1. BY: GOURAB DAS
8TH SEMESTER
AGMC

2. What is Pre-Eclampsia??
 A PREGNANCY SPECIFIC SYNDROME
CHARACTERIZED BY VARIABLE DEGREES OF
PLACENTAL DYSFUNCTION AND A MATERNAL
RESPONSE FEATURING SYSTEMIC INFLAMMATION.

3. Presenting features..
 GESTATIONAL HYPERTENSION
Systole: >(or=) 140 mm Hg
Diastole: >(or=) 90 mm Hg
RENAL INVOLVMENT: (PROTEINURIA)
Protein > 0.3g / 24 hours
Dipstick > 1 +
PCR > 30mg / mmol

4. WHEN WE ARE CONSIDERING A CASE AS
NON SEVERE???
 Cases with sustained rise of blood pressure of more than
140/90 mm Hg but less than 160 mm Hg systolic or 110 mm
Hg diastolic without significant protienuria (less than or
equal to 2+) and without any signs of end organ
injury/damage.
Headache, Seizures, Visual disturbance.
Epigastric pain, Liver enzymes.
Fetal growth.
Clotting.
 Pre Eclampsia is a bad disease and the term mild is
discouraged.
 Classified as NON SEVERE and SEVERE PRE ECLAMPSIA.

5. Management
OBJECTIVES:
 To stabilize the HTN and to prevent its
progression to severe pre eclampsia.
 To prevent complications.
 To prevent eclampsia.
 Delivery of healthy baby in optimal time.
 Restoration of the health of the mother.

6. Management

7. Management
 Blood pressure:
 Should be recorded more frequently in women at high risk of PE
 Rapid increases warrant closer observation
 Oedema:Rapidly increasing generalised, facial and/or periorbital oedema
requires further assessment.
 New onset of PE is suspected laboratory investigations to track
progression:
 Haemocrit values
 Liver function tests
 Renal tests
 Coagulation screening
 Urinanalysis

8. Management
 Fetal monitoring:
 Antepartum surveillance (CTG’s)
 Symphyseal-fundal height measurements
 Record of fetal movements
 Ultrasonography:
 Amniotic fluid index
 Fetal growth
 Biophysical profiles
 Umbilical artery Doppler studies
 Used to monitor fetal growth and to ascertain the most appropriate
and safest time for delivery

9. Management
 If DBP settles, protienuria becomes insignificant then
she will be adviced to take rest, have her BP checked
regularly.
 Report to the hospital if she develop significant
swelling or develops other symptoms of severe
pre-eclampsia.

10. Management
 If there are any signs of fetal compromise, labour is
induced.
 If there is no fetal compromise, and the pre-eclampsia
doesnot worsen, pregnancy could be continued for
another week.

11. Management
 Expectant Management:
 No evidence that hospital admission for Non severe PE
improves maternal or fetal outcomes
 Admission to hospital is stressful, emotionally and
financially costly
 Women with Non severe PE without significant
proteinuria may be treated as outpatient or admitted as
a ‘day case’ for assessment and evaluation

12. Management
 Expectant Management:
 Expectant management at home or hospital requires:
 Reduced activity
 Woman may be advised to stop working
 May be advised to go on bed rest – although this is logical it
has not been proved to improve outcomes
 Careful recording and daily checking of:
 Fetal activity
 Blood pressure
 Urine protein
 Any other signs and symptoms of PE

13. Management
The role is to:
 Recognise pre-eclampsia early
 Monitor the woman for evidence of disease
progression that would mandate either
delivery of more intensive fetal surveillance

14. Management
 Hospital Management:
May be necessary for woman who:
 Feel safer in hospital
 Hypertension worsens
 Presence of significant proteinuria
 Signs of end organ involvement
 There are concerns about fetal wellbeing
 Baseline laboratory evaluations to monitor progression
of disease
 Crucial that an accurate fluid-balance chart maintained
to ensure that renal impairment detected early

16. THANK YOU