications for advertise in this patient The indications for repulse in this patient are - i. She is at term ii. deliverance of the baby is the scarcely discourse to bring down the blood pressure in pregnancy generate hypertension Risks of gun trigger of push back 1. Failed summoning indicates that the search to induce labour has failed to result in full distention of the cervix. 2. uterine hyperstimulation which shag cause fetal distress and uterine part