2. Definition
Pre eclampsia : sustained BP elevation in
pregnancy after 20 weeks’ gestation in the
absence of preexisting hypertension
Systolic BP>160 or diastolic >110 on two
occasions at least 6 hour apart
Proteinuria ≥ 5 g/24 H
Oliguria < 500 cc /24 H
Cerebral or visual symptoms
Epigastric or Rt upper quadrant pain
Pulmonary edema
IUGR
Eclampsia :is the presence of new-onset grand
mal seizures in a woman with preeclampsia that
cannot be attributed to other causes
3. Mechanisms behind preeclampsia
The mechanisms by which
preeclampsia occurs is not
certain. The factors currently
considered to be the most
important include the
following :
Inadequate uteroplacental
perfusion leading to
placental ischemia, or
hypoxia, appears to be
central to the development
of the disease
Maternal immunologic
intolerance
Abnormal placental
implantation
Genetic, nutritional, and
environmental factors
Cardiovascular and
inflammatory changes
4. Risk factor
• Primigravidae
• Previous pre-eclampsia
• Family history
• Race black > white
• Maternal age >35
• Placenta abnormalities
• Pre existing vascular disease
• Chronic renal disease
• Chronic hyprtension
• antiphospholipid syndrome
• Thrombophilias
• DM
• Obesity
• multiple gestation
9. Investigations
CBC
platelet count , LDH if abnormal, order D-dimers,
coagulation panel, and smear .
Clotting profile , electrolytes
Renal studies: serum BUN creatinine and uric acid,
urinalysis, 24-hr urine for protein and creatinine, or
protein/creatinine ratio
Liver function tests: AST, ALT, and bilirubin
10. Management
• Delivery is the only definitive cure for preeclampsia.
• Individualized
• stabilization of the patient with magnesium sulfate for seizure prophylaxis,
along with medical control of severe hypertension and corticosteroids will
allow delivery to be delayed in the hopes of advancing gestational age
• complete medical history, physical examination, and laboratory evaluation.
• A careful fetal evaluation is also indicated
• Chronic antihypertensive therapy or diuretic therapy does not prevent the
progression to severe disease and is not recommended.
• Termination of pregnancy with the least possible complication to the
mother & fetus
• No rule for c/s except if there is one of the indication for C/S
• the blood pressure should not be lowered too rapidly or too much <130/80
mm Hg , may result in a decreased uteroplacental blood flow
11. Anti
hypertensive
treatment
• Methyldopa 500 mg P.O. loading followed by
250- 750 mg not used in acute need 8H to start
action
• the safest, most efficacious drugs for the acute
control of severe hypertension complicating
preeclampsia are labetalol and hydralazine
• Nifedipine should be used cautiously to avoid
hypotension, particularly when used in
conjunction with magnesium sulfate
• Antihypertensive medications that should be
avoided Diuretics
• Atenolol
• Angiotensin converting enzyme inhibitors (ACE)
• Angiotensin receptor-blocking drugs (ARB)
12. SEIZURE PROPHYLAXIS
• magnesium sulfate
• IV + IM , IM is very painful not recommended
• Therapeutic levels are generally accepted to be in the range of 4.8 to 9.6
mg/dL, but to avoid toxicity, levels should not be allowed to rise above 7
to 8 mg/dL
• Carful monitoring of urine output monitoring patellar reflexes ,
respiratory rate
• Magnesium toxicity is treated by stopping the infusion and, when severe,
administering IV calcium gluconate, 10 mL of a 10% solution
• D/C 24 after delivery
13. FLUID MANAGEMENT
Total fluids should be limited to 30 to
50 ml/ hour should be monitored
closely to avoid excessive
administration.
For how are at risk of pulmonary
edema and significant third-spacing
maintenance infusion of a balanced
salt or isotonic saline solution at
approximately 80 mL/hour is often
adequate for a patient who has no
ongoing abnormal fluid losses .
Fluid restriction should be maintained
until postpartum diuresis ensures
14. • Vital signs
• 2 large IV canula
• Send blood sample
• cross match 4-6 unit of blood
• Foley's catheter
• Control fluid intake
• Control blood presser
• Full examination
• Fetal assessment (CTG)
• Deliver
