Professional Documents
Culture Documents
PIH (Pregnany Induced HTN) - Case History
PIH (Pregnany Induced HTN) - Case History
INDUCED
HYPERTENSION
(PIH)
Case History and Topic Presentation
Case History
Profile of patient
Name: Mamona
Occupation: Housewife
Age: 25yr old
Wife of: Mr. Mohd Ashraf
Married for: 3yrs
Resident of: shadbagh Lahore
Gravida: 2
Para: 1
LMD: 10th June 2015
EDD: 17th March 2016
DOP: 33 weeks and 1day
MOA: Opd
DOA: 29th Jan 2016
Presenting complaints
My patient was having regular menstrual cycle of 6 / 28 until when she missed her last period on
10th July 2015 since then she has developed gestational amenorrhea for 33 weeks + 1 day and she
confirmed her pregnancy by urine dipstick test at home on 15th July 2015 and later went to doctor
who confirmed this pregnancy again by USG on 27th July 2015
1st Trimester
No history of headache
No visit to doctor on 7th week for dating USG
No history of spotting, PV discharge
History of intake of Folic acid
2ND Trimester
1.
2.
3.
4.
3rd Trimester
1.
2.
3.
.
.
CBC (WBCs 6820, Polymorph 72%, Lymphocyte 21%, Monocytes 5%, Eosinophils 2%,
platelets 25300, Hb 10.8mg/dl)
Blood grouping (A+)
APTT (35 sec)
PT
(15 sec)
HbSAg ve
HCV -ve
Urine analysis (Proteins 0.08 g/dl)
RFT (Serum creatinine, Serum BUN, GFR____________Normal)
LFT (SGOT, SGOPT__________Normal)
Fasting glucose
Drugs given for management of HTN (Aldomet 1+1+1)
Transfusion of 1pint blood on 29 th of january
Obstetrics History
No.
AGE
SEX
Pre-natal History
MOD
TERM
Weight
Post-op
Post-natal
1yr
6mon
Jaundice at 6th
month of pregnancy,
HTN at 6th month of
pregnancy
NVG
PRETERM
2.8 kg
N/S
Fetal low
vision
Gynecological History
1.
8.
Family History
Socioeconomic History
2.
3.
4.
5.
6.
7.
Systemic Review
Examination of Patient
My patient, a lady of young age, with average height and weight, was sitting comfortably in bed,
oriented in time place and person.
Pulse: 86/min
BP: 160/100mmHg
Respiratory Rate: 17/min
Temperature: 98.2*F
No signs of
Pallor
Koilonychia
Excessive sweating
Peripheral/central cyanosis
Jaundice
Palpable lymph nodes
Thyroid swelling
Increased JVP
Periorbital, Sacral, pretibial or ankle edema
Systemic examination
CNS: Grossly intact
CVS: HTN (160/100mmHg), Normal S1 S2 with no added sounds
Respiratory: Normal vesicular breathing with no added sounds
Abdominal Examination
Inspection:
Abdomen was protuberant in shape, having regular symmetry, with stria gravidum
present.
Umbilicus was central in position, moving equally with respiration
No visible scar marks or visible veins present
Palpation:
Fundal height of 31 weeks with longitudinal lie and cephalic presentation. No engagement
(5/5)
Auscultation:
Fetal Heart Rate: 130-140/min
Case Summary
TOPIC PRESENTATION
DEFINITION:
INCIDENCE:
DIFFERENTIAL DIAGNOSIS:
CHRONIC HYPERTENSION:
B.P > 140/90 mmHg/
evident before 20th week.
without proteinuria
P.I.H:
B.P> 140/90 mmHg
occurs after 20th week
without proteinuria
PREECLAMPSIA:
B.P> 140/90 mmHg
occurs after 20th week
with proteinuria & edema.
RISK
FACTORS:
Maternal causes
Obesity
Age 35 years or more.
Past history of D.M, Hypertension and Renal diseases.
Adolescent pregnancy.
New paternity.
Anti-phospholipid syndrome
Having donated a kidney.
Pregnancy
Family history
PATHOPHYSIOLOGY:
COMPLICATIONS OF PIH
Maternal effects:
HELLP syndrome
Abruptio placentae
Pulmonary edema
Acute renal failure
Cerebral hemorrhage
Visual disturbances
Electrolyte imbalance
Hepatic rupture
Postpartum collapse
Put mother at risk for possible heart disease or high blood pressure
when she becomes older
Fetal Complications
Reduce blood flow to the placenta,
so fetus receives less oxygen and
fewer nutrients.
Causes baby to be born too small
or too soon (preterm)
MANAGEMENT
Objectives of Management:
Cure/prevent progression
Reduce blood pressure to normal
Promote fetal maturity
Prolong pregnancy (36-38 weeks)
Delivery: best day, best way, best place
Prevent/manage complications
MATERNAL MONITORING:
FOETAL MONITORING:
CLINICAL MONITORING:
Fundal height, FHR, Foetal movement count,
liquor, CTG
ULTRASOUND:
at the date of admission and then 3 weekly
for foetal biophysical parameters, placenta and liquor volume.
L/S RATIO for foetal lung maturity
TREATMENT
GENERAL MEASURES:
Hospitalization
Nutritional supplements: iron, vit E, Protein, calcium etc.
Stop smoking and alchohol
Reduce salt intake
DRUGS:
DELIVERY:
BEST DAY:
BEST WAY:
BEST PLACE:
POSTPARTUM:
You
Thank