This document discusses the prevention and management of preeclampsia. It recommends low-dose aspirin and supplements for women at risk of preeclampsia. For mild cases, expectant management can be done until term delivery. Severe uncontrolled hypertension, worsening symptoms, or fetal distress require hospitalization and closer monitoring. Antihypertensives are given to control blood pressure, and magnesium sulfate is the most effective drug for preventing and treating seizures. Prompt delivery is needed to cure preeclampsia.

1. Prevention
 Indicated for women whom are at risk : multiple
pregnancy, vascular or renal disease, previous severe
pre-eclampsia-eclampsia, and abnormal uterine artery
doppler velocimetry.
 Give :
1. Low-dose aspirin (75mg daily). Started at 13 wks .
2. Magnesium .
3. Zinc.
4. Fish oil.
5. Calcium.

2. A characteristic *Notch* can be seen in waveform
pattern.

3. MANAGEMENT OF
PREECLAMPSIA & PIHAfter early diagnosis, further management
depends on …
Severity of disease
Fetal maturity
Condition of cervix

4. For mild - controlled disease :
Thereafter induction may be done at
term depending on cervical condition
Can be managed expectantly till term at
home/hospital and continued till term.
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5. Hospitalisation???
• Gestational HTN : only if severe HTN
• Indicationof pre-termdelivery :
1. Severe uncontrolled hypertension.
2. Progressive symptoms. ( headache, visual disturbance,
epigastric pain.)
3. Pulmonary edema.
4. Renal compromise with oliguria.
5. Eclampsia.
6. Fetal distress.

6. When should we use antihypertensive
to control the BP???
• Acute management of
severe hypertension
(BP > 150/100: to
prevent stroke)
which may require
parenteral therapy.

7. What are the
options???
Acute
Hydralazine inj.:
now available
Labetalol
Injection
Nifedipine
capsule/Tablet
Long
term
Methyl Dopa
250 mg Tab.
Labetalol Tablet
100 mg
Nifedipine
5,10,20 mg

8. For severe-uncontrolled disease:
LUCS OR In case of very severe uncontrolled disease elective LUCS
may be done without induction
Preinduction
Cervical ripening with prostaglandin/osmotic dilators followed by
induction
Termination is considered
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If failed

9. DELIVERY CARE
• Antihypertensives : continued throughout labour
to maintain BP < 160/110 mmHg .
• 3rd Stage : actively managed with oxytocin 5 units
IV or 10 units IM, particularly in the presence of
thrombocytopenia or coagulopathy.
• Ergometrine should NOT be given
• Prolonged pushing should be avoided.
• Fluid management is important in severe PE.
( 1L ringer lactate/ 12 h ).

11. Management Of
Eclampsia:

12. Management of Eclampsia :
Prompt delivery of fetus to achieve cure
Avoidance of diuretics & hyper osmotic agents
Limitation of I.V fluid
Intermittent antihypertensive to control BP judiciously
Control of convulsion by MgSO4 (IM/IV route)
Protection & supporting care during convulsion
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13. to control convulsion
“It is the most effective drug
to control even recurrent
seizures without any central
nervous system depression to
mother & fetus”
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Magnesium
sulphate

14. Some more about Magnesium
• Duration : 24 hrs from last convulsion or from delivery which
one is longer.(This is called Magnesium sulphate prophylaxis
in severe preeclampsia.)
• Features of toxicity:
i> Impaired breathing.
ii>Arrythmia and Asystole.
iii>Decreased/absent deep tendon reflex.
iv> Shock.
• For a maintenance dose following must be present -
Serum Mg level 4-7meq/l(twice
daily)
Having Patellar reflex
Urine output >30ml/hr
RR>12/min
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15. WHAT If magnesium toxicity is suspected???
Administration of 10mL of 10% calcium gluconate (1 g in total) as
a slow intravenous push.
Serum magnesium level obtained.
Magnesium infusion should be discontinued, supplemental oxygen
administered,

16. Case:
• A healthy 29-year-old G2P1 is admitted to
labor and delivery at 28 weeks’ gestation
complaining of a severe headache and blurred
vision. Her BP is 200/110 mmHg with 2+
proteinuria on urinalysis. Repeat BP a few
hours later is 160/110 mmHg. Laboratory
studies showed a normal hematocrit, platelet
count, and liver transaminase levels.

17. • Q / What type of pre-eclampsia does she have?
A / “severe” pre-eclampsia.
Q / Shouldshe be delivered or can she be managedexpectantly?
a/ Delivery is the only effective treatment for
pre-eclampsia.

18. Thank You…