The appropriate treatment for a third degree perineal tear is surgical repair in theatre by a trained clinician under local or general anaesthetic. This is necessary as the tear involves the external anal sphincter, which can lead to complications such as infection, prolapse, long-term pain, and faecal incontinence if left untreated. Analgesia should also be provided to manage the patient’s pain, with paracetamol being the first-line option. Emergency repair in theatre is not usually required unless the patient is unstable. Suture repair on the ward by a midwife or clinician is not appropriate for tears involving the anal complex, which require intervention in theatre. However, grade 2 tears can be repaired on the ward by senior midwives trained in perineal repair.

Perineal tears are a common occurrence during childbirth, and the Royal College of Obstetricians and Gynaecologists (RCOG) has developed guidelines to classify them based on their severity. First-degree tears are superficial and do not require any repair, while second-degree tears involve the perineal muscle and require suturing by a midwife or clinician. Third-degree tears involve the anal sphincter complex and require repair in theatre by a trained clinician, with subcategories based on the extent of the tear. Fourth-degree tears involve the anal sphincter complex and rectal mucosa and also require repair in theatre by a trained clinician.

There are several risk factors for perineal tears, including being a first-time mother, having a large baby, experiencing a precipitant labour, and having a shoulder dystocia or forceps delivery. It is important for healthcare providers to be aware of these risk factors and to provide appropriate care and management during childbirth to minimize the risk of perineal tears. By following the RCOG guidelines and providing timely and effective treatment, healthcare providers can help ensure the best possible outcomes for both mother and baby.

Understanding Pre-eclampsia and HELLP Syndrome in Pregnancy

Pre-eclampsia is a serious condition that can occur during pregnancy, characterized by high blood pressure and proteinuria. Diagnosis requires two readings of blood pressure, taken 4-6 hours apart, with a systolic reading of 140 or higher, a diastolic reading of 90 or higher, or an increase of 30 systolic or 20 diastolic from booking blood pressure in the second half of pregnancy. Proteinuria of at least 1+ on reagent stick testing is also required.

The severity of pre-eclampsia is classified based on blood pressure readings. Mild pre-eclampsia is characterized by a systolic reading of 140-149 or a diastolic reading of 90-99. Moderate pre-eclampsia is characterized by a systolic reading of 150-159 or a diastolic reading of 100-109. Severe pre-eclampsia is diagnosed with a systolic reading of 160 or higher or a diastolic reading of 110 or higher.

HELLP syndrome is a subtype of severe pre-eclampsia, characterized by haemolysis, elevated liver enzymes, and low platelets. Diagnosis requires a blood film showing fragmented red cells, an LDH level over 600 IU/litre, and raised bilirubin. Elevated AST or ALT levels over 70 IU/litre and platelet counts below 100 x 10^9/litre are also required.

It is important to note that not all cases of high blood pressure in pregnancy are pre-eclampsia or HELLP syndrome. However, if a pregnant woman meets the diagnostic criteria for pre-eclampsia, it is an obstetrical emergency and requires immediate attention. Additionally, if a pregnant woman has high ALP levels, an ultrasound scan of the biliary tree may be necessary to check for biliary obstruction. It is also important to note that ALP levels are typically elevated during pregnancy due to the placenta releasing ALP.

If blood glucose targets are not achieved through diet and metformin in gestational diabetes, insulin should be introduced as the next step. This is in accordance with current NICE guidelines, which recommend that pregnant women with any form of diabetes aim for plasma glucose levels below specific target values. Commencing anti-emetic medications or metformin would not be the most appropriate options in this scenario, as the former would not address the underlying issue of gestational diabetes and the latter is not acceptable to the patient. Additionally, offering a 2 week trial of diet and exercise changes would not be appropriate at this stage, as medication is now required. However, this may be an option for patients with a fasting plasma glucose of between 6.0 and 6.9 mmol/L without complications, who can be offered a trial of diet and exercise for 2 weeks before medication is considered if blood glucose targets are not met.

Gestational diabetes is a common medical disorder affecting around 4% of pregnancies. Risk factors include a high BMI, previous gestational diabetes, and family history of diabetes. Screening is done through an oral glucose tolerance test, and diagnostic thresholds have recently been updated. Management includes self-monitoring of blood glucose, diet and exercise advice, and medication if necessary. For pre-existing diabetes, weight loss and insulin are recommended, and tight glycemic control is important. Targets for self-monitoring include fasting glucose of 5.3 mmol/l and 1-2 hour post-meal glucose levels.

Breastfeeding is generally safe with most anti-epileptic drugs, except for a few exceptions. Lamotrigine is one of the drugs that is considered safe for breastfeeding, but infants should still be monitored for certain symptoms. Aspirin, codeine, and lithium are not recommended for breastfeeding mothers due to potential risks to the infant’s health. Aspirin can cause metabolic acidosis and Reye’s syndrome, while codeine is excreted in breast milk and lithium can cause renal and thyroid dysfunction in neonates.

Pregnancy and breastfeeding can be a concern for women with epilepsy. It is generally recommended that women continue taking their medication during pregnancy, as the risks of uncontrolled seizures outweigh the potential risks to the fetus. However, it is important for women to take folic acid before pregnancy to reduce the risk of neural tube defects. The use of antiepileptic medication during pregnancy can increase the risk of congenital defects, but this risk is still relatively low. It is recommended to aim for monotherapy and there is no need to monitor drug levels. Sodium valproate is associated with neural tube defects, while carbamazepine is considered the least teratogenic of the older antiepileptics. Phenytoin is associated with cleft palate, and lamotrigine may require a dose increase during pregnancy. Breastfeeding is generally safe for mothers taking antiepileptics, except for barbiturates. Pregnant women taking phenytoin should be given vitamin K in the last month of pregnancy to prevent clotting disorders in the newborn.

A warning has been issued about the use of sodium valproate during pregnancy and in women of childbearing age. New evidence suggests a significant risk of neurodevelopmental delay in children following maternal use of this medication. Therefore, it should only be used if clearly necessary and under specialist neurological or psychiatric advice. It is important for women with epilepsy to discuss their options with their healthcare provider and make informed decisions about their treatment during pregnancy and breastfeeding.

Management of Severe Pre-eclampsia with HELLP Syndrome

Severe pre-eclampsia with HELLP syndrome is a serious complication of pregnancy that requires prompt management to prevent maternal and fetal morbidity and mortality. The first-line medication for pre-eclampsia is labetalol, but if it fails to improve symptoms, second-line treatments such as intravenous hydralazine or oral nifedipine can be used. In cases of severe pre-eclampsia, delivery of the fetus is the only definitive treatment. However, if delivery is planned before 36 weeks, intramuscular betamethasone is required to protect the fetus from neonatal respiratory distress syndrome. Intravenous magnesium sulfate infusion is also necessary for neuroprotection and to lower the risk of eclampsia. It should be considered in cases of mild or moderate pre-eclampsia with certain symptoms. While these interventions are essential in managing severe pre-eclampsia with HELLP syndrome, they are not definitive treatments. Close monitoring of both the mother and fetus is necessary, and delivery should be planned as soon as possible to prevent further complications.

Understanding the Signs of a Good Latch for Successful Breastfeeding

Latching on the breast is crucial for successful breastfeeding, but many women struggle with it. A poor latch can lead to pain and frustration, causing some women to give up on breastfeeding altogether. However, there are clear signs of a good latch that can help mothers and babies achieve successful breastfeeding.

One indicator of a poor latch is clicking noises, which can be painful for the mother and indicate that the baby is chewing on the nipple. In contrast, a good latch is associated with visible and audible swallowing, a rhythmic suck, and relaxed arms and hands of the infant. The baby’s chin should touch the breast, with the nose free, and the lips should be rolled out, not turned in. The mouth should be open wide, and the tongue positioned below the nipple, with the latter touching the palate of the baby’s mouth.

Another sign of a good latch is that less areola should be visible below the chin than above the nipple. This indicates that the baby is taking in not only the nipple but also the areola, which is essential for effective milk expression and feeding. By understanding these signs of a good latch, mothers can ensure successful breastfeeding and a positive experience for both themselves and their babies.

Chickenpox exposure in pregnancy can pose risks to both the mother and fetus, including fetal varicella syndrome. Post-exposure prophylaxis (PEP) with varicella-zoster immunoglobulin (VZIG) or antivirals should be given to non-immune pregnant women, with timing dependent on gestational age. If a pregnant woman develops chickenpox, specialist advice should be sought and oral acyclovir may be given if she is ≥ 20 weeks and presents within 24 hours of onset of the rash.

Managing Hypothyroidism in Pregnancy: Importance of Levothyroxine Dosing and Thyroid Function Tests

Hypothyroidism is a common condition in pregnancy that requires careful management to ensure optimal fetal development and maternal health. Levothyroxine is the mainstay of treatment for hypothyroidism, and its dosing needs to be adjusted during pregnancy to account for the physiological changes that occur. Here are some key recommendations for managing hypothyroidism in pregnancy:

Increase Levothyroxine by 25 mcg and Repeat Thyroid Function Tests in Two Weeks

As soon as pregnancy is confirmed, levothyroxine treatment should be increased by 25 mcg, even if the patient is currently euthyroid. This is because women without thyroid disease experience a physiological increase in serum fT4 until the 12th week of pregnancy, which is not observed in patients with hypothyroidism. Increasing levothyroxine dose mimics this surge and ensures adequate fetal development. Thyroid function tests should be repeated two weeks later to ensure a euthyroid state.

Perform Thyroid Function Tests in the First and Second Trimesters

Regular thyroid function tests should be performed in pregnancy, starting in the preconception period if possible. Tests should be done at least once per trimester and two weeks after any changes in levothyroxine dose.

Continue on the Same Dose of Levothyroxine at Present if Euthyroid

If the patient is currently euthyroid, continue on the same dose of levothyroxine. However, as soon as pregnancy is confirmed, increase the dose by 25 mcg as described above.

Return to Pre-Pregnancy Dosing Immediately Post-Delivery

After delivery, thyroid function tests should be performed 2-6 weeks postpartum, and levothyroxine dose should be adjusted to return to pre-pregnancy levels based on the test results.

In summary, managing hypothyroidism in pregnancy requires careful attention to levothyroxine dosing and regular thyroid function testing. By following these recommendations, we can ensure the best outcomes for both mother and baby.

The correct first-line surgical intervention for postpartum haemorrhage is an intra-uterine Bakri catheter. This device is used to tamponade the bleeding caused by uterine atony, which is a failure of the uterine myometrium cells to contract. Hysterectomy is not the first option as it is a last resort and will make the patient infertile. Lying the patient on her left lateral side is not relevant for a woman who has already delivered her baby. Ligation of the internal iliac artery may be used, but it is not the next most appropriate step as it may lead to ischaemic complications. Intra-uterine balloon tamponade is the first-line surgical intervention if other measures fail.

Understanding Postpartum Haemorrhage

Postpartum haemorrhage (PPH) is a condition where a woman experiences blood loss of more than 500 ml after giving birth vaginally. It can be classified as primary or secondary. Primary PPH occurs within 24 hours after delivery and is caused by the 4 Ts: tone, trauma, tissue, and thrombin. The most common cause is uterine atony. Risk factors for primary PPH include previous PPH, prolonged labour, pre-eclampsia, increased maternal age, emergency Caesarean section, and placenta praevia.

In managing PPH, it is important to involve senior staff immediately and follow the ABC approach. This includes two peripheral cannulae, lying the woman flat, blood tests, and commencing a warmed crystalloid infusion. Mechanical interventions such as rubbing up the fundus and catheterisation are also done. Medical interventions include IV oxytocin, ergometrine, carboprost, and misoprostol. Surgical options such as intrauterine balloon tamponade, B-Lynch suture, ligation of uterine arteries, and hysterectomy may be considered if medical options fail to control the bleeding.

Secondary PPH occurs between 24 hours to 6 weeks after delivery and is typically due to retained placental tissue or endometritis. It is important to understand the causes and risk factors of PPH to prevent and manage this life-threatening emergency effectively.

There are several factors that can increase the risk of miscarriage, including age, previous miscarriages, chronic conditions, uterine or cervical problems (such as large cervical cone biopsies or Mullerian duct anomalies), smoking, alcohol and illicit drug use, and weight. Invasive prenatal tests like chorionic villus sampling and amniocentesis also carry a slight risk of miscarriage. It’s important to note that other options are not considered risk factors for 2nd-trimester miscarriage.

Miscarriage: Understanding the Epidemiology

Miscarriage, also known as abortion, refers to the expulsion of the products of conception before 24 weeks. To avoid any confusion, the term miscarriage is often used. According to epidemiological studies, approximately 15-20% of diagnosed pregnancies will end in miscarriage during early pregnancy. In fact, up to 50% of conceptions may not develop into a blastocyst within 14 days.

Recurrent spontaneous miscarriage, which is defined as the loss of three or more consecutive pregnancies, affects approximately 1% of women. Understanding the epidemiology of miscarriage is important for healthcare providers and patients alike. It can help to identify risk factors and provide appropriate counseling and support for those who have experienced a miscarriage. By raising awareness and promoting education, we can work towards reducing the incidence of miscarriage and improving the overall health and well-being of women and their families.

Understanding Dilutional Anaemia of Pregnancy

Dilutional anaemia of pregnancy is a common condition that occurs during pregnancy. It is characterized by a normal mean cell volume (MCV) and is caused by a disproportional rise in plasma volume, which dilutes the red blood cells. This condition is the most likely option for a patient with a normal MCV.

Iron deficiency anaemia, on the other hand, is microcytic and gives a low MCV. Pancytopenia, which is the term for low haemoglobin, white cells, and platelets, is not applicable in this case as the patient’s white cells and platelets are in the normal range.

Folic acid or B12 deficiency would give rise to macrocytic anaemia with raised MCV, which is not the case for this patient. Myelodysplasia, an uncommon malignant condition that usually occurs in patients over 60, is also unlikely.

In conclusion, understanding dilutional anaemia of pregnancy is important for healthcare professionals to provide appropriate care and management for pregnant patients.

Understanding Risk Factors for Intrauterine Growth Restriction (IUGR)

Intrauterine growth restriction (IUGR) is a condition where a baby does not grow properly in the womb. There are various risk factors associated with IUGR, including smoking during pregnancy, which can increase the likelihood of developing the condition.

There are two types of IUGR: symmetrical and asymmetrical. Symmetrical growth retardation occurs at the start or during early pregnancy and is characterized by a small head and short length. Asymmetrical growth retardation occurs in advanced pregnancy and is characterized by reduced abdominal growth compared to head circumference, due to selective shunting of blood to the brain.

It’s important to note that a baby with a birthweight below the tenth centile is considered small for gestational age (SGA), which may be normal or due to IUGR.

Contrary to popular belief, hypotension (low blood pressure), obesity, and stress are not recognized risk factors for IUGR. However, poorly controlled diabetes is a risk factor for IUGR, while well-controlled diabetes is not.

Understanding these risk factors can help healthcare providers identify and manage IUGR early on, leading to better outcomes for both mother and baby.

Folic Acid Supplementation for Neural Tube Defect Prevention

Explanation:
Folic acid supplementation is recommended for women who are trying to conceive in order to reduce the risk of neural tube defects and congenital abnormalities in their babies. The recommended dose is 400 μg daily in the preconception period and until the 12th week of gestation. However, women who are identified to be at high risk of having a baby with a neural tube defect should take a higher dose of 5 mg daily, ideally starting in the preconception period and continuing until the 12th week of gestation. It is important to note that folic acid supplementation should be discontinued after the first trimester. Side-effects of folic acid treatment may include abdominal distension, reduced appetite, nausea, and exacerbation of pernicious anaemia. High risk factors for neural tube defects include a family history of neural tube defects, a previous pregnancy affected by a neural tube defect, personal history of neural tube defect, and chronic conditions such as epilepsy and diabetes mellitus.

The most appropriate action for managing umbilical cord prolapse is to insert a urinary catheter and fill the bladder with saline, which can help lift the presenting part off the cord. Alternatively, the presenting part can be manually lifted to prevent cord compression. Applying suprapubic pressure is not the correct management for cord prolapse, as it is used for shoulder dystocia. Administering IV oxytocin is not recommended, as it can induce contractions. Tocolytics such as terbutaline or nifedipine can be used to relax the uterus and delay delivery while transferring the patient to theatre for a caesarian section. Episiotomy may be used in the management of shoulder dystocia, but it is not appropriate for cord prolapse. Pushing the cord back inside the vagina is not recommended, as it can cause vasospasm and lead to foetal hypoxia.

Understanding Umbilical Cord Prolapse

Umbilical cord prolapse is a rare but serious complication that can occur during delivery. It happens when the umbilical cord descends ahead of the presenting part of the fetus, which can lead to compression or spasm of the cord. This can cause fetal hypoxia and potentially irreversible damage or death. Certain factors increase the risk of cord prolapse, such as prematurity, multiparity, polyhydramnios, twin pregnancy, cephalopelvic disproportion, and abnormal presentations like breech or transverse lie.

Around half of all cord prolapses occur when the membranes are artificially ruptured. Diagnosis is usually made when the fetal heart rate becomes abnormal and the cord is palpable vaginally or visible beyond the introitus. Cord prolapse is an obstetric emergency that requires immediate management. The presenting part of the fetus may be pushed back into the uterus to avoid compression, and the cord should be kept warm and moist to prevent vasospasm. The patient may be asked to go on all fours or assume the left lateral position until preparations for an immediate caesarian section have been carried out. Tocolytics may be used to reduce uterine contractions, and retrofilling the bladder with saline can help elevate the presenting part. Although caesarian section is the usual first-line method of delivery, an instrumental vaginal delivery may be possible if the cervix is fully dilated and the head is low.

In conclusion, umbilical cord prolapse is a rare but serious complication that requires prompt recognition and management. Understanding the risk factors and appropriate interventions can help reduce the incidence of fetal mortality associated with this condition.

Benzylpenicillin is the preferred antibiotic for GBS prophylaxis during childbirth. It is important to recognize that Streptococcus agalactiae is the same as group B streptococcus (GBS). According to the guidelines of the Royal College of Obstetricians and Gynaecologists, mothers who have had a previous pregnancy complicated by neonatal sepsis should receive intravenous benzylpenicillin antibiotic prophylaxis during delivery. Administering IV benzylpenicillin to the neonate after birth is not recommended unless the neonate shows signs and symptoms of sepsis. Intrapartum IV benzathine benzylpenicillin is not used for GBS prophylaxis and is instead used to manage syphilis.

Group B Streptococcus (GBS) is a common cause of severe infection in newborns. It is estimated that 20-40% of mothers carry GBS in their bowel flora, which can be passed on to their infants during labor and lead to serious infections. Prematurity, prolonged rupture of membranes, previous sibling GBS infection, and maternal pyrexia are all risk factors for GBS infection. The Royal College of Obstetricians and Gynaecologists (RCOG) has published guidelines on GBS management, which include not offering universal screening for GBS to all women and not offering screening based on maternal request. Women who have had GBS detected in a previous pregnancy should be offered intrapartum antibiotic prophylaxis (IAP) or testing in late pregnancy and antibiotics if still positive. IAP should also be offered to women with a previous baby with GBS disease, women in preterm labor, and women with a fever during labor. Benzylpenicillin is the preferred antibiotic for GBS prophylaxis.

To evaluate a patient with suspected premature rupture of membranes, a thorough medical history should be obtained, including the number of pregnancies. A sterile speculum examination is necessary to check for the accumulation of amniotic fluid in the posterior vaginal vault. Digital examination should be avoided to prevent infection. Serum beta-HCG is not recommended, and the patient should have had previous ultrasound scans and have confirmed her pregnancy by this stage. Ultrasound is the appropriate diagnostic tool if there is no evidence of amniotic fluid pooling in the posterior vaginal vault.

Preterm prelabour rupture of the membranes (PPROM) is a condition that occurs in approximately 2% of pregnancies, but it is responsible for around 40% of preterm deliveries. This condition can lead to various complications, including prematurity, infection, and pulmonary hypoplasia in the fetus, as well as chorioamnionitis in the mother. To confirm PPROM, a sterile speculum examination should be performed to check for pooling of amniotic fluid in the posterior vaginal vault. However, digital examination should be avoided due to the risk of infection. If pooling of fluid is not observed, testing the fluid for placental alpha microglobulin-1 protein (PAMG-1) or insulin-like growth factor binding protein-1 is recommended. Ultrasound may also be useful to show oligohydramnios.

The management of PPROM involves admission and regular observations to ensure that chorioamnionitis is not developing. Oral erythromycin should be given for ten days, and antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome. Delivery should be considered at 34 weeks of gestation, but there is a trade-off between an increased risk of maternal chorioamnionitis and a decreased risk of respiratory distress syndrome as the pregnancy progresses. PPROM is a serious condition that requires prompt diagnosis and management to minimize the risk of complications for both the mother and the fetus.

When a pregnant patient presents with painful bleeding and a hard, tender uterus, it may indicate placental abruption. In this case, the patient has risk factors such as being a smoker, having pre-eclampsia, and a transverse lie. The management of placental abruption depends on the gestation, maternal condition, and fetal condition. In this scenario, the patient is stable, at 34 weeks gestation, and the fetus is not showing signs of distress. Therefore, the appropriate plan is to admit the patient and administer steroids for observation.

Administering anti-D and performing a Kleihauer test is unnecessary as the patient is already known to be rhesus positive. Induction of labor is not indicated as the fetus has not matured to term. Emergency caesarean section would only be necessary if fetal distress was present. Performing a sterile speculum examination is not appropriate as it could cause or worsen hemorrhage, especially if the patient has placenta previa. The best course of action is to admit the patient to the ward until access to notes becomes available or an ultrasound is performed.

Placental Abruption: Causes, Management, and Complications

Placental abruption is a condition where the placenta separates from the uterine wall, leading to maternal haemorrhage. The severity of the condition depends on the extent of the separation and the gestational age of the fetus. Management of placental abruption is crucial to prevent maternal and fetal complications.

If the fetus is alive and less than 36 weeks, immediate caesarean delivery is recommended if there is fetal distress. If there is no fetal distress, close observation, administration of steroids, and no tocolysis are recommended. The decision to deliver depends on the gestational age of the fetus. If the fetus is alive and more than 36 weeks, immediate caesarean delivery is recommended if there is fetal distress. If there is no fetal distress, vaginal delivery is recommended. If the fetus is dead, vaginal delivery should be induced.

Placental abruption can lead to various maternal complications, including shock, disseminated intravascular coagulation (DIC), renal failure, and postpartum haemorrhage (PPH). Fetal complications include intrauterine growth restriction (IUGR), hypoxia, and death. The condition is associated with a high perinatal mortality rate and is responsible for 15% of perinatal deaths.

In conclusion, placental abruption is a serious condition that requires prompt management to prevent maternal and fetal complications. Close monitoring and timely intervention can improve the prognosis for both the mother and the baby.

Perineal tears are a common occurrence during childbirth, and the Royal College of Obstetricians and Gynaecologists (RCOG) has developed guidelines to classify them based on their severity. First-degree tears are superficial and do not require any repair, while second-degree tears involve the perineal muscle and require suturing by a midwife or clinician. Third-degree tears involve the anal sphincter complex and require repair in theatre by a trained clinician, with subcategories based on the extent of the tear. Fourth-degree tears involve the anal sphincter complex and rectal mucosa and also require repair in theatre by a trained clinician.

There are several risk factors for perineal tears, including being a first-time mother, having a large baby, experiencing a precipitate labour, and having a shoulder dystocia or forceps delivery. It is important for healthcare providers to be aware of these risk factors and to provide appropriate care and management during childbirth to minimize the risk of perineal tears. By following the RCOG guidelines and providing timely and effective treatment, healthcare providers can help ensure the best possible outcomes for both mother and baby.

During the term of pregnancy, there is ample space for the fetus to reposition itself and move towards the head-down position. However, in cases of occipitoposterior presentation, the posterior fontanelle is located in the back quadrant of the pelvis, which requires more rotation and often results in a longer labor. Additionally, there is a higher likelihood of medical intervention, with a rate of 22.

Breech presentation occurs when the caudal end of the fetus is in the lower segment, and it is more common at 28 weeks than near term. Risk factors include uterine malformations, placenta praevia, and fetal abnormalities. Management options include spontaneous turning, external cephalic version (ECV), planned caesarean section, or vaginal delivery. The RCOG recommends informing women that planned caesarean section reduces perinatal mortality and early neonatal morbidity, but there is no evidence that the long-term health of babies is influenced by how they are born. ECV is contraindicated in certain cases, such as where caesarean delivery is required or there is an abnormal cardiotocography.

1. The only effective treatment for pre-eclampsia is delivery, while IV magnesium sulphate is administered to prevent seizures in eclampsia.
2. Delivery on the same day is a viable option after 34 weeks.
3. Nifedipine is considered safe for breastfeeding mothers. (However, labetalol is the preferred antihypertensive medication, as beta-blockers should be avoided in patients with a history of asthma.)
4. Epidural anaesthesia can help lower blood pressure.
5. It is important to continue hypertension treatment during labour to manage blood pressure levels. Please refer to the NICE guideline on the diagnosis and management of hypertension in pregnancy for further information.

Pre-eclampsia is a condition that occurs during pregnancy and is characterized by high blood pressure, proteinuria, and edema. It can lead to complications such as eclampsia, neurological issues, fetal growth problems, liver involvement, and cardiac failure. Severe pre-eclampsia is marked by hypertension, proteinuria, headache, visual disturbances, and other symptoms. Risk factors for pre-eclampsia include hypertension in a previous pregnancy, chronic kidney disease, autoimmune disease, diabetes, chronic hypertension, first pregnancy, and age over 40. Aspirin may be recommended for women with high or moderate risk factors. Treatment involves emergency assessment, admission for observation, and medication such as labetalol, nifedipine, or hydralazine. Delivery of the baby is the most important step in management, with timing depending on the individual case.