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• BP ≥ 14/90 mmHg for the first time during 35 y/o G3, 15 weeks
pregnancy after 20 weeks BP: 150/100 mmHg
24⁰ urine protein = 500 mg
Proteinuria
Urine/protein creatinin
ratio of 0.3 mg/dL
1
Lecturer: Dra.
OB II: PREGNANCY HYPERTENSION Bagayao
CLASSIFICATION OF PREECLAMPSIA
Chronic Hypertension
• Mild
ECLAMPSIA • “Non Severe”
• “Less Severe”
• Seizures that cannot be attributed to other • Severe
causes in a woman with preeclampsia o Preeclampsia + ≥1 of a series of
• 35 y/o, G5, 14 weeks brought to the ER due to complication
loss of consciousness with convulsive episodes o Without severe features
at home. BP = 180/110 mmHg o With severe features
o This is NOT eclampsia
Proteinuria
PREECLAMPSIA
THE CASE
Admitting diagnosis:
• G1P0, PU 28 weeks, CNIL
• Preeclampsia Severe
• SGA
Give the plan of management. Give 5.
SGPT 45
Observe in the labor and delivery suite 24-48 hrs Urinalysis CHON +++
•Magnesium sulfate for 24 hrs 24⁰ Urine Albumin 3,045 mg
•Antihypertensives if indicated LDH 385 U/L
•UTZ, moniroting of FHT and symptoms, labs
YES
4
Lecturer: Dra.
OB II: PREGNANCY HYPERTENSION Bagayao
5
Lecturer: Dra.
OB II: PREGNANCY HYPERTENSION Bagayao
THE CASE
On admission
• MgSO4 was given x 24 hrs
• Hydralazine 5 mg IV given for 2 doses
• Dexamethasone 6 mg IM q12⁰ x 4 doses
HD1 (28 1/7 weeks)
• Methyldopa 500 mg q6
SGA
Laboratory Results
CBC
Platelet Count
Hgb: 13.7 gm/dL
275
Constitution
ally Small IUGR
Creatinine 69.98 mmol/L
SGPT 45
Urinalysis CHON +++
24⁰ Urine Albumin 3,045 mg
LDH 385 U/L
PROBLEM #2
6
Lecturer: Dra.
OB II: PREGNANCY HYPERTENSION Bagayao
Guidelines
Management of fetal growth restriction
• The assessment of growth requires at least two
measurements at least 2 weeks apart.
ETIOLOGIES
• Genetics
• Congenital Anomalies
• Infection
• Multiple Gestation THE CASE
• Maternal Nutrition • 27 y/o Primigravid, 28 weeks AOG (LMP &
• Environmental Toxin EUTZ)
• Placental Factors • Referral from a LHC
• UTZ result: SGA fetus
• SLIUP compatible with 24 weeks and 2 days by
fetal biometry, cephalic, anterior placenta grade
II; Adequate AFI, EFW: 717 grams, SGA
7
Lecturer: Dra.
OB II: PREGNANCY HYPERTENSION Bagayao
INTERVENTION or MANAGEMENT
Steroid Therapy
• Antenatal administration of steroids before 34
weeks
Timing of Delivery
• Prenatal management is aimed primarily at
determining the IDEAL TIMING and MODE of
delivery
• Management is more complicated for
pregnancies between 25 and 32 weeks’
gestation, where each day gained in utero may
improve survival 1-2%.
8
Lecturer: Dra.
OB II: PREGNANCY HYPERTENSION Bagayao
10