PREGNANCY RELATED PREGNANCY RELATED HYPERTENSIONHYPERTENSION

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Dr. Ali Abd El-Monsif ThabetDr. Ali Abd El-Monsif Thabet

The classification of The classification of hypertensive disordershypertensive disorders

Chronic hypertensionChronic hypertension: is defined as : is defined as hypertension that is present prior to hypertension that is present prior to pregnancy or is diagnosed before the 20pregnancy or is diagnosed before the 20thth week of gestation.week of gestation.

Chronic hypertension with superimposed Chronic hypertension with superimposed Pre- eclampsiaPre- eclampsia: Pre-eclampsia may occur in : Pre-eclampsia may occur in women already hypertensive and the women already hypertensive and the prognosis for mother and fetus is much prognosis for mother and fetus is much worse than with either condition alone.worse than with either condition alone.

  

Transient hypertensionTransient hypertension: is the : is the development of elevated blood development of elevated blood pressure during pregnancy or in pressure during pregnancy or in the 1the 1stst 24 hours post partum 24 hours post partum without other signs of pre without other signs of pre eclampsia.eclampsia.

Pre-eclampsiaPre-eclampsia: (hypertension : (hypertension peculiar to pregnancy).peculiar to pregnancy).

pre-eclampsia (PE)pre-eclampsia (PE)

It is a form of hypertension It is a form of hypertension that is unique to human that is unique to human pregnancy. Hypertension (blood pregnancy. Hypertension (blood pressure 140/90 mmHg after 20 pressure 140/90 mmHg after 20 weeks gestation), proteinuria weeks gestation), proteinuria and oedema are considered the and oedema are considered the classic triad of pre-eclampsia.classic triad of pre-eclampsia.

DegreesDegrees Mild PE is diagnosed when the blood Mild PE is diagnosed when the blood

pressure is 140/90 mmHg and there is pressure is 140/90 mmHg and there is more than 0.3 gm/Liter of protein in more than 0.3 gm/Liter of protein in urine,urine,

while severe PE is characterized by while severe PE is characterized by diastolic blood pressure which exceeds diastolic blood pressure which exceeds 110 mmHg and protein excretion 110 mmHg and protein excretion greater than 3 gm/day. greater than 3 gm/day.

The incidence of PE ranges between 10-The incidence of PE ranges between 10-14%. in primigravidae and between 5-7 14%. in primigravidae and between 5-7 % in multiparae.% in multiparae.

Physical Therapy Physical Therapy ManagementManagement

Relaxation training in form of Relaxation training in form of diaphragmatic breathing exercise for diaphragmatic breathing exercise for 15 minutes, in addition to Methyldopa 15 minutes, in addition to Methyldopa 250 mg three times daily.250 mg three times daily.

Submaximal exercise program at 70% Submaximal exercise program at 70% of maximal heart rate, in addition to of maximal heart rate, in addition to the use of Methyldopa drug, 3 times the use of Methyldopa drug, 3 times daily. All movement were performed daily. All movement were performed through full range of motion with through full range of motion with repetition of 10 times.repetition of 10 times.

Role of P.T. in polycystic Role of P.T. in polycystic ovarian syndromeovarian syndrome

PCOSPCOS

DefinitionDefinition

is a common hyper-androgenic is a common hyper-androgenic disorder and is characterized by disorder and is characterized by constellation of sings and symptomsconstellation of sings and symptoms such as acne, hirsutism, male pattern such as acne, hirsutism, male pattern baldness, obesity, hyperandrogenism, baldness, obesity, hyperandrogenism, menstrual cycle disturbance and menstrual cycle disturbance and infertilityinfertility

PCOS is an extremely common disorder that occurs in 7% to 10% of reproductive age.

Incidence and prevalence of PCOS

Infertility

Clinical picture of PCOS

Menstrual irregularity

AcneHirsutism

Virilization

Obesity

AmenorrheaFunctional bleeding

Cephalic hair loss

Acnthosis nigricans

The fundamental pathophysiologic defect of PCOS was attributed to insulin resistance, androgen excess and abnormal gonadotropin dynamics.

Pathophysiologyof PCOS

Obesity and PCOS

Obese women often suffer from a variety of menstrual cycle abnormalities including hypermenorrhea, amenorrhea, infertility and premature menopause. Obesity also appears to be associated with PCOS.

So, 80% of obese patients subsequently found to have PCOS.

A- Prior to any treatment exclude other causes of infertility

Treatment of PCOS

B- Weight loss

C- Ovulation induction

A- Exclude other factors of infertility

InPatient

As tubal adhesion,

Endometriosis ,

In Husband

B- Weight lossB- Weight loss

Weight loss is the first line of treatment Weight loss is the first line of treatment in all women with obesity and PCOS in all women with obesity and PCOS

It appear to be associated with significant It appear to be associated with significant improvement in menses abnormalities, improvement in menses abnormalities, ovulation and fertility rate with a ovulation and fertility rate with a reduction of reduction of hyperandrogenismhyperandrogenism and and hyperinsulinemia.hyperinsulinemia.

B- Weight loss

I- Nutritional education of low calorie diet

Caloric restriction including

Moderate energy restriction (1200Kcal/day)

Calorie restricted diet accompanied by a return toward normal levels of LH, FSH with normalization of the ovulatory menses.

B- Weight loss

II- Exercise

Moderate aerobic exercise at 50-70% of Vo2max for > 45 minutes daily for 3 -6 months.

So, exercise training program reduced fasting insulin, LH pulse frequency and androgen production.

B- Weight loss

III- Low calorie diet and exercise

Addition of exercise to low calorie diet is advocated to counteract the negative metabolic adaptations that occur during caloric restriction, because exercise training prevents declines in fat oxidation.

B- Weight loss

IV- Low calorie diet & antidiabetic drug

This combination aimed to reduce insulin resistance as well as hyperinsulinemia and

correct the LH abnormalities.

B- Weight loss

Parameters of electrolipolysis*Frequency: 100 pulses/minutes.*Pulse width: 400 microseconds.*Placement of electrodes: on the abdominal and gluteal region.*Duration: 30 min on the abdominal region and other 30 min on both gluteal max.& mediums. 3 months.*Biological effect: Electrolipolysis increases oxidation of fat and glucose uptake so, it reduces weight, waist/hip ratio, LH and LH/FSH ratio, increasing FSH, resuming normal menstrual cycle and occurrence of pregnancy.

V- Low calorie diet and electrolipolysis

As pharmacological and surgical induction of ovulation in women with PCOS is associated with negative side effects, alternative or complementary methods are needed.

Thus electro acupuncture (EA) and may be an alternative or a complement to pharmacological induction of ovulation in women with PCOS who have minor metabolic disturbance.

C- Non pharmacological approach for induction of ovulation

Electro acupuncture )EA(

*It is effective in women with minor metabolic disturbance.*The needles must applied to the effective acupuncture points in somatic segments that innervates the ovary and uterus (Th12- L2 and S2-4).*Electric stimulation with low frequency (2Hz, pulse width 0.5ms for 30minutes.*EA was given two times/ week for two weeks, then once a week, of total treatment sessions from 10-14. *EA corrects the hypothalamic pituitary ovarian axis that resulting in the correction of some hormones such as LH, FSH.

Chronic pelvic painChronic pelvic pain

DefinitionDefinition

Any pain in pelvic region that lasts 6 months Any pain in pelvic region that lasts 6 months or longer that affect entire area rather than one or longer that affect entire area rather than one spot and characterized by: spot and characterized by:

* severe and steady pain* severe and steady pain

* sharp and cramping pain* sharp and cramping pain

* heaviness deep within pelvis* heaviness deep within pelvis

CausesCauses

A)A) Non cyclic:Non cyclic:1- Adhesions.1- Adhesions.2- Endometriosis.2- Endometriosis.3- Salpigo-oophoritis3- Salpigo-oophoritis4- Ovarian neoplasm.4- Ovarian neoplasm.

B- Cyclic:1- Primary dysmenorrhea.

2- secondary dysmenorrhea.

P.T. TreatmentP.T. Treatment

ExercisesExercises

Relaxation TechniquesRelaxation Techniques

Hot ApplicationHot Application

ULTRASOUNDULTRASOUND

Interferential currentInterferential current

Frequency :- 100 Hz constant Frequency :- 100 Hz constant and/or 0-100 Hz rhythmicaland/or 0-100 Hz rhythmical

Intensity :- 12-25 mAIntensity :- 12-25 mA

Time :- 15-20 minTime :- 15-20 min Duration :- 15 sessions.Duration :- 15 sessions. Sites of ApplicationSites of Application

Short waves diathermy20- 30 min.

Thank you