HYPERTENSIVE

DISORDER
IN PREGNANCY
PUAN N

• 32 / Malay / Para 3
• Occupation : Clerk
• Education level : Degree
ANTENATAL HISTORY

• LMP: 03/06/2024 • Antenatally :

• EDD : 10/03/2024 • Hx of GBS CARRIER
• LATE ONSET PIH
• NO PMHX
• Diagnosed at 38 weeks POA
• NO PSHX
• Mentrual hx: 12 (5-7 days, every 27-30
days), not on contraception
 Tarikh Pemeriksaan Catatan TCA

29/08/2024 BP: 125/82 mmHg Patient came to KK GERSIK for booking

12w 2 d 10/09/2024
MO KK Pulse: 88 /min SOD, regular period @8.00am
(MGTT)
No active complain
Wt: 64.7 kg o/e: alert, pink 12/09/2024
HB: 12 @8.30am
TAS: singleton, FH+ shown to mother, (RV MGTT)
CRL: 53.08 mm (12w)
REDD: 12/03/24 12/09/2024
@8.00am
1st TAS done in GP (SCAN)
REDD: 10/3/2024. ? Simple cyst

Plan:
1. Follow EDD 10/3/2024
2. MGTT next week on 10/9/24 , review on 12/9/24
3. TAS at 28 w: 19/12/24
4. Obimin I/I OD
5. TCA STAT if PV bleed / abdominal pain.
6. Repeat TAS in 2/52 to confirm ? simple cyst
 Tarikh Pemeriksaan Catatan TCA

12/09/2023 BP : 121/87 mmHg Referred to rv MGTT 17/12/23 :

14 w 3 d R : 84 bpm MGTT
MO KK Otherwise, 19/12/23:
Review MGTT
Pt has no active complaint
No PV bleeding or abdominal pain
No fever
No UTI/URTI sx

O/E: Alert, GCS full

MGTT : 4.4/5.8

Plan:
1. Repeat MGTT at 28 weeks of POA
2. TAS at 28 weeks POA as planned
3. Cont Obimin I/I OD
4. TCA STAT iv PV bleed or abdominal pain
 Tarikh Pemeriksaan Catatan TCA

19/12/2023 BP : 120/78 mmhg Referred to review MGTT’S result 13/12/2023

28 w 3 d PR: 96 bpm TAS 36 w
MO KK HB : 12 Pt:
WT: 66.7 Pt has no active complaint
Good FM
TAS :
Singleton, cephalic MGTT : 4.3/6.5
FH/FM+
Parameters 26-27 w Plan:
EFQ: 1031 gram 1. Next TAS at 36 weeks POA
Placenta : Posterior 2. Cont Obimin I/I OD
not low lying 3. TCA STAT if PV bleeding or abdominal pain
 Tarikh Pemeriksaan Catatan TCA
27/12/2023 BP : 127/83 Referred for increasing weight : 09/01/2024:
29 w 4 d PR: 82 ↑ 1.6 kg over 2/52. To review EOD BP
MO KK
Booking weight : 64.8kg, Booking BP:127/88
Current weight : 69.4kg, Current BP : 127/83
Total weight gain : +4.6 kg
MGTT x 2 : normal

Pt:
No active complaint,
No nausea/ vomiting,
No IE sx
FM is good

Plan:
1. Biweekly BP monitoring x 2/52
2. KIV refer PSP if persistent weight gain
3. Cont t Obimin I/I OD
4. Next TAS at 36 weeks POA as planned
5. TCA STAT if PB bleeding or abdominal pain
 Tarikh Pemeriksaan Catatan TCA
10/01/2024 BP: 116/73 mmhg Referred for reducing weight 400 gram x 2/52 and to 13/2/24: TAS 36 w
31 w 3 d PR: 77 bpm review EOD BP
MO KK
booking weight : 64.8kg, booking BMI 26.9
current weight : 69kg, total weight gain +4.2kg
MGTT x 2 : normal

reviewed biweekly BP monitoring x2/52

bp range: 116-126/72-78
urine albumin nil

Pt :
Has no active complaint
No IE sx

Plan:
1. Off biweekly BP
2. Cont Tab Obimin I/I OD
3. TAS at 36 weeks POA: 13/2/24
4. TCA STAT if PV bleeding or abdominal pain
 Tarikh Pemeriksaan Catatan TCA
13/2/24 BP: 128/81 REFERRED FOR 2nd RME 10/3/2024:
36 w 2 d PR: 85 bpm Pt: TCA TAS @ EDD
MO KK Has no active complaint
TAS: FM is good
Singleton No IE sx
Cephalic
FH/FM+ Plan:
EFW: 2964gram 1. T Obimin I/I OD
AFI: 11.2 2. Next TAS at 40 w POA for AFI
Parameter: 35-37w 3. TCA STAT if PV bleeding or abdominal pian
Placenta:PUS
 Tarikh Pemeriksaan Catatan TCA
27/2/24 BP : REFERRED TO RV BP and weight ↓ 0.8kg x 1/52 10/3/2024:
38W 2 D 160/87 X 1 TCA TAS @ EDD
MO KK 152/83 X 2 booking weight : 64.8kg, booking BMI 26.9
128/ 73 x 3 current weight : 70.7,
total weight gain +5.9kg over 38 weeks pregnancy
MGTT x 2 : normal

noted initial BP today 160/87mmhg

repeated BP 128/73mmHg
urine albumin nil

Otherwise,
No active complaint
No headache / dizziness
No ie sx
Good FM
no PV bleed / leaking liquor

Plan:
1. EOD BP monitoring x 2/52
2. TAS at 40w on 10/3/24
3. TCA STAT if s/sx of labour or reduced FM
 Tarikh Catatan

28- 28-29/2/2024
29/2/2024 Dx:
Admitted 1. Day 1 post SVD with 1st degree tear
labour with U/L PIH
room
- Uncomplicated
- EBL : 200 ml
- BP in ward remain normotensive
- Discharged HPSF without anti HPT
medications

Plan:
1. For EOD BP monitoring in KK

2. TCA KK in 2/52 to review BP

POST NATAL – HOME VISIT

• Discharge on 29/2/24 at 6 PM
• Home visit done on day 3, 4,5, 9 and 15
• PN Day 3-9: BP 125-139/79-89 mmhg
• PN Day 15 (13/3/24) :
• BP: 169/98 mmhg, repeated BP : 130/91 mmhg
• Urine Albumin: NIL
• No IE sx
• Referred to MO KK, BP: 130/90
• Plan:
• Daily BP monitoring
• 2. inform if BP > 140/90 mmhg
POST NATAL DAY 16 (14/3/2024, THURSDAY)

• Referred to MO KK to review BP
• PT:
• No IE sx
• Unable to sleep well last night, taking care of baby
• BP: 150/90 x1, 165/110 x 2 , urine albumin : NIL
• PLAN:
• Start T methyldopa 250 mg tds
• Daily BP x 1/52, to rv on 21/3/24
• Inform if BP > 140/90 mmhg
POST NATAL DAY-18 (HOME VISIT)

• 16/3/24 (SATURDAY)
• Noted BP :
• 150/100 x 1, 182/112 x2 ,pt no IE sx, urine albumin NIL
• DW MO: Given Tab nifedipine 10 mg STAT
• Repeated BP 1 hour :118/73 mmhg
• Plan:
• 1. TCA KK CM
• 2. Inform if BP > 140/90
POST NATAL DAY-19 (17/3/2024, SUNDAY)

• Come to review BP
• Pt :
• No IE sx,
• BP: 150/100 x 1, 148/110 x2,
• Urine albumin : NIL

• DW FMS
• TAB LABETOLOL 200 MG STAT
• REPEATED BP : 153/101 MMHG

• DW O+G SPECIALIST
• TAB NIFEDIPINE 10 MG STAT
• REPEATED BP 1 HOUR : 140/90 MMHG
• REFER TO ED HPSF ACCOMPANIED BY MO
 DISCHARGE
NOTE
• Pt was discharged on 19/3/24
• Dx: Resolved Hypertension Crisis
• Plan:
• 1. Off T Nifedipine
• 2. Cont T labetolol 300 mg
tds
• 3. EOD BP monitoring at kk
• 4. TCA KK 2/52 to see mo
to rv bp
• 5. TCA STAT if
Hypertensive Crisis/IE sx
DISCUSSION
DISCUSSIO
N
HYPERTENSIVE DISORDER
IN PREGNANCY
ANTIHYPERTENSIVE TREATMENT POST PARTUM
THANK YOU