Antenatal Complications Management

Hypertension - Pressure Cooker Pregnancy

• Gestational HTN: BP ≥140/90 mmHg after 20 wks gestation; no proteinuria.
• Pre-eclampsia: BP ≥140/90 mmHg after 20 wks + Proteinuria (≥300mg/24h or ≥1+ dipstick).
  • Severe Pre-eclampsia: BP ≥160/110 mmHg OR end-organ damage (e.g., thrombocytopenia <100,000/µL, ↑LFTs, renal insufficiency, pulm. edema, new visual/CNS sx).
• Eclampsia: Pre-eclampsia + New-onset grand mal seizures.
• HELLP Syndrome: 📌 Hemolysis, Elevated Liver enzymes, Low Platelets. Key Management:
• Antihypertensives (BP goal <160/110 mmHg): Labetalol, Nifedipine, Methyldopa. (Avoid ACEi/ARBs).
• MgSO4 for seizure prophylaxis (severe pre-eclampsia) & treatment (eclampsia):
  • Loading dose: 4-6g IV over 15-20 min.
  • Maintenance: 1-2g/hr IV.

  ⭐ MgSO4 is the drug of choice for seizure prophylaxis and control in eclampsia; its therapeutic range is 4-7 mEq/L. Antidote: Calcium gluconate.

• Definitive treatment: Delivery. Complications: Maternal (abruption, DIC, CVA, organ failure), Fetal (IUGR, prematurity, IUD).

GDM - Sugar Spike Saga

• Screening: Universal (DIPSI: 75g OGTT, non-fasting) or risk-based.
• Diagnosis (IADPSG/WHO): ≥1 abnormal value from 75g OGTT:
  • Fasting: ≥ 92 mg/dL
  • 1-hr: ≥ 180 mg/dL
  • 2-hr: ≥ 153 mg/dL
• Complications:
  • Maternal: Pre-eclampsia, polyhydramnios, ↑ C-section.
  • Fetal: Macrosomia, IUGR, RDS, neonatal hypoglycemia.
• Management:
  • MNT (Medical Nutrition Therapy) first.
  • OHAs: Metformin (preferred), Glibenclamide (caution).
  • Insulin: If targets unmet (Target HbA1c <6.5%).

⭐ India's DIPSI (Diabetes in Pregnancy Study Group India) recommends a one-step procedure with 75g oral glucose load for GDM diagnosis, irrespective of last meal.

APH - Code Red Bleeds

*   Types: Complete (covers os), Partial, Marginal (edge at os), Low-lying (near os).
![Normal placenta vs. placenta previa](https://ylbwdadhbcjolwylidja.supabase.co/storage/v1/object/public/notes/L1/Obstetrics_and_Gynecology_Prenatal_Care_Antenatal_Complications_Management/4852bdaf-9bdc-4e24-b259-79746d862374.png)

• Abruptio Placentae: Premature separation of a normally implanted placenta.
• Risk Factors:
  • Previa: Prior C-section, multiparity, AMA, smoking.
  • Abruptio: Maternal HTN, trauma, smoking, cocaine, prior abruption.
• Management Principles:
  • Expectant: Stable, preterm (<37 wks). Corticosteroids for fetal lung maturity.
  • Active: Term (≥37 wks), maternal/fetal instability, significant bleeding → Prompt delivery (often LSCS for previa; LSCS for fetal distress in abruption).
• Couvelaire Uterus: Extravasation of blood into uterine musculature in severe abruption; uterus appears bruised, woody.
• ⭐ > In Placenta Previa, per-vaginal (PV) examination is contraindicated until placenta location is confirmed by ultrasound to avoid catastrophic hemorrhage.

Preterm & PROM - Tiny Timers

• Definitions:
  • Preterm Labor (PTL): Regular contractions + cervical changes <37 weeks.
  • PROM: Rupture of membranes before labor onset.
  • PPROM: Preterm PROM, <37 weeks.
• Risk Factors: Prior PTL, infection, multiple gestation, cervical insufficiency.
• Diagnosis: Clinical (cervical changes), +fFN, USG Cervical Length (CL) <25mm.
• Management:
  • Tocolytics: Delay delivery. Nifedipine, Atosiban. Indomethacin <32 wks (max 48h). 📌 IT'S NOT MY TIME (Indomethacin, Nifedipine, MgSO4, Terbutaline, Atosiban).
  • Antenatal Corticosteroids (ACS): Betamethasone 12mg IM x2 (24h apart) or Dexamethasone. Lung maturity (24-34 wks).
  • MgSO4: Fetal neuroprotection if imminent delivery <32 weeks.
  • Antibiotics: For PPROM (latency) & Group B Strep (GBS) prophylaxis.

⭐ ACS (Betamethasone) significantly ↓ RDS, IVH, NEC in preterms (24-34 wks).

High‑Yield Points - ⚡ Biggest Takeaways

• Gestational Diabetes Mellitus (GDM): Screen with OGTT; manage with diet, exercise, insulin.
• Preeclampsia: Hypertension (>140/90 mmHg) & proteinuria after 20 weeks; MgSO4 for seizure prophylaxis.
• Ectopic Pregnancy: Suspect with amenorrhea, pain, bleeding; β-hCG & transvaginal ultrasound (TVS) are key.
• Placenta Previa: Painless third-trimester bleeding; avoid per-vaginal (PV) exams.
• Abruptio Placentae: Painful vaginal bleeding, uterine tenderness; risk of fetal distress.
• Intrauterine Growth Restriction (IUGR): Monitor with serial ultrasounds (USG) & Doppler studies.
• Rh Isoimmunization: Administer Anti-D immunoglobulin at 28 weeks & post-delivery for Rh-negative mothers with Rh-positive babies.