PRECLAMPSIA IS A SNODITION MARKED BY HIGH BLOOD PRESSURE AND PROTEINURIA IN PREGNANT WOMEN. TO KNOW MORE CHECK SLIDE.

1. PREECLAMPSIA
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2. INTRODUCTION

3. DEFINITION
Preeclampsia is a multisystem disorder of
unknown etiology characterized by
development of hypertension to the extent of
140/90 mm Hg or more with proteinuria after
the 20th week in a privousley normotensive
and non proteinuric women

4. Incidence
 Incidence of preeclampsia in hospital practice
varies widely from 5% to 15%
 Primigravida is about 10%
 Multigravida 5%

5. Causes
1)Failure of trophoplast invasion
2)Increased production of antiangiogenic
factors
3)Coagulation disturbance
4)Altered vascular reactivity
5) Retention of sodium

6. 6) Nutritional factors
7)Inflammatory mediators (cytokines)
8) Immunological intolerance between
maternal and fetal tissues
9)Genetic factors
10) Abnormal lipid metabolism

7. Risk factor
 Primigravida
 Family history
 Placenatl abnormality –hyperplacentosis –
excessive exposure to chorionic villi
-Placental ischemia
 Obesity – BMI more than 35 kg/m2 , insulin
resistence
 Pre existing vascular disease
 New paternity , pregnancy following ART
 Thrombophilias

8. Pathophysiology

9. Clinical types
 Non severe – blood pressure of more than
140/90 mmHg but less than 160 mm Hg
systolic or 110mmHg diastolic without
signficant proteinuria .
 Severe – peristent systolic blood pressure
above or equal to 160 mmHg or diastolic
pressure above 110mmHg
 Proteinuria
 Oliguria less than 400mL /24hour

10.  Platelet count less than 100,000/mm3
 Elevated liver enzyme
 Cerebral or visual disturbance
 Persistent severe epigastric pain
 Retinal hemorrhage ,exudates
 Intrauterine growth restriction of the fetus
 Pulmonary edema
 Serum creatinine more than1.1 mg /dl

11. Symptoms
1)Mild symptoms
2)Alarming symptoms-headache
 Disturbed sleep
 Diminished urinary output – less then 400ml
 Epigastric pain – results from hepatocelluler
necrosis and stretching of liver capsule
 Eye symptoms – blurring , scotomata , dimness
of vision on at times complete blindness vision is
usually regained within 4-6 weeks following
delivery due to spasm of retinal vessel

12. Investigation
 Urine – presence of hyaline cast , epithelial
cells or even few red blood cell , protein
 Ophthalmoscopic examination – retinal
edema , constriction of the arterioles ,
alteration of normal ratio of veins : arteriole
diameter from 3:2, 3:1 ,hemorrhage .

13.  Blood values – serum uric acid level of more
than 4.5mg /dl , serum creatinine level may
be more than 1mg /dl , thrombocytopenia ,
hepatic enzyme level may be increased.
 Antenatal fetal monitoring –daily fetal kick
count ,ultrasonography liquor pockets ,
cardiotocography , umbilical artery flow
velocimetry and biophysical profile

14. Prediction and prevention of
pre eclampsia
 Screening tests –
 Doppler ultrasound –high resistance index in
the uterine artery
 Presence of diastolic notch – at 24 weeks
gestation in the uterine artery
 Development of renal dysfunction –
hyperuricemia and microalbuminuria

15.  Absence of end diastolic frequencies –
 Average mean arterial pressure (MAP) in second
trimester more than or equal 90mmHg
 Maternal serum level of sFlt -1 is increased
 Fetal DNA- detection of free fetal DNA in
maternal plasma in early pregnancy
 Proteomics ,metabolomics and transcryptomic
marker
 Roll over test – an increase of 20mmHg in
diastolic pressure

16. Prophylactic measures for
prevention
 Regular antenatal checkup
 Antiplatelet agents –low dose aspirin 60mgdaily
it inhibit cyclo oxygenase in platelet ,preventing
formation of thromboxane
 Low molecular weight heparin in thrombophilias
 Calcium supplementation
 Antioxidants – vitamins c and E , magnesium
,zinc , fish oil and low salt diet
 Balance diet – increase protein ,reduce risk

17. Management of gestational
hypertension and pre eclampsia
 Rest
 Diet
 Diuretics – furosemide 40mg ,orally after
breakfast for 5 days in a week
 Antihypertensive drugs – methyldoma
 Labetalol
 Nifedipine
 Hydralazine

18. Management of preeclampsia

19. Management of severe
preeclampsia
 Group 1 (24-26)-usual management fail to
control ,pregnancy has to terminated after
proper counseling
 Group 2(26-34)- depends on their clinical
response ,antihypertensive and steroids are
given for enhancement of fetal lung maturity
, pregnancy is terminated anytime if
parameter are unfavorable

20. Continue..
 Group 3 (more than 34)- worsening of
biophysical or biochemical parameter
pregnancy is terminated ,NICU facility is
must to reduce perinatal mortality

21. Methods of delivery
 Induction of labor
 Indication of labor – aggravation of
preeclamptic feature along with epigaastric
pain
 Hypertension persist inspite of medical
treatment with pregnancy reaching 37 weeks
 Acute fulminating pre eclampsia
 Tendency of pregnancy to overrun the
expected date

22. Cesarean section
 Indication –
 Urgent termination is indicated , cervix is
unfavorable (unripe and closed)
 Associated complicating factors such as
elderly primigravidae , contracted pelvis

23. Management during labor
 Patient should be in bed
 Antihypertensive drugs are given
 B.P and urinary output are to be noted
 Careful monitoring of fetal wellbeing

24. Complication
 Maternal –during pregnancy
1 . Eclampsia
2. Accidental hemorrhage
3. Oliguria and anuria
4. Dimness of vision and even blindness
5 . preterm labor
6. HELLP syndrome

25. Continue..
 During labor – eclampsia ,postpartum
hemorrhage
 Puerperium – eclampsia , shock , sepsis
 FETAL – intrauterine death
 intrauterine growth restriction
 Asphyxia

26. Nursing management

27. Summary and conclusion

28. Thank you

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