Book of Medical Disorders in Pregnancy - Tintash

showering and in a number of
autoimmune and hypersensitive states.
Orthostatic or postural proteinuria occurs
in 5 to 20 per cent of young adults.
Vaginal discharge or bleeding readily
contaminates urine specimens that are
obtained casually and will yield falsely
high levels of protein. The need for
clean, midstream voided or a
catheterized specimen is therefore
strongly advocated. This can help in
avoiding erroneous result due to
contamination. However, when protein
in excess of 500 mg is discovered in 24hour
urine specimen the protein urea is
considered pathologic.
Hypertension:
An elevation of 30 mm. Hg or more in
the systolic and 15 mm. Hg or more in
the diastolic pressure is considered
abnormal in pregnancy regardless of the
absolute levels observed. Levels in
excess of 140 mm. Hg systolic and/or 90
mm. Hg diastolic by convention are
hypertensive levels in pregnant women.
The blood pressure must be abnormal on
at least two occasions with at least a sixhour
interval between the two determinations,
before a diagnosis of hypertension
in pregnancy is definitely made.
Stages of preeclampsia:
The disease may be mild, moderate and
severe. The differentiation of mild,
moderate and severe is not always
possible. However the student will come
across three distinct groups. One in
which the disease can remain mild,
second in which the disease can be
checked by therapy and third in which
the disease is only checked by delivery.
This is the reason why boundaries
between mild, moderate and severe form
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of disease continue to remain blurred
and purely arbitrary.
Severe pre eclampsia:
Pre eclampsia is regarded severe when
one or more of the following features are
detected.
1. Blood pressure of at least 160
mm Hg systolic or 110 mm Hg
diastolic on two occasions at
least 6 hours apart while the
patient is at bed rest.
2. Proteinuria of at least 5g per 24hours,
or 3+ to 4+ by semi-
quantitative assay.
3. Oliguria (24-hour urinary output
less than 400 ml). Cerebral or
visual disturbances such as
altered consciousness, headache,
scotoma, or blurred vision.
5. Pulmonary edema or cyanosis.
6. Epigastric Pain.
These criteria for defining severe preeclampsia
were adopted by both the
Committee on Terminology of the American
College of Obstetricians and Gynecologists
and the American Committee
on maternal Welfare.
In practice, however, we do not wait six
hours be-tween diastolic blood pressure
readings of greater than 100 mm Hg
before taking action, to reduce the blood
pressure for presumed severe PET.
Headache: This is a late sign and often
forerunner of eclampsia. Headache is
often frontal but may be occipital. It is
often resistant to analgesic agents.