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CHBP before 20th week progress note
Name: August 21, 2013
DOB:
Case of a XX y/o female Gx Px LMP ____/____/____ and EDC on ____/____/____ with XX weeks of
gestation with apparent history of preexisting high blood pressure.
Patient has (been or not) treated. Preexisting hypertension is defined as systolic pressure above 140 mmHg
and/or diastolic pressure >90 mmHg and antedates pregnancy or is present before the 20th week of
pregnancy.
Gestational hypertension refers to elevated blood pressure first detected after the 20th week of gestation in
the absence of proteinuria.
Patient was oriented that, although widely recommended, there are no studies evaluating the benefits and/or
risks of bed rest during pregnancy. Bed rest is disruptive for some women and could be associated with an
increased risk for thromboembolic episodes. For that reason, bed rest is not advised for all pregnant
women. Avoidance of alcohol and tobacco is encouraged. Sodium restriction will be considered (2–3 g/d).
Rigorous activity should be avoided, as should weight reduction. She was also informed that she is at
increased risk for an adverse pregnancy outcome, being superimposed preeclampsia the most common
complication. 3-fold increase in perinatal mortality, 2-fold increase in abruptio placenta, 5-fold increase in
IUGR even in absence of superimposed PIH. Other potential problems stem from known risks of hypertensive disease such as heart failure, encephalopathy, retinopathy, cerebral hemorrhage, and acute
renal failure. Baseline labs were recommended and will be done soon. These labs will help us to determineif there is some other etiology for her elevated blood pressure.
Our goal is to minimize or prevent maternal cardiovascular or cerebrovascular events. Will try to maintain
an acceptable blood pressure of about systolic 145-150mmHg or less
and a diastolic between 90-95mmHg. Patient was recommended to monitor her B/P TID at home and to
keep a chart, and to annotate any symptoms that she may feel. She should bring that chart during her
following visits to optimize therapy.
Precise knowledge of the fetal age is needed to be able to make decisions in a later date. U/S was also
ordered in this patient. Also, the baby will be followed by serial U/S every 4 weeks to asses growth and
adequate AFI. Fetal well-being will be started at 28 weeks and Doppler velocimetry will be considered at
that time.
Medication will be discussed after evaluation of her labs and B/P chart in next app.
App in 2 weeks.
Dr. Pou