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Critical Care Obstetrics part 46

Critical Care Obstetrics part 46 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Complications of Pre-eclampsia Table 34.1 Classification of hypertensive diseases during pregnancy. Table 34.2 Complications of severe pregnancy-induced hypertension. Chronic hypertension Hypertension that is present before pregnancy or diagnosed before 20 weeks of gestation Pre-eclampsia - eclampsia Hypertension plus proteinuria usually occurring after 20 weeks of gestation or earlier with trophoblastic diseases Pre-eclampsia superimposed upon chronic hypertension Chronic hypertension with signs and symptoms of pre-eclampsia such as Blood pressure 160 110mmHg Proteinuria 2.0g 24h Serum creatinine 1.2mg dL unless previously elevated Thrombocytopenia Persistent epigastric pain Elevated hepatic transaminases Persistent neurologic disturbances Gestational hypertension These are retrospective diagnoses. If pre-eclampsia is not present at the time of delivery and elevated blood pressure Transient hypertension of pregnancy returns to normal by 12 weeks post partum Chronic hypertension persists beyond 12 weeks Modified from the Working Group Report on High Blood Pressure in Pregnancy. National Heart Lung and Blood Institute. NIH Publication No. 00-3029 July 2000. chronically stimulating autoregulatory mechanisms thus increasing vascular tone and producing vascular hypertrophy. These changes then may impede pregnancy-induced plasma volume expansion which occurs in normal pregnancies and result in general circulatory maladaptation. One of the more striking clinical risk factors for the development of pre-eclampsia is the antiphospholipid syndrome. At the University of Utah Branch et al. 44 studied 43 women who presented with severe pre-eclampsia prior to 34 weeks of gestation and found 16 to have significant levels of antiphospholipid antibodies. They recommended that women with early- onset severe pre-eclampsia be screened for antiphospholipid antibodies and if detected be considered for prophylactic therapy in subsequent pregnancies. The same group 45 found a high .