Book of Medical Disorders in Pregnancy - Tintash

fetuses. Recent studies indicate that it is
useful in preventing neonatal jaundice
since it helps in early induction of liver
enzyme system necessary for conjugation
of bilirubin.
Monitoring of pregnancy and
delivery:
Constant evaluation of fetal growth, his
wellbeing and maturation should be
carried out routinely in all cases.
Monthly sonograms for increase in fetal
biparietal diameter can be reassuring.
Similarly estriol should be measured.
Weekly oxytocin challenge tests and the
use of amnioscopy may also provide
important information regarding intrauterine
status of the fetus. Amniocentesis
for both the presence of meconium and
lung maturation should be started by the
35th week and delivery accomplished as
soon as lung maturity is confirmed.
Hospital management:
When B P. is greater than 140/90; or
when there is increase of 30 mm Hg. in
pre-pregnancy systolic blood pressure
and 15 mm Hg in the diastolic, the
patient should be admitted to hospital for
treatment. She should be weighed on
admission and then daily, to note trend
of fluid retention. Blood pressure should
be recorded four hourly daily. The urine
should be screened for protein, quantitative
analysis in 24 hour urine
specimen is better. Creatinine clearance
should be checked if renal involvement
is suspected.
Management generally varies wi-th
severity of disease, similarly course in
hospital depends on duration of gestation
and condition of the cervix. The
underlying disease process does not
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abate until after delivery, but in general
three groups emerge; (1) those who
settle on bed rest. (2) Those needing
antihypertensives before settling. (3)
Those who settle only after delivery. The
two most important aspects of management
of this complication include control
of convulsions and con-duct of delivery
as soon as control is obtained. The
patients with hypertension can be
broadly divided into 3 groups.
Group I: The recognition of hypertensive,
prior to 36 weeks means, at least
several weeks of medical mana-gement
in anticipation of delivery. There fore
treat the patient as in ambula-tory management.
Group II:
When hypertensive syndrome develops
at 36 weeks or later, it presents a
different type of challenge to the
obstetrician. The objectives of therapy in
these patients should be rapid
stabilization, confirmation of fetal maturity
and delivery. If the diastolic pressure
with bed rest is persistently over 110
mm Hg, an antihypertensive drug should
be added very early in the management.
The most frequently used antihypertensive
agent is methyldopa (Aldomet)
this is quite practical agent for long term
therapy, but for the short term acute
management of hypertension, hydralazine
(Apresoline) is given parenterally.
It is also relatively easy to titrate its dose
and maintain its effect. If long term
therapy is indicated, oral hydra-lazine
may be equally effective. Recently
hydralazine has been added to Propranolol
beta blocking agent for its
independent hypotensive action and to
relieve some of side effects of hydralazine.
This therapeutic meddling is