labour pain : Rhythmic pain

Hypertension pregnancy
·
-

in - >
z4ed Vascular
=

false labour : NOT Rhythmic

numen
-

Avoid
using the term "PEH "> Obsolete
.

If it doesn't occur then Risk of PTL Ned PE Why ?

·

in .

,
·

Ted risk in :
- H

① primigravida : -Exposure to paternal Ags .

Endothelial dysfunch d/E SFLT-1& Placental ischemia/UPI
, Ned risk of PE -R
.
soluble
② Distant Interpregnancy period of Ned risk. endoglein
(210 yrs) loss of memory to Ags . **

⑦ Chr HTN , CDMEAGEs

. cause foete Adrenals #Q
③ (J18 >35 yrs) ↓
Extremes of
age .
endothelial dysfunch
,

f?
foeto-placental clock activation
*
why 18 is U
Hypothalamus
.

adrenal,
(foetal ,
s

① use of ART for conception- pituitary

+
placenta)
⑤ multifoetal gestation = Fed placental prect/0 pre-eclaemia
↓
mass
⑨ Obesity/metals Syndrome
diverse genetic material
,
.
catecholamines
(CRH corticosteroids)
⑥ Auto Immune -APLA SLE : ,
,

Gross endothelial dysfunction

Pre-eclampsia
. CKD
present
>
-
Placental
already
. total maturation +

↓ ⑪ Early onset PE :-molar

preg. > Cervical dilatalin +

H contractions-
Maternal GTD : -

Trophoblastic hyperplasia,
ed paternal Ag exposure Placental Abruption :
↑
·
Med foetal size = requires .
·
-

↑ Blood flow ·

In complete mole : - ↑ trophoblasts, concealed hemorrhage

Normally -
:

Extra-villous trophoblasts will ↑ Hormones . ↓

of pain to uterine stretching
destroy tunica Intima and mention site and location
·

Hy
media , sparing Adventice .
rule out premonitory symptoms. PTL .

Adventitia is not responsive to vasopressors.

Any passage of Rules out Letrozole : to induce ovulation. - ·

premonitory Symptoms
-

Blood/Clob plu ?
:

#
abmation ovulation induction I planned coitus/IUI ·
.

O Headache : Cerebral oedema dit

·

bed foetal mumnts ? N

Leaky Capillary
↓ Twins in 7-1 : -Ask nausea
/vomiting Vasogenic GLOBAL HEADACHE
.
, ,

chronic
hypoxia * NOT HEG DONT MENTION HEG . .
↑ ICT .

↓ he not relieved
in T-1 <12-16
·

Throbbing on
analgesics-
Aspirin : -75-150
my
oligohydramnios
·
S

Chr HTN : Essential HTN simia

wks)
·

ye' perception of foetal mumnts.

·
N
TAzO bed pltt,
.

aggregation o"cipital lobe IB and like

↓ ②
NST : -
Parameters - :
vasoconstrictive- Blurring vision/ring scotomal (A 1) .

tunnel vision loss/amaurosis

FHR ,
B2B variability
s
·
Doesn't PGIz (Mostacycin) =
PG32 W fugux/
is vasodilator
Accelerations ,
Declarations Diplopia
A F is occipital Blindness
.

NST done after around 30-32 was ·

TW/Due in
pregnancy Endothelial
.

.
: -

ANS develops
by this time. posterior reversible
:

damage microthembi formation T

·

encephalogaby
any hypoxia is
Synonome
,
B2B variabily
marker of H
In
hypoxia. uncontrolled BP- occipital bleed
·

· NST depends on Autonomic NS.

·:
Give Aspirin Hy
Blindness
st invasion
S

*D
By 12 WKs · .
: -

↓ foetal mumnts : --
·
oligo
IUGR
2nd invasion: -

By 16 WKs.
on fundoscopy : -

·
IUFD
con examination * Ideal time : -12-16 wks. to start Papilloedema (4ICP) =common
more
·

concealed hemorrhage -
:

Aspirin Puertscher Retincipally

·

Story/woody hand uterus

Start & 12-16 H
.

wh,
Salicylate
:-
contracted uterus
·

Tonically ,

Stay & 36 wks.

rare

no relation felt
.
③ Epigastric passi - rule out filariasis also If labet fails :-
:

-
.

Subcapsular hematoma in Liver

Liver changes :
·
Twin pregnancy :
-
Zuc compression
·

Nifedipine (CCB)
↓
↑ed liven enzymes : - PE : -Protein loss
, oncotic Albumin
·

ORAL :-120
mg/day mone
·

Periportal Hepatocellar hemorrhage pressure Sle of Wifedipine -

:

Hepatocyte Necrosis Fed ·

in BP out anything else : -Gestannal Reflex Zachy Cardia ,
HTN
AFLP : palpitation pulsatile/throbbing
-fatty leading
-

= deposition ,

Pre-eclamysia headache

!
: - 1TN .

to X Albumin Glucose clotting

, ,

factor Proteinuria/TCP (ILakh pItits)

·

sublingual Nife :
-
drastic in BP
↑ NH3 so aaid
keeping in month,
Renal
Insufficiency (Cheats 1 1)
.

swallow
immediately
.

444ed Liver SGPT10T

dysfunction, ·

: -
12x of normal
enzymes Target BP ↓ by 25 % initial
.

: -

HELLP has liver

·

Creat > 1 1 :· GFR Mes so

↓
dysfunch
.
·

no

creat should win preg. 140190 rhy is

target
·

Pedal Gedema : -Grade, normally .

Relieved DD
Associated
,
? ⑪ creat in pregnancy -9ule
: .

swelling 135/85 for Chr . HTN.

Physiological, varicose m close of labet :

-Ivi-t noso

o Hydralazine
W related -

L + B Blocker * Itali
:

oedema
relieve on
arteriolant
Ny
it is
rest . not just B.
1200
my Iday man Se ,

venodilator
D
(CF Cli of labet : -Asthma (avoid B Blockade) Notpreferred : -Sudden
·

in Asthmanes. HypoTN ,

Hypercoagulability in peri-
partum ② Pulmo-Edema
IUfD .

1) period -
:

DVT .
 Previously Post-op hemodilution correction of HCt it
Imaging
-
X-mD : -
now ,
:

, 3% falli 500 m
not used . Hct Ved ,
·

umb artery doppler

.

in HCE Blood Loss

copper
wis
↓X ·
uterine
artery

Hemolyhe Anemia risk, Peripheral smear : -Schistocyte echinocyte I NTNB Scan

·

,
Trophoblashe invasion
,

Central Sle Fed. Helmet cells/Burr cells .

↓
·
DTR Gradesi- Echinocytes : -
RBC cell mmbrne
Can start Aspirin
Absent refer USE KUB : To wo nephropathy
0:
structural defect
- .
-

+ 11 -
Diminished
PE :-Cholesterd
dysfunce, convulsion :-
·

0
·

+ 2: -

+ 3: -

Exaggerated : - PE ↓/
loading close given ↑
if creat

+ n :-Clonus
RBC mmhine affected myson => caution in RenalDs .
If obese Bices tendon, H Pritchand <Zuspun : -why ?
lady :
·

preferred in obese. Echinocytes .

zuspen is zu

Scratch marks : InPrisk Echinocytosis indicates Chl dysfuncton HELLP : -Pritchend Im ! Abscess
: ,
. -

in twins +ed Lesser convol

LFT: Indirect
·
-

> Direct BU : 'Hemolysis

·

mmnt
-
:
cli Zuspan :-(CF Heart
·

Alp Ned in
every pregnancy, Disease
Admitpt if multiple "Placental isoform of enzyme.
&
· ·

Disease :-
Pritchard
10-morbidities (BP DM twins
RFT :
,
Ned.
,
·
Creat , wil acid
et)
-

Baad convulsion
Zuspanke
·

Investigations -
wit acid Ned
Why ? X
placental
:

Fed hephoblasne turnover due to

Repeat loading
·

Serum - : ↑
close
CBC
hypona
Renal ↓
dysfunction
·
·

/
Platelet count y,
Hct4ed 35-40 % in PE ↑ in his acid is indicator of PE . again cone

↓
,

Anesthesia.
Pregnant female :-HCt = 30 %
)normally Levetir Pheytain
>
-

,
Non-"-i- 35 % - 40 %
 mysou : --RR Should be
·
Urine cutput (L30m/hr ,
<100 my nm)
·
DTRs should be present
·

HR : -
Ned PR interval on ECC

If toxicity: -

Ca-Gluconate -> 10 % -10m-10 min

urine : -If no dipstick-

of proteins
Heat wine => coag
Heller's nitric acid test :
-Dangerous X
·

Sulphosalicylicacid
·

Dipstick :-
false tuel-ve rate
,unreliable

Divurnal/seasonal variations due to Changes in

flid intake.
 Best test : UPCRC 0 3
is
·
-
.

24 hr proteinuria -300
.
mg