Managing Complications in Pregnancy and Childbirth: - IAWG

S-36 Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure- Protect her from injuries (fall), but do not attempt to restrainher;- Provide constant supervision;- If eclampsia is diagnosed (Table S-9, page S-38), givemagnesium sulfate (Box S-3, page S-45);- If the cause of convulsions has not been determined, manageas eclampsia and continue to investigate other causes.DIAGNOSIS OF HYPERTENSIVE DISORDERSThe hypertensive disorders of pregnancy include pregnancy-inducedhypertension and chronic hypertension (elevation of the bloodpressure before 20 weeks gestation). Headaches, blurred vision,convulsions and loss of consciousness are often associated withhypertension in pregnancy, but are not necessarily specific to it. Otherconditions that may cause convulsions or coma include epilepsy,complicated malaria, head injury, meningitis, encephalitis, etc. SeeTable S-9, page S-38 for more information on diagnosis.• Diastolic blood pressure is a good indicator of prognosis for themanagement of hypertensive disorders in pregnancy:- Diastolic blood pressure is taken at the point at which thearterial sound disappears:- A falsely high reading is obtained if the cuff does notencircle at least three-fourths of the circumference of thearm;- A wider cuff should be used when the diameter of theupper arm is more than 30 cm;- Diastolic blood pressure measures peripheral resistance anddoes not vary with the woman’s emotional state to the degreethat systolic pressure does.• If the diastolic blood pressure is 90 mm Hg or more on twoconsecutive readings taken 4 hours or more apart, diagnosehypertension (If urgent delivery must take place or if the diastolicblood pressure is 110 mm Hg or more, a time interval of less than4 hours is acceptable):