Pregnancy Induced Hypertension Essay Example

aligned with the expected values.

During her regular medical examinations, she consistently exhibited normal blood pressure levels. Unexpectedly, a surge was observed in her most recent visit. The movements of the fetus commenced at 20/52 weeks into the pregnancy and have been progressively amplifying in both frequency and power. Considering her past obstetric track record, she tied the knot in 2011 when she was just 21 years old and is currently experiencing her maiden pregnancy. Discussing her earlier gynaecological history, she began menstruating at the age of 13 with cycles regularly lasting between five to six days every four to five weeks interval. Her heaviest menstrual flow occurs on day two but without any symptoms of menorrhagia or dysmenorrhea. She has not encountered inter-menstrual bleeding or bleeding after intercourse.

The patient has not previously used any form of birth control and lacks past pap smear results. A comprehensive check-up did not uncover any considerable health issues, with no signs such as headache, nausea, vomiting or vision disturbances that might be associated with hypertensive heart disease present. This is the initial hospital admission for the patient. Their medical history does not document instances of conditions like asthma, primary hypertension, diabetes mellitus or cardiac diseases. Moreover, they have never undergone any surgical operations before. It's reported that all their siblings are in good health condition.

In her family, there's no record of twins or inborn disorders. Both her parents are alive and enjoy good health. As for her personal and social background, she lives with her student husband in Taman Jalan Abdullah. She herself is a student too and affirms not to smoke or

drink alcohol. Like his wife, the husband also refrains from smoking and drinking alcohol. When it comes to allergies related to food or drugs, none are known presently in relation to her diet and drug history. To conclude, my patient being a 23-year-old primigravida at 37/52 POA was brought into admission due to high blood pressure observed during an ante-natal check-up that had symptoms.

PHYSICAL EXAMINATION

The woman being examined was comfortably reclined on her back, with a single pillow providing support. She revealed no signs of discomfort or breathing problems. The patient's body mass was average, and she displayed good hydration and nutritional status clinically. There were no apparent abnormalities or unusual skin pigmentation in her physical appearance. Additionally, there was no intravenous line attached to any part of her body.
Vital Signs:
Blood Pressure: 140/88 mmHg
Heart Rate: Regular rhythm and robust volume at 96 beats per minute.
Body Temperature: Measures 37 degrees Celsius
Respiration Rate: Recorded as 20 breaths each minute
In-depth Physical Examination:
Hand:
Her hand was warm and slightly damp upon contact while the creases on her palm appeared more pink than pale.

No palmar erythema or peripheral cyanosis and clubbing were present. The conjunctiva was pink and there was no jaundice. Oral hygiene was good and there was no central cyanosis or injected tonsils. There was no ankle edema in the lower limbs. The abdomen was distended due to the gravid uterus, evidenced by the presence of linea nigra and striae gravidarum. The umbilicus was centrally located and flat, with no dilated veins or surgical scars. The abdomen was soft and non-tender. Clinical fundus corresponded to 38 weeks of gestation and the symphyseal-fundal

height measured 36 cm, which was consistent with the date.

The baby was a singleton with a longitudinal lie and cephalic presentation. The fetal back was positioned on the mother's left side and the fetal head was not engaged. The amount of amniotic fluid was clinically adequate and the fetal heart sound was detected. The examination of other systems found the following:
i. Cardiovascular System - The apex beat was located at the left 4th intercostal space, lateral to the mid-clavicular line. Both heart sounds were present with no additional sounds.
ii. Respiratory System - Air entry was normal and equal on both sides with no additional sounds.
iii. Central Nervous System - All motor and sensory functions were grossly intact.

DISCUSSION PREGNANCY-INDUCED HYPERTENSION

Pregnancy Induced Hypertension (PIH) is defined as a rise in blood pressure after the 20th week of pregnancy. The condition becomes noticeable when systolic blood pressure reaches or surpasses 140/90 mmHg, with an increase of at least 30 mmHg from the original systolic BP and a similar elevation of no less than 15 mmHg in diastolic BP from its initial level. To ensure accurate readings, there needs to be at least a six-hour gap between each BP measurement while the patient is resting. PIH can further be broken down into sub-categories such as mild or severe pre-eclampsia, gestational hypertension, and eclampsia.

When high blood pressure is identified in pregnant women during prenatal examinations, it's crucial to consider PIH as a potential cause. A thorough medical evaluation including obstetric history and indications of heart disease, liver dysfunction, and renal diseases should be carried out to exclude

essential hypertension and upcoming eclampsia. In this particular case study, the patient had no previous record or familial history of essential hypertension. Her elevated blood pressure was discovered during her third trimester check-up at week 37. She was diagnosed with mild Pregnancy Induced Hypertension because her recorded BP continually fluctuated around 170/100 mmHg during subsequent prenatal appointments. Due to the absence of proteinuria, pre-eclampsia could not be confirmed.

The patient was meticulously examined for any possible issues stemming from pregnancy-induced hypertension, which could affect both the pregnant woman and her unborn baby. However, no irregularities were detected in all performed tests. This might be attributed to the fact that the elevated blood pressure was relatively mild and only presented itself late in the pregnancy, thereby reducing potential complications. Hypertension triggered by pregnancy can lead to an array of complications.

Maternal:

• Cerebral hemorrhage
• Heart failure

Hepatic necrosis and acute tubular necrosis of the kidney occur in the placenta.

• Placental insufficiency
• Abruptio placenta

The fetus is experiencing oligohydramnios.

• Intrauterine growth retardation Drugs that can be used in pregnancy

Methyldopa, also known as Aldomet, is a medication used for various medical conditions.

• It is a central adrenergic inhibitor
• Action: v sympathetic activity, v total peripheral resistance
• Adverse effect: lethargy, drowsiness
• It is the safest drug in pregnancy

2. The medication Labetalol is also known as Trandate.

Nifedipine, also known as Adalet, is a calcium channel blocker.

• Action: inhibit calcium influx in vascular smooth muscle
• Adverse effect: headache, reflex tachycardia, flushing

Hydralazine

is number 4.

• Peripheral vasodilator
• Action: direct action on vascular smooth muscle, v TPR
• Adverse effect : headache, sweating, nausea, palpitation
• Indication of use : in hypertension crisis In the ward, the blood pressure of the patient was controlled by given her good bed rest and daily monitoring of blood pressure.

In addition to various methods, the health of the fetus is monitored using cardiotocography (CTG). The potential for labor induction is also being explored. Reasons for this induction are full-term pregnancy and a necessity to reduce high blood pressure that can be caused by pregnancy. However, it's important to recognize that there can be risks linked with inducing labor.

1. Failed induction - indicates that the attempt to induce labour has failed to result in full dilatation of the cervix.
2. Uterine hyperstimulation - which can cause fetal distress and uterine rupture