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![PREGNANCY-INDUCED HYPERTENSION
PREECLAMPSIA
PREGNANCY-INDUCED HYPERTENSION [PIH]
Hypertension (BP ≥ 140/90 mm Hg) during pregnancy
can be classified as chronic or gestational.
Chronic hypertension is BP that is high before pregnancy
or before 20 wk gestation. Chronic hypertension
complicates about 1 to 5% of all pregnancies.
Gestational hypertension develops after 20 wk gestation
(typically after 37 wk) and remits by 6 wk postpartum;
it occurs in about 5 to 10% of pregnancies, more
commonly in multifetal pregnancy.](https://image.slidesharecdn.com/antenatalandpostnatalcomplicationstheirremedies-251010104638-fc424c20/75/Antenatal-and-Post-natal-complications-their-remedies-pptx-17-2048.jpg)
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Antenatal and Post natal complications & their remedies.pptx
- 1. ANTENATAL AND POSTNATAL COMPLICATIONSAND THEIR REMEDIES Prof. K. Bharathi Head Department of Prasutitantra & Striroga National Institute of Ayurveda, Jaipur.
- 2. Antenatal complications • Pregnancyis a dynamic state and mother adapts anatomic, physiological and endocrinological changes to accommodate and support the foetus throughout gestation, for delivery and lactation.
- 3. • Because ofthese adaptations pregnant women suffer with minor to major problems. Minor problems: • DIGESTIVE SYSTEM - Nausea and vomiting, Constipation, Acidity and heartburn, Excessive salivation (Ptyalism), Abdominal discomfort, Pica
- 4. NAUSEA AND VOMITING: •Especially in the morning, soon after getting out of bed • Usually common in primigravidae • 50% women have both nausea and vomiting, 25% have nausea only and 25% are unaffected • Most commonly occurs during the first 10 weeks • Related to higher levels of hcg
- 6. MANAGEMENT • Dietary changes •Behavior modification • Hospitalization may be necessary to correct fluid and electrolyte imbalance • Explanation, reassurance, and symptomatic relief are sufficient. Avoid: Disagreeable odors and rich, spicy, or greasy foods Drink water or other fluids between meals to avoid dehydration and acidosis Medication: well-known over-the-counter drugs should be administered only when absolutely indicated and prescribed.
- 7. CONSTIPATION: Quite common ailment Atonicityof the gut due to the effect of progesterone, diminished physical activity and pressure of the gravid uterus on the pelvic colon, sluggish bowel function are the possible explanations. MANAGEMENT: Regular bowel habit may be restored Emphasize ample fluids and laxative foods and prescribe a stool softener Purgatives should be avoided because of the possibility of inducing labor. Exercise and good bowel habits are helpful.
- 8. ACIDITY AND HEARTBURN Dueto relaxation of the esophageal sphincter & hiatus hernia Heartburn (pyrosis, acid indigestion) results from gastroesophageal reflux disease (GERD) in almost 10% of all gravidas. In late pregnancy, this may be aggravated by displacement of the stomach and duodenum by the uterine fundus. Most likely to occur when the patient is lying down or bending over
- 10. MANAGEMENT • To avoidover eating and not to go to bed immediately after the meal. • Liquid antacids may be helpful • Sleeping in semi-reclining position with high pillows • This hernia is reduced spontaneously after delivery • Symptomatic treatment is recommended • Hot tea and change of posture are helpful. • Calcium-containing antacids & the histamine H2- receptor antagonists are pregnancy category B (e.g., Tums) to reduce gastric irritation
- 11. MUSCULO-SKELETOL SYSTEM 1. Fatigue2. Backache 3. Leg cramps 4. Round ligament pain FATIGUE • The pregnant patient is more subject to fatigue during the last trimester of pregnancy because of altered posture and extra weight carried. • Management: Anemia and other systemic diseases must be ruled out. • Frequent rest periods are recommended.
- 12. BACKACHE • Common problem(50%) in pregnancy • Physiological changes that contribute to backache are: joint ligament laxity (relaxin, estrogen), weight gain, hyperlordosis and anterior tilt of the pelvis. • May be due to faulty posture and high heel shoes, muscular spasm, urinary infection or constipation. • Fatigue, muscle spasm, or postural back strain most often is responsible • MANAGEMENT: • Excessive weight gain should be avoided. • Rest with elevation of the legs to flex the hips may be helpful. • Improvement of posture, well-fitted pelvic girdle belt which corrects the lumbar lordosis during walking and rest in hard bed
- 13. BACKACHE • Improvement inposture is often achieved by the wearing of low-heeled shoes. • To achieve proper posture, the abdomen should be flattened, the pelvis tilted forward, and the buttocks tucked under to straighten the back. • Massaging the back muscles, analgesics and rest • Back exercises under the supervision of a rehabilitation physician, an orthopedist, or a physical therapist. • Recommend sleep on a firm mattress. • Apply local heat and light massage to relax tense, taut back muscles. • Give acetaminophen 0.3–0.6 g orally or equivalent. • Obtain orthopedic consultation if disability results. • Note neurological signs and symptoms indicative of prolapsed intervertebral disk syndrome, radiculitis.
- 14. LEG CRAMPS • Quitecommon, usually in the leg. • Worse at night. • The cause of leg cramps in pregnancy is not known but it may be due to deficiency vitamin b1 and of diffusible serum calcium or elevation of serum phosphorus. • It may due to ischemia and changes in ph or electrolyte status. • MANAGEMENT: • Supplementary calcium therapy in tablet or syrup after the principal meals may be effective. • Massaging the leg, application of local heat and intake of vitamin B1 (30 mg) daily may be effective. • Sleep with the foot end elevation by 20 to 25 cm. once the cramps is occur gentle kneading is effective.
- 15. Early pregnancy complications •Abortion • ECTOPIC PREGNANCY: Pregnancy outside uterine cavity, In fallopian tube (fimbrial, ampullary, isthmic, interstitial) , in the ovary, In the abdominal cavity, In the cervical site
- 16. Medical problems GESTATIONAL DIABETES: •Gestational diabetes is a type of diabetes that occurs only during pregnancy. • Like other forms of diabetes, gestational diabetes affects the way the body uses blood sugar (glucose). • As a result, the blood sugar level is too high. • If untreated or uncontrolled, gestational diabetes can result in a variety of health problems to fetus and mother. • The controlling the blood sugar can helps ensure a healthy pregnancy and a healthy start for the baby. • It usually occurs about the 20th to 24th week of pregnancy and can be measured by the 24th to 28th week of pregnancy. • After the baby is born and placental hormones disappear from the bloodstream, blood sugar levels should quickly return to normal.
- 17. PREGNANCY-INDUCED HYPERTENSION PREECLAMPSIA PREGNANCY-INDUCED HYPERTENSION[PIH] Hypertension (BP ≥ 140/90 mm Hg) during pregnancy can be classified as chronic or gestational. Chronic hypertension is BP that is high before pregnancy or before 20 wk gestation. Chronic hypertension complicates about 1 to 5% of all pregnancies. Gestational hypertension develops after 20 wk gestation (typically after 37 wk) and remits by 6 wk postpartum; it occurs in about 5 to 10% of pregnancies, more commonly in multifetal pregnancy.
- 18. • Preeclampsia isa common problem during pregnancy, affecting up to one in seven pregnant women around the world. • This condition is defined by high blood pressure and excess protein in the urine after 20 weeks of pregnancy. • It may also be called toxemia or pregnancy-induced hypertension. • It can lead to serious, even deadly complications for the pregnant woman and the unborn baby.
- 19. • Globally, preeclampsiaand other high blood pressure disorders during pregnancy are a leading cause of maternal and infant illness and death. • The only cure for preeclampsia is delivery of the baby. After the baby is born, blood pressure usually returns to normal within a few days. • So delivery is the obvious solution when preeclampsia is found near the end of pregnancy, which is typically the case. • However, if diagnosed earlier, treatment is trickier.
- 20. Eclampsia • Eclampsia ispre eclampsia with convulsion and or coma Or Development of Convulsions and/or unexplained coma during pregnancy or postpartum inpatients with signs and symptoms of preeclampsia • Incidence :o 1:500 to 1: 30 & Common in Primigravida (75%) than multigravida (25%)o In 80% cases it is proceeded by severe preeclampsiao • Commonly occurs between 36th week to term • Types a) Antepartum -50%b) Intrapartum-30%c) Postpartum-20% (Early & Late)d) Intercurrent-Rare 3
- 21. Eclampsia CAUSES OF CONVULSION •Cerebral anoxia : spasm of cerebral vessel due to hypertension-increase cerebrovascular resistance-decrease oxygen consumption-convulsion • Cerebral edema –irritation • Cerebral dysarhythmia: increases following edema & anoxia MANAGEMENT • General 1). Maintenance of airway 2) Oxygen administration 3) Fluid Management 4) Organization of investigation • Control of Convulsions • Control of BP • Obstetric Management • Complication Management • Postpartum Care
- 22. Garbhini Vishishta Vyadhi •Hrillasa – Bhunimba with honey • Garbhaja Vamana – Rice water mixed with sugar, honey, flour of parched paddy; Bilva majja, lajambu • Kikkisa – Madhuragana sadhita navanita (internal); candana & mrinala (external) • Garbhini jvara • Garbhini udavarta • Garbhini atisara • Garbhini parikartika
- 23. Puerperium • It isthe period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the prepregnant state both anatomically and physiologically. • Involution is the process whereby the genital organs revert back approximately to the state as they were before pregnancy.
- 24. General principles oftreatment • Use of soft, sweet, cold, pleasing and gentle drugs, dietetics and behaviour. • Emetics, purgatives, sternutatory drugs, bloodletting should not be done • Asthana and Anuvasana vasti should not be used frequently • After eighth month gentle emesis can be done • Use of pungent drugs, exercise and coitus should be avoided.
- 25. PUERPERAL PROBLEMS –Sutika Vyadhi
- 26. Sutika vyadhi accordingto Ayurveda • Sutika jvara • Yoni bheda • Yoni sopha • Yoni vedana • Yonishula • Katishula • Yonibhramsha • Makkalla • Mutrasanga • Stanaroga • Malarodha etc.
- 27. Puerperal Problems • Puerperalpyrexia • Puerperal sepsis • Subinvolution • Urinary complications • Breast complications • Puerperal venous thrombosis & pulmonary embolism • Puerperal emergencies • Psychiatric disorders
- 28. General principles oftreatment • Nidana parivarjana • Congenial diet and oleaginous substances • Massage, anointment, irrigation and ghee, oil or decoction prepared with bhautika, jivaniya drugs, brimhaniya, madhura, vatahara drugs along with specific drugs • Rice gruel treated with appetizing drugs
- 29. Puerperal Pyrexia • Arise in TPR above 100.4°f or more on two separate occassions at 24 hours apart (excluding first 24 hrs) within first 10 days following delivery. • Puerperal Sepsis or infection An infection of the genital tract which occurs as a complication of delivery.
- 30. Predisposing causes • Homebirths in unhygienic conditions • Low socioeconomic status • Anemia • Malnutrion • Multiple vaginal examinations in labour • Prolonged labour & prolonged rupture of membrane • Trauma to the genital tract (vaginal,perineal & cervical lacerations) • Caesarian Section
- 31. Clinical Features • Genitaltract infection • Rise in temparature • Septicemia • General peritonitis • Salpingo-oophoritis and cellulitis • Pelvic abscess • pyemia
- 32. Grades of puerperalinfection • Grade I : infection involving the lower genital tract & the uterus • Grade II : grade I plus infection involving the adnexa • Grade III : grade II plus entire pelvic involvement • Grade IV : septicemia
- 33. complications • Maternal &fetal • Maternal : septicemia,endotoxic shock, peritonitis, or abscess formation leading to surgery and compromised future fertility • Fetal : neonatal septicemia & pneumonia
- 34. D.D of puerperalfever • Site of puerperal infection : Endometrium: endometritis & parametritis Pelvis :pelvic abscess Lungs : respiratory infections Urinary tract : urinary tract infections Wound: C.S , episiotomy, vaginal/ cervical lacerations Veins: septic thrombophlebitis Breasts : mastitis
- 35. investigations • Blood culture •Urine culture & sensitivity • Vaginal swab culture • USG of pelvis • X-ray chest • Blood urea and serum electrolytes
- 36. Management • In mildcases of pelvic infection :oral antibiotics • In moderate to severe cases : parenteral therapy with broad –spectrum antibiotics • First line of treatment is ampicillin + gentamycin • Patients with more serious infections or infections following cesarean delivery : to anerobic cover metronidazole. • Commonly used regimen : clindamycin, gentamycin + ampicillin.
- 37. Urinary complications • UrinaryTract Infection • Retention of urine • Incontinence of urine • Suppression of urine.
- 38. Breast complications • Breastengorgement • Cracked & retracted nipple • Mastitis & breast abscess • Lactation failure
- 39. Venous thromboembolic diseases •DVT • Thrombophlebitis • Pulmonary embolism
- 40. Puerperal emergencies Immediate: 1) Postpartumhemorrhage, 2) shock, 3)postpartum eclampsia, 4) Pulmonary embolism, 5) inversion Early (within one week): 1) Urinary tract infection, 2) Puerperal sepsis, 3) breast engorgement, 4) pulmonary infection. Delayed: 1) Secondary PPH, 2) Psychosis 3) Pulmonary embolism, thrombophlebitis
- 41. Psychiatric disorders • Puerperalblues • Postpartum depression • Postpartum psychosis (schizophrenia)