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Department of Reproductive Health and Research (RHR), World Health Organization

Managing Complications in Pregnancy and Childbirth

A guide for midwives and doctors 

 


Section 2 - Symptoms


Tableau S-9

Diagnosis of headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure

Presenting Symptom and Other Symptoms and Signs Typically Present

Symptoms and Signs Sometimes Present

Probable Diagnosis

• Diastolic blood pressure 90 mm Hg or more before first 20 weeks of gestation

Chronic hypertension

• Diastolic blood pressure 90–110 mm Hg before 20 weeks of gestation

• Proteinuria up to 2+

 

Chronic hypertension with superimposed 

mild  pre-eclampsia

• Two readings of diastolic blood pressure 90–110 mm Hg 4 hours apart after 20 weeks gestation

• No proteinuria

Pregnancy-induced hypertension

• Two readings of diastolic blood pressure 90–110 mm Hg 4 hours apart after 20 weeks gestation

• Proteinuria up to 2+

 

Mild pre-eclampsia

• Diastolic blood pressure 110 mm Hg or more after 20 weeks gestation

• Proteinuria 3+ or more

• Hyperreflexia

• Headache (increasing frequency, unrelieved by regular analgesics)

• Clouding of vision

• Oliguria (passing less than 400 mL urine in 24 hours)

• Upper abdominal pain (epigastric pain or pain in right upper quadrant)

• Pulmonary oedema

Severe pre-eclampsiaa

• Convulsions

• Diastolic blood pressure 90 mm Hg or more after 20 weeks gestation

• Proteinuria 2+ or more

• Coma (unconscious)

• Other symptoms and signs of severe pre-eclampsia

Eclampsia

• Trismus (difficulty opening mouth and chewing)

• Spasms of face, neck, trunk

• Arched back

• Board-like abdomen

• Spontaneous violent spasms

Tetanus

• Convulsions 

• Past history of convulsions

• Normal blood pressure

 

Epilepsy b

• Fever

• Chills/rigors

• Headache

• Muscle/joint pain

• Enlarged spleen

Uncomplicated malaria

• Symptoms and signs of uncomplicated malaria

• Coma

• Anaemia

• Convulsions

• Jaundice

Severe/complicated malaria

• Headache

• Stiff neck

• Photophobia

• Fever

• Convulsions

• Confusion

• Drowsiness

• Coma

Meningitisb,c or Encephalitisb,c

• Headache

• Blurred vision 

• Vomiting

Migrained

a If a woman has any one of the symptoms or signs listed under severe pre-eclampsia, diagnose severe pre-eclampsia.

b If a diagnosis of eclampsia cannot be ruled out, continue treatment for eclampsia.

mine spinal fluid and give appropriate treatment for meningitis or encephalitis.

d Give analgesics (e.g. paracetamol 500 mg by mouth as needed).

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