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Query: UMLS:C0034065 (pulmonary embolism)
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Hypertension is the most common medical complication of pregnancy in South Africa and a major cause of maternal and perinatal morbidity and mortality worldwide. At King Edward VIII Hospital in Durban, 18% of all admissions to the obstetric unit have some degree of high blood pressure. Hypertension in its most severe form produces convulsions, proteinuria, and edema and may lead to fetal and maternal death. High-risk groups for preeclampsia are teenage mothers, primigravidas, and women with a history of elevated blood pressure, previous preeclampsia, molar pregnancies, multiple pregnancies, or hydrops fetalis. Methods used to prevent preeclampsia include a low-salt diet supplemented with calcium, magnesium, zinc, fish, and pharmacological manipulation. In developing countries, prevention and detection of preeclampsia is difficult since women seek antenatal care late in their pregnancies. In Durban, the average gestational age at first antenatal attendance is 28 weeks, and 80% of patients presenting with eclampsia have defaulted antenatal care. Treatment includes admission to hospital to establish the etiology of the hypertension and maternal renal function tests . Fetal condition is a sensitive index of hypertension and is judged by 1) clinical evidence of fetal growth, 2) weekly antepartum cardiotocography, and 3) ultrasonographic screening. Patients are managed according to three clinical groups: 1) those identified before 36 weeks, 2) those identified after 36 weeks, and 3) patients in hypertensive crisis. Dihydralazine is the drug of choice for imminent eclampsia. If the patients has a ripe cervix, delivery is induced with 6-8 hours. Steroid contraception use in the older hypertensive patient should be avoided because of possible development of atherosclerosis and stroke. Puerperal tubal ligations in the hypertensive patient ought to be avoided because of the risks of thromboembolic phenomena and pulmonary embolism. Methyldopa is the treatment of choice in cases of moderate to severe hypertension. Intravenous dihydralazine is relatively safe for the rapid reduction of high blood pressure.
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PMID:Coping with hypertension in pregnancy. 1234 38