3.6 Danger signs in Pregnancy
Danger signs are the serious signs detected in pregnancy which if not treated immediately will impair the life of the mother and fetus. These signs include;
1. Vaginal bleeding.
2. Liquar drainage.
3. Hypertension
4. Pre-eclampsia
5. Convulsions
6. Anaemia
7. Urinary tract infection
8. Fever
9. Abdominal pains
10. Dizziness
11. Foul smelling vaginal discharge
12. Oedema of the feet, hands, and face.
1. Vaginal bleeding: - In pregnancy any bleeding from the vagina is abnormal no matter how small, it become a cause of concern for both the woman and the health provider. Bleeding can occur either in early pregnancy or late pregnancy.
Bleeding before the 28th week of gestation is considered as threatening abortion.
Bleeding after 28th weeks before delivery is ante partum hemorrhage.
In early pregnancy there are many causes of vaginal bleeding e.g. ectopic pregnancy, cervical polyps (small vascular growths), or cervical cancers. But the most common cause is spontaneous abortion.
In late pregnancy 28th week and above, bleeding is normally due to either placenta praevia which is abnormal location of the placenta on the lower uterine segment, abruptio placenta which is the premature separation of a normally situated placenta, or incidental haemorrhage in which bleeding is not as a result of the 2 above.
Management – Do not perform V E.
- set IV line and refer the patient immediately.
2. Hypertensive Disorders: - Hypertension is defined as Blood pressure of > 140/90mmHg on two occasions measured 4-6 hours apart
Hypertension is a rise in the normal values of the blood pressure to greater 30mmHg in the systolic and 15mmHg in the diastolic even if the value does not reach 140/90mmHg.
This is why every woman’s BP must be measured at every ANC visit regardless of her complains.
Hypertensive disorders includes: -
Pregnancy-induced Hypertension (Gestational hypertension)
Pre-eclampsia
Mild pre-eclampsia
Severe pre-eclampsia
Chronic Hypertension in pregnancy
Essential Hypertension
Secondary Hypertension e.g. chronic renal disease
Chronic Hypertension with superimposed pre-eclampsia
Eclampsia
Chronic hypertension: When the client presents at booking (initial ANC visit) with a BP of 140/90mmHg or above with history of having similar condition even before present pregnancy.
Management: Monitor the patient closely; if at any point you feel the BP is rising refer immediately.
Pregnancy induced hypertension: This is the development of high BP in the 2nd half of pregnancy (20wks) in a woman with normal BP.
Management:
Monitor the BP closely
Advice adequate rest (at least 2hrs rest in day time and 8hrs in the night)
Advice patient to lie on the left side
Give Diazepam tablet 5-10mg or phenobarboitone 30mg at night to ensure adequate rest.
Refer when BP rises above 140/90mmHg and do not subside.
Pre-eclampsia: high blood pressure in pregnancy after 20 weeks of gestation measured on two occasions at least four hours apart and presence of proteinuria.
Mild Pre-eclampsia
Two readings of diastolic blood pressure of 90–110 mm Hg, 4 hours apart after 20 weeks gestation
Proteinuria up to 2+ in Dip stick urinalysis or 300mg /litre of urine (midstream clean catch specimen)
Usually presents without any symptoms
Severe Pre-eclampsia
