This document discusses the complications of hypertensive disorders in pregnancy including preeclampsia and eclampsia. It outlines various maternal and fetal complications that can occur such as HELLP syndrome, seizures, organ damage, and fetal growth restriction. The management of these complications is also described, including termination of pregnancy if needed and treatment with magnesium sulfate. Finally, ways to prevent hypertensive disorders in pregnancy are discussed including modifying risk factors, low dose aspirin, calcium supplementation, antioxidants, regular checkups and timely delivery.
2. COMPLICATIONS OF PREECLAMPSIA
• Immediate
Maternal-
1. During pregnancy- a) Eclampsia-
b) accidental hemorrhage
c) oliguria and anuria
d) dimness of vision or blindness
e) preterm labor
f) HELLP syndrome
g) cerebral hemorrhage
h) ARDS-
2. During labor- a) eclampsia
b) postpartum hemorrhage
3. Puerperium- a) eclampsia
b) shock
c) sepsis
8. COMPLICATIONS OF CHRONIC
HYPERTENSION
• Pre-eclampsia superimposed on HTN
• FGR
• Premature births
• Fetal demice
• Placental abruption
• Caesarean delivery
• End organ damage- CCF, ARF,
• pulm. Edema, intracerebral bleed
• Abruptio placentae with DIC
• Death
9. Management of complications
• Eclampsia-
1. Signs of impending eclampsia--epigastric pain,
headache, visual symptoms.
2. Prevention by prophylactic MgSO4
3. Treatment by MgSO4
4. immediate termination if gestational age >34wks/
termination within 24hrs after giving steroid 2nd dose in
case Gestational age of <34wks cases.
• Intracranial hemorrhage
1. Diagnosis-by c/f (deepening stuper, sensory motor
deficits, focal neurological signs), confirmed by CT/MRI.
2. Aggressive t/t with hypotensive agents.
10. • HELLP syndrome-
1. Hemolysis, elevated liver enzymes and low platelets
2. c/o rt upper quadrant pain/ epigastric pain in 3rd
trimester.
3. Tenesse criteria ( LDH> 600IU/L, SGOT/SGPT>70U/L,
platelet count< 1lakh/mm3)
4. -Abnormal PBS, serum bilirubin> 1.2mg/dL
5. D/d acute fatty liver of pregnancy
6. T/t- immediate termination if gestational age >34wks/
termination within 24hrs after giving steroid 2nd dose in
case Gestational age of <34wks cases.
11. • Pulmonary complications
1. Propped up position, O2 mask, restriction of IV and oral
fluids
2. Furosemide 40mg IV f/b mannitol 20mg IV – for
oedema and ARDS
3. Pulse oximeter- monitoring
4. Suction apparatus- aspiration of mucus
• Heart failure
1. Oxygen inhalation
2. Parenteral lasix
3. Digitalis
12. • Anuria/ oliguria and ARF
1. Fluid balance
2. Nutrition
3. Regulating electrolyte imbalance and supportive
therapy
4. Prevent and treat any complications
• Hyperpyrexia
1. Cold sponging
2. Antipyretics
• Psychosis
1. Chlorpromazine or eskazine
13. • Shock and sepsis-
1. Hospitalisation
2. Iv infusion of ringer lactate for shock
3. Iv antibiotis for sepsis
• visual symptoms-
1. In preorganic stage – close observation
2. Advanced cases- termination of pregnancy
• ARDS-
1.
16. • Primary prevention-
1. Modifying risk factors- obesity, avoiding pregnancy at
extremes of age, embarking on a pregnancy with a well
controlled diabetes, renal disease and chronic HTN
preconceptionally.
• Secondary prevention
1. Low dose aspirin administration
2. Calcium supplimentation
3. Antioxidant administration
• Tertiary prevention-
1. Proper t/t of pre-eclampsia
Prevention of pre-eclampsia
17. Prophylactic measures for prevention of
preeclampsia
• Regular antenatal checkups
• Exercises
• Antiplatelet agents in high risk pregnancy
• Heparin or LMW heparin
• Calcium supplementation
• Antioxidants, vit-C, vit-E
• Balanced diet
• Sildenafil
18. Prevention of eclampsia
• Early detection of preeclampsia
• Effective institutional t/t with judicious termination of
pregnancy during preeclampsia
• Use of antihypertensives, prophylactic anticonvulsant
therapy(MgSO4) and timely delivery.
• Close monitoring during labor and 24hrs postpartum
