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= Hypertensive disorder during pregnancy:
2_Sever Pre-eclampsia:
= Symptoms:
_ high BP >160/110
_ proteinuria >1gm
_ if the pt become symptomatic:
*Visual disturbance "diplopia, blurring of vision , Flashes of light"
* Frontal headache
* Epigastric pain ± nausea & vomiting
= Full investigations
= Management :
_ Admission
_ 2IV lines
_Urinary catheter "to monitor UOP"
_close monitoring of PR , RR , Temp , UOP , CTG
_ IV hydralazine or labetalol
_Mg sulphate loading & maintenance
_ Termination by C/S after 4 to 6 hrs after control of pt condition
#Obs__shift
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= Hypertensive disorder during pregnancy:
1_ Pre-eclampsia:
= Symptoms
_ high BP 140/90
_ proteinuria >300mg in 24 hrs urine collection
in previously normotensive pt
= Plan of management:
_ For observation and followup weekly " to check BP +investigations "
_ نعمل كاونسلينغ كويس للبيشنت في اي لحظة تمشي أقرب حوادث اذا حست بأعراض ex
"Headache, blurring of vision , epigastric pain or vomiting "
_ Terminate pregnancy at 38w by induction of labour or C/S
_Give dexamethasone inj 48hr before induction
_ Ergometrine is contraindicated
#Obs__shift
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=UTI with pregnancy:
= Symptoms:
- Dysuria
- Increased frequency
- subrapubic pain
±Loin pain / Fever
* من الcommon cases البتلاقينا في الطوارئ
* ما دايما بتجي typical presentation ممكن مايكون في أعراض ونكتشفها accidentally by investigations او تكون vague presentation
العيانة تكون بتشكي فقط من low back pain or general malaise/ flue like symptoms
* مهم نأكد على العيانة تكمل علاجها لانها
"risk for Pre_term labour &neonatal sepsis "
=Investigations:
_ Routine investigations ( UG= pus cells > 6 )
= Management:
*حسب حالة العيانة اذا كانت stable
Treat at out patients
*اما اذا كانت Very toxic and illتحتاج admission
Usually pt become a symptomatic after 48 hrs, discharge on oral antibiotics
#Obs__shift
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=Bronchial asthma :
= Symptoms:
_SOB
_Cough
±wheeze
=O/E:
_signs of respiratory distress
_wheezing
=Management:
*Acute and chronic asthma should be treated as non-pregnant state
*Medications of asthma are safe during lactation
#Obs__shift
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= Malaria with pregnancy:
= Symptoms:
- Fever - Headache
- Vomiting - Generalised fatigability
= Investigation:
Routine investigations + BFFM
= Management:
*حسب حالة العيانة نحدد اذا هي simple Malaria treat at out patient واذا هي sever Malaria تحتاج admission
*Coartem & DHAP are contraindicated at first trimester "teratogenic "
*Drug of choice for simple Malaria at first trimester is Quinine , Coartem & DHAP can be used at second and third trimester
= Features of sever Malaria:
- cerebral Malaria " convulsions or loss of consciousness"
-Jaundice
-Anemia
- Hypoglycemia
- Excessive vomiting
- AKI
- Hyperparasitemia
- Fever >40
* في حالة Sever Malaria نعمل correction حسب الحالة لل Hypoglycemia ,
if sever Anemia for transfusion ,
Antiematic + Antipyretic...
*في حالة p.vivax ما بندي العيانة primaquine لانو contraindicated during pregnancy & lactation
#Obs__shift
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_ Hyperemsis Gravidarum:
= Symptoms:
- Pregnant lady complaining of sever nausea & vomiting "vomit every thing "
O/E:
- sings of dehydration( Dry mouth and skin ,Sunken eyes , decrease urine output)
_ check the pulse and BP
= Management:
_ IV lines
_ Request routine investigations + specific " to detect complications "
* RFT "hypokalemia, hyponitremia , AKI"
*CBC " nutritional anemia"
* بعد العيانة تبقى stable ما ننسى ال U/S
* Discharge when she became stable, encouraging oral intake ± Vominore tabs 25 mg
= D/D of nausea &vomiting in early pregnancy:
_ Hyperemsis Gravidarum
_Malaria
_ UTI
_ DKA
_ Gastritis
_ Ectopic pregnancy
#Obs__shift
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#Plans of Manegment:
= Diagnosis of pregnancy + ANC :
= Symptoms:
- Amenorrhoea :
*ما دايما بتكون الشكوى الأولى لحدي ما العيانة يجيها GI disturbanceاو تبدأ تحس بال increase in uterine size " between 7_8 week" خاصة لو هي primigravida
-Morning sickness :
* من الأعراض البتبدأ بدري من الأسبوع الرابع وممكن تستمر لحدي 12week of gestation
*سميت كده لانو ال nausea&vomiting بتكون اكتر الصباح لكن ممكن تحصل في اي وقت خلال اليوم
- Increase frequency of micturition:
* خلال الحمل بيحصل increase in renal blood flow وزيادة في ال GFR
- Breast changes "enlargement &pain":
*برضو من الأعراض اللي بتظهر بدري ممكن من الأسبوع السادس
*others:
- Insomnia
- Mood changes
- Headache
- Back pain
-Heartburn, tachypnea ,constipation "due to progesterone "
=ANC: antenatal care
_بعد تأكيد الحمل تجي العيانة كل شهر للمتابعة:
*نشوف اذا في new complain
* نقيس ال Blood pressure &Fundal level
*نطلب ليها ال Routine investigations وتتسجل كل الحاجات دي في كرت المتابعة
* نرسل العيانة للتحصين لمتابعة جرعات التطعيم
#Obs__shift
