HYPERTENSIVE DISORDERS SCRIPT

So, for our Disposition and Future Plans.

Since our patient is a case of pre-eclampsia, it is important for us to

address factors that may contribute to the worsening of
hypertension present in the patient which may then lead to a
likelihood of future health problems even if the patient does not
become pregnant anymore, like a heart attack, stroke, kidney
disease, and many more.

Hence, primarily, we should advise the patient to have a healthy

balanced diet with low salt and low- fat. Looking back at our
history, it was noted that the patient prefers salty and fatty foods.
So, from hereon, it is important to advise the patient to take regular
meals and snacks of nutrient dense foods which may help maintain
energy levels, promote healing, and meet the nutrients and calories
needed for milk production, which requires 500 calories compared
to the normal intake. We can show the patient the pinggang pinoy
and explain to her the benefits of eating a balanced diet comprised
of adequate carbohydrate, protein, and fat to ensure a healthy
mother and baby during this period. We can also refer our patient
to a dietician to make sure that they would adhere to a diet plan
designed for them in correlation with their nutritional goals.

So the National Nutrition Council noted on their guidelines for Lactation and
Postpartum Care (Nutrition for Lactating Women), that the mother should take a
single 200,000 IU dose of Vitamin A within 6 weeks after delivery and Iron with
Folate supplements once a day for 3 months in order to replenish nutrient losses
and meet nutrient demands of the body.

Since our goal for eating healthy is not just for the mother but also
for the baby, we should also discuss the benefits of breastfeeding.
They should understand that taking hypertensive medications does
not prevent them from breastfeeding and to assure them that the
antihypertensive medication they would be taking has not caused
any adverse effects in breastfed infants and that the levels of the
medication are usually low and undetectable in the plasma of our
babies. We should explain that breastfeeding can help the baby
grow and develop, breast milk contains antibodies that protect
infants from certain illnesses, it can trigger the release of oxytocin
that causes the uterus to contract which helps it to return to its
normal size quickly and may also decrease the amount of bleeding
after giving birth, it can also help the mothers lose weight, also
breastfeeding itself can be a form of contraception if certain
guidelines are met.

Which brings us to advising the family about methods of family

planning as well. Since there are a lot of postpartum birth control
methods, it is important to discuss these one by one with the family
and for them to choose a plan of contraception that they feel
comfortable with.

So again, considering that our patient is Obese, the NICE

guidelines suggest maintaining a healthy weight and to achieve
and keep a BMI within the healthy range before their next
pregnancy. (BMI: 18.5- 24.9) (18.5-22.9), Many of the physiological
and morphological changes of pregnancy persist for four to six
weeks post- partum so as soon as the patient can already tolerate
physical activity, they should gradually start exercising. The ACOG
recommends to stay active for 20-30 mins a day and to try simple
post- partum exercises (like walking, kegel exercises, yoga, pilates,
etc.).

No known maternal complications are associated with resumption of training.

NEXT SLIDE PLEASE

The NICE guidelines also recommends to regularly monitor the

blood pressure postpartum at least 4 times a day while the woman
is an inpatient, and every 1-2 days for up to 2 weeks or until the
woman is off treatment and has no hypertension. We should
remind the patient to record these monitoring in a notebook for
future reference and to inform them that usually the blood pressure
of patients who have had pre-eclampsia would normalize within 3
months after delivery. However, if it persists, then subsequent
follow ups should be initiated for diagnosis and management.

But in the meant time, we shall advice our patient to continue her
present anti- hypertensive medication which is: Amlodipine
10mg/tab 1 tab OD.
Perineal care should also be advised. Patient should thoroughly
wash the external genitalia, washing in the direction of perinium to
rectum and to dry the area thoroughly.

Lastly, we should also advise the patient regarding prevention

strategies for future pregnancies. Since one of the risk factors for
subsequent pre-eclampsia episodes in future pregnancies is a prior
pregnancy with pre-eclampsia, then we should advise the patient to
have regular pre-natal check-ups in the event that she would
conceive again.

Also, the World Health Organization, NICE, and the ACOG

guidelines have recommended the use of low dose aspirin (75mg)
for the prevention of pre-eclampsia in women at high risk of
developing the condition. The ACOG recommends 81mg/day as
prophylaxis and should be initiated between 12 weeks and 28weeks
of gestation, optimally before 16 weeks and continued daily until
delivery.

Also the WHO, and ACOG recommends that in areas where dietary
calcium intake is low, calcium supplementation during pregnancy
is recommended for the prevention of pre-eclampsia in all women,
but especially those at high risk of developing pre-eclampsia.

Nutritional interventions have also been done to prevent pre-

eclampsia however there is insufficient evidence to demonstrate
the effectiveness of Vitamin C and E, fish oil, garlic
supplementation, Vitamin D, Folic Acid for reducing the risk of
preeclampsia and thus they have a weak recommendation from
WHO and ACOG.