CHBP before 20th week progress note

Name: DOB:

August 21, 2013

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 (23 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 determine if 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