Maternal Physiological Adaptations in Pregnancy

Preeclampsia: Diagnosis and Management

Diagnose preeclampsia with new hypertension (140/90 mmHg or higher) after 20 weeks of gestation plus proteinuria or maternal organ dysfunction. Severe features include pressure of 160/110 mmHg or higher, severe headache, visual disturbance, epigastric pain, thrombocytopenia, renal impairment, or pulmonary edema. Severe preeclampsia mandates admission, magnesium sulfate for seizure prophylaxis, and antihypertensive therapy with labetalol, oral nifedipine, or hydralazine. The definitive treatment is delivery, timed by gestational age and severity: immediate stabilization then delivery at term or with severe features, and expectant management only in carefully selected preterm cases without severe features. Continue magnesium for 24 hours postpartum.

Chronic Hypertension: Diagnosis and Management

Chronic hypertension is a persistent and sustained elevation of blood pressure, typically defined as a systolic blood pressure greater than or equal to 130 mmHg or a diastolic blood pressure greater than or equal to 80 mmHg on multiple occasions. It is a major modifiable risk factor for various cardiovascular diseases, stroke, and kidney disease. Treatment for chronic hypertension involves a multi-faceted approach, starting with lifestyle modifications such as dietary changes (e.g., DASH diet), regular physical activity, weight loss, and reduced sodium and alcohol intake. Pharmacological therapy is often necessary and may include various classes of antihypertensive medications like diuretics, ACE inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, and calcium channel blockers, frequently used in combination to achieve target blood pressure. Chronic hypertension is often referred to as 'the silent killer' because it is frequently asymptomatic for many years, even at high levels. When symptoms do occur, they are typically non-specific and may include headaches, dizziness, nosebleeds, or shortness of breath, usually manifesting in severe or long-standing cases or during a hypertensive crisis. Most diagnoses are made during routine medical screenings.

Gestational Diabetes Mellitus (GDM): Screening and Management

Screen all pregnant women at 24-28 weeks with a 75 g oral glucose tolerance test, or earlier when risk factors such as obesity or previous GDM exist. First-line management is medical nutrition therapy with structured physical activity and daily glucose self-monitoring. If fasting or postprandial targets are repeatedly exceeded despite lifestyle measures, start insulin, with metformin as an accepted alternative in many guidelines. Monitor fetal growth because GDM drives macrosomia, and plan delivery around 38-39 weeks when medication is required. After delivery, insulin needs fall sharply; arrange a 75 g OGTT at 6-12 weeks postpartum because about half of women with GDM later develop type 2 diabetes.