Gestation

its actually anotomy presentation of uol frst semester of dr riaz...i keep it here for the help of students..keep remember me in ur prayers

1. Mahnoor Shehzadi. Hamna Naveed. Rija Fatima. Kiran Asghar. Esha Zahid. Amna Shakeel. Group Members

2. Gestation

3. Discharge of ova an ovules from the ovary. Gestation Definition : Gestation is the period of time between conception and birth. During this time the baby grows inside the mother womb or uterus. O vulation

4. Gestational age or period is the common term used during pregnancy. A pregnancy may end in a live birth, abortion or miscarriage. Child birth typically occurs around 40 weeks from the start of the last menstrual period. This is just over 9 months or 280 days .every month averages 31 days. when measured from fertilization it is about 38 weeks. An embryo is the developing offspring during the first eight weeks following fertilization after which the term fetus is used until birth.

5. Symptoms of early pregnancy are given Missed periods. Tender breasts. Nausea. Vomiting. Hunger. Frequent urination. Pregnancy may be confirmed by pregnancy test . S ymptoms

6. Pregnancy is divided in to three trimesters each lasting approximately 3 months. The first trimester include conception which is when the sperm fertilizes the egg. During the first trimester the possibility of miscarriage is at its highest. Around the middle of the second trimester, movement of the fetus may be felt. At 28 weeks more than 90% of the babies can survive outside of the uterus. Trimester

7. First trimester

8. Progesterone. Estrogen. Complications H igh blood pressure (hypertension). Gestational diabetes. Iron deficiency anemia. Severe nausea and vomiting. Hormones

9. HYPERTENSION (HTN) Also known as high blood pressure and arterial hypertension. Two measurements : systolic (when heart contracts) and diastolic(when heart expands) which are maximum and minimum pressures respectively. In adults ; systolic: 100-130 mmHg , Diastolic : 60-80mmHg Blood pressure is measured in Brachial Artery in upper arm.

10. Primary Hypertension : Hypertension with no clear or identifiable cause. Risk factors : old age, obesity, salt heavy diet, sedentary lifestyle. -90-95% cases are of primary hypertension. Secondary Hypertension : Hypertension with identifiable cause. Risk factors : pregnancy, renal disorders, hormonal imbalance or other medical conditions. -5-10% cases are of secondary hypertension. CLASSIFICATIONS :

11. Urgency : Blood pressure rises to 180/110mmHg . No damage to body organs. BP can be brought down slowly within a few hours. Emergency : Blood pressure rises extremely and causes damage to other body organs such as lungs, heart, kidneys etc. It maybe life-threatening may include severe chest pain. HYPERTENSIVE CRISES:

12. Anti-hypertensive medications : vasodilators(for easy blood flow), diuretics(increased production of urine), calcium channel blockers(increase blood supply). Lifestyle modifications : diet regulation(less intake of salt), daily exercise(running, swimming, walking), stress reduction. TREATMENT :

13. HYPERTENSION IN PREGNANCY Hypertension is defined as : systolic pressure of at least 140 mm of Hg and diastolic pressure of at least 90 mm of Hg . It is one of the most common complication during pregnancy. Increased maternal and perinatal morbidity and mortality. It is a sign of an underlying pathology that may be pre-existing or appears for the first time during pregnancy that’s why it is also called as TOXEMIA OF PREGNANCY .

14. 6% to 8% of all the pregnancies. Complicates 10-20% of pregnancies. Cause of 10% of preterm birth.

15. CLASSIFICATION Chronic Hypertension Preeclampsia-eclampsia Preeclampsia superimposed upon chronic hypertension or Renal disease Gestational Hypertension (only during pregnancy) Transient Hypertension (only after pregnancy)

16. Gestational Hypertension It is the hypertension detected for the first time after 20 weeks pregnancy. Resolves by 12 weeks postpartum. Majority of cases are more than or equal to 37 weeks of pregnancy. Absence of any evidences for the underlying cause of hypertension. Generally not associated with hemo-concentration or thrombocytopenia, raised serum uric acid level or hepatic dysfunction .

17. 50% of women diagnosed with gestational hypertension between 24 and 35 weeks develop preeclampsia. Prevalence 6-15% in nulliparas and 2-4% in multiparas. Mild hypertension without proteinuria or other signs of preeclampsia. But it can progress onto preeclampsia (when hypertension is more than 30 weeks gestation) , about 15-25% risk.

18. TYPES OF GESTATIONAL HTN EARLY Before 30 wks, frequently severe, advances to preeclampsia and has a guarded perinatal prognosis. LATE After 30 wks, frequently in obese women and multiple pregnancies, due to poor maternal adaptation to physiology changes in pregnancy.

19. CRITERIA TO IDENTIFY HIGH RISKS WOMEN WITH GESTATIONAL HTN BP> 140/90 mm Hg GA< 30 woks Twins Abnormal CD Fetal growth restriction Oligohydramnios Multiparas or women whose sisters and mothers had PIH Nullipara, age>35 yrs, BMI> 35 kg/m2

20. AFFECT OH GHTN ON BABY Hypertension has negative affects on both mother and baby. Hypertension can prevent the placenta from getting enough blood. If the placenta doesn’t get enough blood, your baby gets less oxygen and food. This can result in low birth weight. Most women still can deliver a healthy baby if hypertension is detected and treated earlier.

21. HOW TO KNOW IF WOMAN HAS GHTN At each prenatal checkup, your healthcare provider will check your blood pressure and urine levels. Your doctor may also check your kidney and blood clotting functions, order blood tests, perform an ultrasound scan to check your baby’s growth, and use a Doppler Scan to measure the efficiency of blood flow to the placenta.

22. DELIVERY COMPLICATIONS Vaginal delivery VS Cesarean section. Depends on severity of hypertension. It might be between 37-38 weeks of gestation if complications occur. If preterm birth occur then antenatal corticosteroids are administered depending on gestation. But if the hypertension is controlled it takes its original time < 37 weeks meaning 40 weeks.

23. Cardiovascular effects: Elevated BP. Increased cardiac output. Renal effect: Atherosclerotic like changes in renal vessels(glomerular endotheliosis). Uric acid filtrations is decreased. Pathophysiology

24. Neurologic effect: Hyper- reflexia /hypersensitity(does not corelate severity of disease. In severe cases, grand mal seizures. Hematologic effects: Third spacing of fluid due to increased blood pressure and decreased plasma oncotic pressure.

25. Pulmonary effects: Pulmonary edema may occur due to decreased collide oncotic pressure . Fetal effects: Vasospasm.

26. Hemostatic changes: Increased PLT activation with increased endothelial fibro- nectin and decreased anti-thrombin III and alpha-2-antiplasmin - - - - further endothelial damage is thought to promote further vasospasm. Changes in EDF: Decrease in nitric Oxide. Pathophysiology Mechanism:

27. Uterine vascular changes: Trophoblastic- mediated vascular changes Decreased musculature in spiral arterioles. Development of low resistance, low pressure, high flow system. Inadequate maternal vascular response. Endothelial damage is also noted with in the vessels.

28. Changes in prostanoids: Both PGI2 (Vasodilation and decreased PLT aggregation)and TXA2(vasoconstriction and PLT aggregation) are increased with balance favored to PGI2. In preeclampsia, TXA2 is favored.

29. Symptoms of Gestation Hypertension Headache does not goes away . Edema (Swelling). Sudden weight gain. Vision changes, such as blurred or double vision. Nausea or Vomiting. Pain in the upper right side of our belly, or pain around your stomach. Making small amounts of urine.

30. Causes of Gestation hypertension Pre-existing hypertension(high blood pressure). Kidney disease. Diabetes. Hypertension with previous pregnancy. Mother’s age younger than 20 or older than 40. Multiple fetuses(twins,triplets). African-Amrican race.

31. TREATMENT OF GESTATIONAL HYPERTENSION

32. Anti hypertensive drugs Anti drug method It can be treated with two following methods

33. If you have mild hypertension and your baby is not fully developed, your doctor will probably recommend the following: Rest, lying on your left side to take the weight of the baby off you major blood vessels. Increase prenatal checkups. Consume less salt. Drink 8 glasses water a day. Anti Drug Method

34. 5. Increase the amount of protein. 6. Decrease the number of junk and fried foods. 7. Exercise regularly. 8. Elevate your feet several time during the day. 9. Avoid drinking Alcohol. 10. Avoid beverages containing caffeine. 11. Your doctor may suggest you to take the prescribed medicine and additional supplements. Anti Drug Method

35. If you have severe hypertension, your doctor may try to treat you with blood pressure medication until you are far enough along to deliver safely. Severe Hypertension

36. First Line Agents Methyldopa 0.5-3 mg /day Labetalol 200-1200 mg/day Second Line Agents Nefedipine 10-30mg p.o. Anti Hypertensive Drugs

37. Verapamil 80 mg tds p.o. Clonidine 0.1-0.6 mg/day Hydralazine 50-300 mg/day Hydrochlorothiazide 12.5-25 mg/day Atenolol Diazoxide 30-50 mg in every 5 to 15 min Prazosin 0.5-5 mg tds Oxprenolol 20-160 mg tds Anti Hypertensive Drugs

38. Nitroprusside Contraindicated Thank You Anti Hypertensive Drugs