pre-eclampsia

1. D R V I J E T A
PRE-ECLAMPSIA

2.  Defination
 Diagnostic criteria of pre-eclampsia
 Types
 Clinical features
 Investigations
 Management
 Complications

3. Define
 Multi-system disorder of unknown etiology
characterized by hypertension to the extent of
140/90 mm of hg or more with proteinuria
after 20 weeks of pregnancy
in a previously normotensive and non-proteinuric
women.

4. Diagnostic criteria of pre-eclampsia
1. Hypertension 140/90 mm of hg or more
2. Edema- pitting edema over the ankles after 12hrs
bed rest or, rapid gain in weight of more than 1
lb/week or 5 lb/month
3. Proteinuria –presence of total protein in 24hrs of
more than 0.3 gms on atleast 2 random clean catch
samples >4 hrs apart in absence of UTI.

5. CLINICAL TYPES
 MILD- blood pressure more than or equal to
140/90mmhg but less than 160/110 mmhg without
significant proteinuria.
 SEVERE- blood pressure =>160/110 mmhg
protein excretion >5 gms in 24hrs
oliguria <400 ml/24 hrs
platelet count < 1 lakhs
HELLP Syndrome
cerebral/visual disturbances
persistent severe epigastic pain,

6.  Retinal haemorrhages , exudates
 IUGR of fetus
 Pulmonary edema

7. Clinical features
 SYMPTOMS
-SWELLING OVER ANKLES
ALARMING SYMPTOMS -5
1. Headache
2. Disturbed sleep
3. Decreased urine output (<400ml in 24hrs)
4. Epigastric pain
5. Eye symptoms- blurring ,dimness of vision.

8.  SIGNS
1. Weight gain (>1 lb in a week or >5 lb in a month)
2. Rise in blood pressure
3. Edema (visible edema over ankles)
4. Pulmonary edema
5. Per abd. Examination – oliguria ,IUGR

9. INVESTIGATIONS
1. Urine -proteinuria
2. Ophthalmoscopic examination
3. Blood – serum uric acid >4.5 mg/dl
s. creatinine >1 mg/dl
thrombocytopenia
abnormal coagulation profile
raised hepatic enzymes
4. Antenatal fetal monitoring –DFMC, CTG, USG for
fetal growth and liquor ,biophysical profile

10. MANAGEMENT
1. Rest
2. Proper diet
3. Anti-hypertensives –methyl dopa, labetalol,
nifedipine ,hydralazine
Methyl dopa – 250 to 500mg tds/qid
labetalol 20mg iv (can be given every 10 min. to
maximum dose 300mg)
NIFEDIPINE -10 to 20mg orally (can be given in
30min. To max dose 240mg /24hrs)

11. COMPLETE CONTROL –PRETERM (Discharged and
follow up)
term (delivery)
Bp persistently high – try to continue pregnancy till 37
week or atleast 34 weeks
Persistently increasing bp – DELIVERY irrespective of
gestation , prophylactic ANTI- CONVULSANT
THERAPY , steroid if <34 weeks

12. COMPLICATIONS
 IMMEDIATE – MATERNAL ,FETAL
 REMOTE

13.  IMMEDIATE –
MATERNAL –
During pregnancy : eclampsia , accidental haemorrhage
,oliguria/anuria ,diminision of vision (even blindness)
,preterm labour, HELLP SYNDROME ,cerebral
haemorrhage ,respiratory distress.
During labour – eclampsia , PPH
Puerperium –eclampsia, shock ,sepsis
FETAL – IUD, IUGR ,ASPHYXIA, PREMATURITY

14.  REMOTE
1. RESIDUAL HYPERTENSION
2. RECURRENT PRE-ECLAMPSIA
3. CHRONIC RENAL DISEASE
4. ABRUPSIO PLACENTA

15.  THANKYOU