Book of Medical Disorders in Pregnancy - Tintash

induced by pregnancy greater than 20
weeks gestation (or earlier if extensive
hydatidiform change is present in the
placenta).
Eclampsia: This is defined as disease in
which fits occur with pre eclampsia.
Chronic hypertensive disease: Chronic
hypertensive disease is the presence of
persistent hypertension, of whatever
cause, before pregnancy or before the
twentieth week of gestation, or persistent
hypertension beyond the forty second
postpartum day.
Superimposed preeclampsia or
eclampsia:
Superimposed preeclampsia or
eclampsia is the development of
preeclampsia or eclampsia in a patient
with chronic hypertensive vascular or
renal disease When the hypertension
antedates the pregnancy, a rise in the
systolic pressure of 30 mm Hg, or a rise
in the diastolic pressure of 15 mm Hg,
and the development of proteinuria,
edema or both are required during
pregnancy to establish the diagnosis.
Unclassified hypertensive disorders:
Unclassified hypertensive disorders are
those in which information is
insufficient for classification.
Pre eclampsia:
Gestational hypertension is the second
most common cause of maternal mortality.
The prognosis for mother can be
considerably improved by adopting proper
preventive measures during prenatal,
natal and post natal period. The
fetal health however is placed in considerable
jeopardy in most cases.
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In normal circumstances, this condition
is unique to human pregnancy and is
common in the primigravida. When it
occurs in multigravida there are usually
other underlying predisposing factors,
such as diabetes mellitus, mul-tiple
pregnancy, fetal hydrops, hyda-tiddiform
mole and chronic vascular disease.
Incidence: The incidence of preeclampsia
is about six to seven percent
among obstetric patients admitted to
hospitals in the United States, while
eclampsia is encountered once in every
2000 pregnancies.
There were 600 cases of preeclampsia
(20 percent) and ten cases of Eclampsia
in 3000 deliveries at Lahore General
Hospital over three years period. These
figures show that standards of obstetrical
care in Pakistan need considerable
improvement.
Pathological changes:
Uteroplacental changes: There is
decrease in perfusion at the utero placental
junction. Radiosodium disappears
more slowly from myometrium and is
typically prolonged in late pregnancy in
hypertensive women implying diminished
perfusion.
Myometrium: This is more active both
spontaneously and in response to
oxytocin therefore induction is more
likely to be successful and hyperstimulation
is also more likely.
Placental function: The decrease in
placental perfusion may cause retarded
fetal growth. The placental infarcts
which are usually present are probably
vascular rather than a primary placental
event.