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Table 3 Summary of the systemic evaluation and special investigations of critical ill women with complications of hypertension

From: Evaluation of a strict protocol approach in managing women with severe disease due to hypertension in pregnancy: A before and after study

Organ system evaluated

Clinical examination

Special investigations

Central nervous system

Glasgow coma scale

Lateralising signs

Reflexes

Pupil reflexes

If any abnormalities consider CT Scan

Respiratory system

Respiratory rate

Blood gas

Check for dullness on percussion, crepitations or wheezes

If any abnormalities do blood gas and Chest X-ray

Cardiovascular system:

Pulse, Blood pressure

Heart sounds

Heart size

Radio-femoral delay

 

Gastro intestinal system:

Check for epigastric tenderness, hepatomegaly

Check AST and for jaundice. 4 hourly blood glucose test if raised AST

Renal system:

Check for renal angle tenderness, macroscopic hematuria

Listen for murmurs over the renal artery

Check creatinine and fluid balance. If signs of kidney dysfunction do full kidney function tests

Haematological system:

Check for anaemia, purpera, bleeding tendency

Check hematocrit and platelets

Immune system:

Body temperature

Check for generalized lymphadenopathy, splenomegaly, signs of immune system failure

Voluntary counselling and HIV testing if CD4 and ESR above 100

Musculosceletal System

Check for signs of DVT

Check for spinal problems that might influence the type of anaesthesia

 

Gynaecological system:

Abdominally: measure symphysis-fundus height, lie & position of the foetus, check for uterine tenderness or contractions, estimate foetal weight, measure amniotic fluid, check for foetal heart rate

Vaginal exam: assess the Bishop score

 

Fundoscopy:

Check for silver wiring, papillar oedema and signs of bleeding