Pre-eclampsia

Pre-eclampsia is a multisystem disorder of unknown etiology characterized by development of HTN to the extent of 140/90 mm of Hg or more with edema or proteinuria or both after the 20th wks of pregnancy in a previously normotensive & non-proteinuric patient.

Pre-eclampsia also defined as a clinical condition or syndrome characterized by elevated BP or HTN (³ 140/90), significant proteinuria (++/ more) with or without oedema which is developed after 20 weeks of gestation.

Pre-eclampsia

• Management of pre-eclampsia :

Mild symptoms:

Slight swelling over the ankles (which persists on rising from the bed in the morning or tightness of the ring on the fingers).

Alarming symptoms: i)   Headache ii) Disturbed sleep iii) Diminished urinary output iv) Epigastric pain v) Eye symptoms.

• Signs of pre-eclampsia:

i)   Abnormal weight gain.

ii) Rise of blood pressure.

iii) Visible oedema over the ankles.

iv) Pulmonary oedema (Due to leaky capillaries and low oncotic pressure.)

• Investigations of pre-eclampsia:

1.    R/M/E of urine :

i)   Quantity-small, ii) Color – dark iii) Specific gravity – high iv) Protein -present.

2.    Serum electrolytes (is helpful for management)

3.    Heat coagulation test: proteinuria

4.    Ophthalmoscopic examination.

5.    ECG

6.    Ultrasonography.

• Effect of Pre-eclamptia  (complications/danger) on foetus & mother:

Immediate:

1. Maternal:

a. Durine pregnancy:

• Eclampsia.
• Accidental haemorrhage
• Oliguria & anuria
• Dimness of vision & even blindness.
• Premature labour.
• DIC à leading to organ failure.
• Pulmonary oedema à Acute LVF
• HELLP syndrome à Haemolysis, elevated liver enzymes, low platelet count.

b. Purine labour:

• Eclampsia
• PPH

c. Puerperium:

• Eclampsia
• Shock.
• Sepsis

2. Foetal:

• IUD
• IUGR
• Pre- maturity
• Asphyxia.
• Side effects of drugs

Remote:

1.    Residual HTN. (HTN may persist even after 6 months following delivery in about 50% cases)
2.    Recurrent pre-eclampsia
3.    Chronic renal disease.

• Treatment of pregnancy-eclampsia:

i)   Bed rest.

ii)  Diet: The diet should contain adequate amount of preotein (about lOOmg)

iii) Sedative : Phenobarbitone 60mg or diazepam 5 mg at bed time,

iv) Antihypertensives :

• Hydralazine
• Melhyldopa
• Nifedipine,

v) Diuretics (frusemide).

vi)Anticonvulsant (prophylactic): MgSO-t/Diazepam.

vii) Termination of pregnancy by cesarean section .

viii) Monitoring of the patient:

1. Pulse
2. Blood pressure
3. Weight -
4. Urine output.
5. Urinary protein (heat coagulation test).

• Treatment & complication of Eclampsia:

a. First aid treatment outside the hospital:

1. Rest
2. High protein diet.
3. Adequate sedation with
4. Airway should be eleaned.
5. A mouth gag should kept in plaee.
6. Pt. should be immediately sent to the hospital-

• Inj. pethidine 100 mg IM or
• lnj. diazepam 10 mg IM.

• in left lateral position in the transport with head down position.
• a doetor or trained midwife should accompany the pt.
• a note regarding the Mx of the pt. in details should be sent along with the pt.

2. Hospital treatment.

a. General management: on receiving the patient?

1.    Rest

2.    High protein diet.

3.    Adequate sedation with Inj. diazepam 10 mg IM.

4.    Airway is to be cleaned & a mouth gag is to be placed (if the pt. is unconscious)

5.    IV fluid is to be started

6.    Blood is drawn & sent for – grouping & cross – matching.

7.    Catheterization.

8.    Short history is to be taken from the attendants.

9.    Quick thorough assessment of maternal & foetal condition.

10.  Pt. is to be kept in an isolated room, in eclamptic position, (protected from noxious stimuli)

b. Control of fit – by anti convulsive treatment.

c. Controlling B.P- by anti hypertensive drug

d. Controlling fluid balance- by input output chart

e. Obstetric management:

1. Termination of pregnancy: No role of continuation of pregnancy
2. Use of partograph is mandatory

Induction of labour by:

1. AKM.
2. Oxytocin.
3. ARM+Oxytocin.

Augmentation of labour by :

1. ARM
2. Oxytocin.
3. Forceps
4. Ventouse

Surgery: Lower Segment Caesarian Section.

•  Complications of eclampsia:

i)             Left ventricular failure (LVF)

ii)            Pulmonary edema,

iii)           Pulmonary embolism,

iv)           Aspiration pneumonia

v)            Cerebral Hemmorhage

vi)           Renal failure,

vii)         HELLP syndrome,

viii)        Post-partum shock,

ix)           Puerperal psychosis.