4. DEFINITION
DEFINITION:
Preeclampsia is a multiple system disorder of unknown etiology
characterized by development of hypertension to the extent of 140/90
mm hg or more with proteinuria after 20th week in a previously
normotensive and non-proteinuric woman.
PREGNANCY INDUCED HYPERTENSION :
The term “pregnancy induced hypertension (PIH)” is defined
as the hypertension that develops as a direct result of a gravid state.
It includes
🞇 Gestational hypertension
🞇 Pre-eclampsia
🞇 Eclampsia
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6. RISK FACTORS
Primigravida
Family history
Placental
abnormalities
Obesity
Pre-existing
vascular disease
New paternity
Thrombophilias
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PATHOPHYSIOLOGY
In normal pregnancy
Angiotensin II is destroyed by angiotensinase enzyme
which is liberated from placenta.
Vascular system becomes refraction to pressure agent like
angiotensin II by increased synthesis of prostaglandin and
nitric oxide, which act as vasodilator.
8. CLINICAL TYPES
PRE-ECLAMPSIA
MILD SEVERE
Diastolic BP is above 90 mm
hg but less than 110 mm hg.
Systolic BP is 30 mm hg above
the pregnancy reading in early
pregnancy.
The mean arterial pressure
exceeds 105 mm hg.
Systolic BP more than 160mm hg
or diastolic more than 110 mm hg.
Proteinuria > 5 gm/24 hours.
Oliguria < 400 ml/24 hours.
Platelet count < 100000 / mm3.
HELLP syndrome.
Cerebral or visual disturbances.
IUGR
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9. CLINICAL FEATURES
PRE-ECLAMPSIA
WARNING SIGNS
Severe headache or blurred vision
Nausea or vomiting
Dizziness or double vision
Excessive swelling of the hands or feet
Decreased frequency of urination
Rapid pulse
MILD SYMPTOMS
Slight swelling over the ankles.
Swelling may extend to face,
abdominal wall, vulva and even the
whole body.
SIGNS
Abnormal weight gain
Raise blood pressure
Oedema
Pulmonary oedema
ALARMING SYMPTOMS
Headache
Diminished urine output.
Disturbed sleep.
Epigastric pain.
Eye symptoms
Blurring vision
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14. SCREENING TESTS
Doppler ultrasound
Presence of diastolic notch at 24 weeks gestation.
Absence of end diastolic frequencies.
Average mean arterial pressure (MAP) in second
trimester more than 90 mm hg.
Fetal DNA.
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15. PROPHYLACTIC MEASURES
Regular antenatal check-up.
Antithrombotic agents.
Heparin or low molecular weight.
Calcium supplementation (2 gms per day).
Antioxidants, vitamins E, C, and nutritional
supplementation with magnesium, zinc, fish oil and
low salt diet.
Balanced diet.
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16. MANAGEMENT
Objectives
To stabilize the hypertension and to prevent severe
pre-eclampsia.
To prevent the complications.
To prevent eclampsia.
Delivery a healthy baby in optimal time.
Restoration of the health of the mother in
Puerperium.
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19. CONT…..
DRUGS DOSE SCHEDULE MAXIMUM DOSE MAINTAINANCE DOSE
Labetalol 10-20 mg, IV every
10 min
300 mg, IV 40 mg/hour
Hydralazine 5 mg, IV every 30
min
30 mg, IV 10 mg/ hour
Nifedipine 10-20 mg, orally,
can be repeated in
30 min
240 mg/ 24 hour 4-6 hour interval
Nitroglycerine 5 µg/ min IV Short term therapy only when the other drugs
have failed.
Sodium
Nitroprusside
0.25-5 µg/kg/min
IV
Antihypertensive crisis
The following drugs can be used when the BP is more than 160/110 mm hg
or the MAP is more than 125 mm hg :
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21. CONT…..
Management during labour
Progress of labour recorded in partograph.
Abdominal and vaginal examination at regular
intervals.
Bed rest in first stage of labour.
Cut short the second stage of labour with using
prophylactic forceps.
Methergine contraindicated in 3rd stage.
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23. HEELLP SYNDROME
This is an acronym for haemolysis, elevated liver
enzymes and low platelet count (< 100000 mm3).
This is rare complications in pre-eclampsia.
HELLP syndrome are developed even without
maternal hypertension.
The symptoms are nausea, vomiting, Epigastric pain,
right upper quadrant pain along with biochemical and
hematological changes.
There may be sub capsular hematoma formation and
peripheral blood smear.
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24. Antiseizure prophylaxis with magnesium sulphate
(MgSO4) are started.
Anticorticosteroids administer to improves the perineal and
maternal outcome.
Caesarean section are common mode of delivery.
Epidural anaesthesia can be used very safely if platelet
count more than 100000 /mm3.
Platelet transfusion if count less than 50,000/mm3.
Recurrent risk of HELLP syndrome 3-19 %.
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25. CONT…..
Expectant management
🞇 This management carried out selectively :
🞇 When pregnancy less than 34 weeks.
🞇 With bed rest.
🞇 Plasma volume expansion.
🞇 Antithrombotic agent (Dipyridamole).
🞇 Anti-immunosuppressant (steroids).
🞇 Others (fresh frozen plasma).
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