Book of Medical Disorders in Pregnancy - Tintash

counterproductive to the overall management
objectives. Propranolol blocks
the positive inotropic and chronotropic
effect of hydralazine upon the heart and
the combined therapy prevents increase
in uterine blood flow. A less satisfactory
alternative antihypertensive agent is the
rauwolfia compound, Reserpine, which
can be given both parenterally and orally
with good effect. The side effects such
as nasal congestion in the neonate are
manageable with good neonatal nursery
care. The maternal risk of catecholamine
depletion in the event of a general anaesthetic
is also manageable in competent
hands.
Group III: The emergency management
of an acute hypertensive crisis presents
the greatest challenge to the obstetrical
team. The patient with diastolic pressure
of 115 mm Hg may very well present
with massive peripheral edema and
impending or frank pulmonary edema. In
these patients aggressive medical
management in an intensive care setting
is directed toward maternal survival and
prevention of fetal sequelae.
Management may progress on several
fronts at the same time hydralazine in
appropriate doses should be started at
once by intravenous route. Pulmonary
edema should be treated by aggressive
management such as intra-venous
infusion of frusemide, in doses of 40 to
80 mg. The fetal prognosis in these acute
situations is generally very poor. The
rapid lowering of the arterial pressure,
for maternal indication, may further
compromise uteroplacental perfusion.
Fulminating disease - When the B.P is
more than 160/110 and edema and
proteinuria along with headache and
epigastric pain are present, the danger of
oliguria and imminent convulsions
56
becomes very real, therefore anticonvulsant
drugs should be given to
avoid convulsions. Antihypertensive agents
to avoid intracranial hemorrhage
and delivery should be planned without
delay to deliver live infant in such cases.
Follow-up:
For patients with BP stabilized by
management, follow up should normally
be three monthly (interval should not
exceed 6 months), at which the following
should be assessed by a trained
nurse:
* Measurement of BP and weight
* Reinforcement of non-
Pharmacological advice
* General health and drug side-
effects.
* Test urine for proteinuria
(annually)
High risk pregnancy units which are
equipped with intensive care facilities
for mother and the neonate can help
improve results of maternal orbidity and
neonatal survival.
Usually rapid improvement in patient’s
blood pressure occurs following delivery
but occ-asionally there may be transient
wor-sening. Fits may occur within 24
hours of delivery but rarely thereafter,
therefore, the patient must be observed
and treated at least for 24 hours after
delivery.
Termination of pregnancy:
It may be justified in milder cases to
temporize with premature babies. The
chance of survival of low birth weight
fetus is greater in neonatal intensive care
unit than if left in utero. If it is decided