Preeclampsia: Diagnosis and Management

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.

Maternal Physiological Adaptations in Pregnancy

During a normal singleton pregnancy, the maternal circulatory system undergoes remarkable physiological adaptations to support the developing fetus, meet increased metabolic demands, and prepare for the demands of labor and delivery. These changes are initiated early in gestation and progress throughout pregnancy, typically peaking by 32-34 weeks. One of the most critical and prominent adaptations is a significant expansion of the total maternal blood volume. Plasma volume increases disproportionately, typically by 40-50% above non-pregnant levels. Red blood cell mass also increases, but to a lesser extent, usually by 20-30% (more with adequate iron supplementation). The combined effect results in an overall increase in total blood volume by approximately 40-45% by term.