This includes a detailed view about Gestational hypertension, Pre-eclampsia,Eclampsia

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2. Prof: Kavitha Mole PJ
3/28/2017
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3. INTRODUCTION
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4. DEFINITION
DEFINITION:
Preeclampsia is a multiple system disorder of unknown etiology
characterized by development of hypertension to the extent of 140/90
mm hg or more with proteinuria after 20th week in a previously
normotensive and non-proteinuric woman.
PREGNANCY INDUCED HYPERTENSION :
The term “pregnancy induced hypertension (PIH)” is defined
as the hypertension that develops as a direct result of a gravid state.
It includes
 Gestational hypertension
 Pre-eclampsia
 Eclampsia
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5. DIAGNOSTIC CRITERIA OF
PREECLAMPSIA
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6. RISK FACTORS
 Primigravida
 Family history
 Placental
abnormalities
 Obesity
 Pre-existing
vascular disease
 New paternity
 Thrombophilias
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7. PATHOPHYSIOLOGY
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In normal pregnancy
 Angiotensin II is destroyed by angiotensinase enzyme
which is liberated from placenta.
 Vascular system becomes refraction to pressure agent like
angiotensin II by increased synthesis of prostaglandin and
nitric oxide, which act as vasodilator.

8. CLINICAL TYPES
PRE-ECLAMPSIA
MILD SEVERE
 Diastolic BP is above 90 mm
hg but less than 110 mm hg.
 Systolic BP is 30 mm hg above
the pregnancy reading in early
pregnancy.
 The mean arterial pressure
exceeds 105 mm hg.
 Systolic BP more than 160mm hg
or diastolic more than 110 mm hg.
 Proteinuria > 5 gm/24 hours.
 Oliguria < 400 ml/24 hours.
 Platelet count < 100000 / mm3.
 HELLP syndrome.
 Cerebral or visual disturbances.
 IUGR
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9. CLINICAL FEATURES
PRE-ECLAMPSIA
WARNING SIGNS SIGNS
 Severe headache or blurred vision
 Nausea or vomiting
 Dizziness or double vision
 Excessive swelling of the hands or feet
 Decreased frequency of urination
 Rapid pulse
 Abnormal weight gain
 Raise blood pressure
 Oedema
 Pulmonary oedema
ALARMING SYMPTOMSMILD SYMPTOMS
 Slight swelling over the ankles.
 Swelling may extend to face,
abdominal wall, vulva and even the
whole body.
 Headache
 Diminished urine output.
 Disturbed sleep.
 Epigastric pain.
 Eye symptoms
 Blurring vision
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10. INVESTIGATION
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11. CONT…..
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12. COMPLICATIONS
IMMEDIATE
Maternal complication
During pregnancy
 Eclampsia
 Accidental hemorrhage
 Oliguria and anuria
 Preterm labour
 HELLP syndrome
 Dimness of vision and even blindness
 Cerebral hemorrhage
 Acute respiratory distress syndrome (ARDS)
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13. CONT…..
During labour
 Eclampsia
 Postpartum hemorrhage
Puerperium
 Eclampsia
 Shock
 Sepsis.
Fetal complications
 Intrauterine death
 Asphyxia
 Prematurity
 IUGR
Remote complications
 Residual hypertension
 Recurrent pre-eclampsia
 Chronic renal disease
 Placental abruption
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14. SCREENING TESTS
 Doppler ultrasound
 Presence of diastolic notch at 24 weeks gestation.
 Absence of end diastolic frequencies.
 Average mean arterial pressure (MAP) in second
trimester more than 90 mm hg.
 Fetal DNA.
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15. PROPHYLACTIC MEASURES
 Regular antenatal check-up.
 Antithrombotic agents.
 Heparin or low molecular weight.
 Calcium supplementation (2 gms per day).
 Antioxidants, vitamins E, C, and nutritional
supplementation with magnesium, zinc, fish oil and
low salt diet.
 Balanced diet.
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16. MANAGEMENT
Objectives
 To stabilize the hypertension and to prevent severe
pre-eclampsia.
 To prevent the complications.
 To prevent eclampsia.
 Delivery a healthy baby in optimal time.
 Restoration of the health of the mother in
Puerperium.
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17. HOSPITAL MANAGEMENT
• REST
DIET
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18. CONT…..
 DIURETICS
 ANTIHYPERTENSIVE
DRUG
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19. CONT…..
DRUGS DOSE SCHEDULE MAXIMUM DOSE MAINTAINANCE DOSE
Labetalol 10-20 mg, IV every
10 min
300 mg, IV 40 mg/hour
Hydralazine 5 mg, IV every 30
min
30 mg, IV 10 mg/ hour
Nifedipine 10-20 mg, orally,
can be repeated in
30 min
240 mg/ 24 hour 4-6 hour interval
Nitroglycerine 5 µg/ min IV Short term therapy only when the other drugs
have failed.Sodium
Nitroprusside
0.25-5 µg/kg/min
IV
Antihypertensive crisis
The following drugs can be used when the BP is more than 160/110 mm hg
or the MAP is more than 125 mm hg :
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20. CONT…..
MANAGEMENT
DURATION OF
TREATMENT
GROUP-
A
METHODS OF
DELIVERY
INDUCTION OF
LABOUR
CAESAREAN
SECTION
GROUP-
B
GROUP-
C
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21. CONT…..
Management during labour
 Progress of labour recorded in partograph.
 Abdominal and vaginal examination at regular
intervals.
 Bed rest in first stage of labour.
 Cut short the second stage of labour with using
prophylactic forceps.
 Methergine contraindicated in 3rd stage.
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22. SCHEME OF MANAGEMENT OF PRE- ECLAMPSIA
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23. HEELLP SYNDROME
 This is an acronym for haemolysis, elevated liver
enzymes and low platelet count (< 100000 mm3).
 This is rare complications in pre-eclampsia.
 HELLP syndrome are developed even without
maternal hypertension.
 The symptoms are nausea, vomiting, Epigastric pain,
right upper quadrant pain along with biochemical and
hematological changes.
 There may be sub capsular hematoma formation and
peripheral blood smear.
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24.  Antiseizure prophylaxis with magnesium sulphate
(MgSO4) are started.
 Anticorticosteroids administer to improves the perineal and
maternal outcome.
 Caesarean section are common mode of delivery.
 Epidural anaesthesia can be used very safely if platelet
count more than 100000 /mm3.
 Platelet transfusion if count less than 50,000/mm3.
 Recurrent risk of HELLP syndrome 3-19 %.
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25. CONT…..
Expectant management
 This management carried out selectively :
 When pregnancy less than 34 weeks.
 With bed rest.
 Plasma volume expansion.
 Antithrombotic agent (Dipyridamole).
 Anti-immunosuppressant (steroids).
 Others (fresh frozen plasma).
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26.  Abruptio placentae
 Cerebral oedema
 Pulmonary oedema
 Laryngeal oedema
 ARDS
 Sepsis
 Acute renal failure
 Severe ascites
 Retinal detachment
 Subcapsular hematoma
 Death
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