2. INTRODUCTION
• Hypertension is a raise in BP>/=140/90measured
2times with at least 6hours interval
• Gestational hypertension is a raise in
BP>/=140/90 which occurs for the first time in
pregnancyafter 20weeks of gestation ,without
protenuria.
• Pre-eclampsia is gestational hypertention with
protenuria of more than 300mg in a 24 hour
urine collection or persistent 1+ (30mg/dL) on
dipstick
3. INTRODUCTION
• Severe pre eclampsia is the elevation of BP (in
pregnant women) above 160/110mmHg with
protenuria accompanied by blurring of vision,
vomiting, epigastric pain and severe and
persistent headache.
• Eclampsia is pre eclampsia complicated with
convulsions and or coma
• Chronic hypertension is a known hypertension
before pregnancy or diagnosed before 20wks of
pregnancy or persistence of hypertension
beyond 12 weeks postpartum
4. • Superimposed pre eclampsia /eclampsia
occurrence of proteinuria in a woman with
chronic hypertension
5. RISK FACTORS
• Primigravida: Young or elderly
• Family history: Hypertension, pre-eclampsia
• Placental abnormalities:
– Hyperplacentosis
Increased placental tissue for gestational age
Resulting from Hydatiform moles, twin pregnancies, etc.
• Obesity: BMI >35 kg/M2, Insulin resistance.
• Pre-existing vascular disease
• New paternity.
• Thrombophilias
• Renal diseases
6. Classification of Pre-Eclampsia-1
Mild–Moderate Pre-Eclampsia
• May be asymptomatic
• BP is raised but is below 160/110 mmHg
• Protein in urine is 1+ or less, less than 5
grams in a 24 hour urine collection
• No symptoms of severe pre-eclampsia
7. Classification of Pre-Eclampsia-2
Severe Pre-Eclampsia
Pre-eclampsia with any of the following features (but
with no convulsion)
• Severe persistent headache, visual disturbances,
epigastric / right upper abdominal pain
• BP is above 160/110 mmHg
• Protein in urine is 3+ or above
• Hyperreflexia
• Respiratory distress (pulmonary oedema)
• Oligohydramnios
• Intra-Uterine Growth Restrictions/Retardation (IUGR)
8. • Oliguria/anuria
• Acute renal failure (Oliguria with less than
500mL per 24 hours)
• HELLP syndrome
• Pulmonary oedema or cyanosis / generalised
edema
• Concerning abdominal pain
• Impaired liver function test findings
• Thrombocytopenia
9. MANAGEMENT-1
Mild–Moderate Pre-Eclampsia before 37 Weeks of
GA
• Manage as outpatient if patient is compliant and
can be followed closely
• Provide antihypertensives: Aldomet, etc.
• Rest at home
• Monitor foetal well-being
• Foetal movements, ultrasound (USS), etc.
• Deliver at 37weeks
• Patients presenting with pre-eclampsia prior to
34 weeks of gestational age (GA) should be given
a course of steroids.
10. MANAGEMENT-2
FOR SEVERE P./ECLAMPSIA PRINCIPLES OF MANAGEMENT ARE:
• Maintain: airway, breathing & circulation
– Oxygen administration 8–10 L/min or Ventilatory
support
• Control BP
• Prevent/arrest convulsions
• Do investigations
• Decide on delivery, If convulsions have occurred
deliver by 6-8 hours-Treatment with steroids for
lung maturity??
• Prevention of complications or injury
• Postpartum care (intensive)
11. Note:
1. Patients with severe pre-eclampsia/
eclampsia should be managed in the hospital
by a doctor.
12. INVESTIGATIONS
• Urine for albumin test
• Full blood count to all admitted patients
• Serum urea and creatinine to all patients
• Liver function test to all patients
• Serum magnesium level
• Malaria test (BS/MRDT)
• Obstetric USS (if needed)
13. MgSO4
Regimens of MgSO4 for the management of severe pre-eclampsia and eclampsia
Regimen Loading dose Maintenance dose
Intramuscular
(Pritchard)
4 gm IV(20%) over 3–5 min
followed by 10 gm deep IM (5
gm in each buttock)
5 gm IM 4 hourly in
alternate buttock
Intravenous
(Zuspan or Sibai)
4–6 gm IV(20%) over 15–20
min
1–2 gm/hr IV infusion
(50%)
14. MgSO4 DILUTIONS
• 1% Solution= 1g/100ml
• 20% solution=20g/100ml=1g/5ml=2g/10ml
• 50% solution=50g/100ml=1g/2ml=5g/10ml
• 1 Ampoule of MgSO4; 5g in 10ml=1g/2ml= 50% solution
• Loading dose; ------------------------------- 4g of 20% MgSO4
8ml of 50% MgSO4 (4g) + 12ml NS
4g in 20ml solution= 4/20 x100= 20% MgSO4
IV slowly for 15min
• Maintenance dose
1 g of 50% MgSO4 hourly for 24hrs from the last fit or delivery
(depending on what comes LAST)
15. MgSO4
• IN CASE THE PATIENT FITS AFTER THE
LOADING DOSE, GIVE ANOTHER LOADING
DOSE OF 2G OF 20% MGSO4 AND CONTINUE
WITH YOUR MAINTENANCE DOSE.
• Continue with and Magnesium for at least
24 hours post-delivery, and Aldoment
orally until BP is back to normal.
17. MgSO4
Monitoring of patient on MgSO4
• Respirtory rate> 16 b/min
• Patellar reflex should be present
• Urine output of at least 30ml/hr
18. MgSO4
Signs of Mg toxicity
• Absent patellar reflexes
Stop MgSO4 until the reflexes return
Give antidote Calcium gluconate
• Respiratory depression
Give oxygen by mask
Stop MgSO4
Maintain airway
19. ANTI-HYPERTENSIVES
DRUG MODE OF ACTION DOSE
Methyl-dopa Central and peripheral
anti-adrenergic action
250–500 mg tid or qid
Labetalol Adrenoceptor antagonist
(α and β blockers)
100 mg tid or qid
Nifedipine Calcium channel blocker 10–20 mg bid
Hydralazine Vascular smooth muscle
relaxant
10–25 mg bid
21. Complications of Pre-Eclampsia-1
Pre-eclampsia can produce complications in many
different systems.
• Cardiovascular System
o Haematological changes – HELLP syndrome may
lead to DIC.
• Kidneys-o Acute renal failure-AKI (oliguria/anuria)
• Brain
– o Cerebral oedema
– o Infarction, cerebral haemorrhage
– o Blindness, possibly due to retinal artery vasospasms
and retinal detachment
– o Coma – may be a result of CVA
22. Complications of Pre-Eclampsia-2
• Respiratory
– o Pulmonary oedema and cyanosis
• Reduced utero-placental perfusion
– o May be due to increased vasospasms and
perfusion and acute artherosis
• Foetal complications
– o Intrauterine growth restriction, foetal distress,
intrauterine foetal death
23. Key Points
• Severe pre-eclampsia and eclampsia are
dangerous medical conditions, requiring referral
to the hospital level.
• Manage minor hypertensive problems during
pregnancy to prevent progression into eclampsia.
• In severe cases, control convulsions and BP,
maintain fluid balance, deliver the mother at
whatever gestation age, and keep records.
