Monday, March 21, 2011

Signs of of Pre-eclampsia in pregnancy

  • Pre-eclampsia is a multi system disorder characterised by hypertension and proteinuria. It is difficult to define clinically due to it's heterogeneous nature.
  • It is defined as blood pressure of more than 140/90 and more than 300mg/24hr of protein in the urine.
  • In women who are hypertensive, a rise of systolic of more than 30mmHg or diastolic of more than 15mmHg is taken.
  • Affects 5% to 10% of pregnancies
  • Believed to be placenta in origin
  • Increase vascular resistance : hypertension
  • Increase vascular permeability: proteinuria, edema
  • Decrease placenta blood flow: Intra-uterine growth restriction
  • Decrease cerebral perfusion: Eclampsia
  • Edothelial cell damage: Clotting abnormality and liver damage
Classification of pre-eclampsia
  • Mild - BP <170/110
  • Moderate - BP >170/110
  • Severe - Pre-eclampsia <32>
Risk factors for pre-eclampsia
  • Nulliparous
  • Previous pre-eclampsia
  • Family history of pre-eclampsia
  • Extremes of maternal age
  • Large placeneta : eg twin
  • Microvascular disease : DM, renal disease, autoimmune disease
  • Existing hypertension
  • Obesity
Symptoms of Pre-eclampsia
  • Central nervous system: Headache, drowsy, visual problems
  • Gastro-intenstinal: Nausea, vomting, epogastric pain
Signs of Pre-eclampsia
  • Hypertension
  • Edema
  • Clonus
  • Epigastric tenderness
Complications of pre-eclampsia and treatment of problems
  • Eclampsia : grand mal seizure - treat with IV magnesium sulphate
  • Cerebral hemorrhage: Preventing BP of more than 170/110 (belived to prevent loss of autoregulation)
  • HELLP: Hemolysis, Elevated Liver enzymes, Low Platelets. - supportive
  • DIVC (disseminated intra-vascular coagulation)
  • Renal failure: May need dialysis
  • Pulmonary edema: Frusemide, ventilation
  • Fetal: IUGR, Placental abruption, fetal hypoxia
Prevention of pre-eclampsia
  • Patients with previous severe or early onset pre-eclampsia should be offered low dose aspirin.
Admission criteria for pre-eclampsia
  • BP> 160/110
  • Any complications
  • Once proteinuria 1+ (admit for 24hr UTP)or >300mg/24hr
Management of Pre-eclampsia
  • Monitor for complications: Fetal and blood and clinical monitoring
  • Control BP: Oral nifedipine and methyldopa (s.e depression, loss of patellar reflex)
  • Steroids if gestation <34>
  • Delivery (Eclampsia can still happen up to 24hrs post delivery)

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