1. PIH and Eclampsia
Dr. V. L. Deshmukh
Associate Professor
Dept. of OBGY
Govt. Medical College
AURANGABAD

2. Maternal Mortality
Major causes of maternal mortality are
• PIH
• Eclampsia
• APH
• PPH
• Puerperal sepsis
• Obstructed labour
• Unsafe abortions

3. Introduction
• Hypertensive disorders in pregnancy
• Significant maternal morbidity
• Fetal morbidity and mortality
• Includes PIH, pre-eclampsia,
eclampsia, chr. Hypertension, chr.
Hypertension with superadded PIH

4. Definition
• Multi systemic disorder
• After 20 wks
• B.P. > 140/90 mmHg
• Proteinuria
• Edema
• Excessive wt. Gain

5. Classification
Finding Mild pre-eclampsia Severe pre-eclampsia
B.P. •The diastolic pressure
rises 1`5-20 mmHg
above the “usual’ level,
OR
•The absolute level of
BP is >140/90 mmHg
but <160/110 mmHg
The diastolic pressure
rises >20 mmhg above
the ‘usual’ level; OR
The absolute level of BP
is 160/110 mmhg
Proteinuria Present, but 2+ or less 3+ or persistently greater
Generalized edema (including
in the face and hands)
May or may not be
present
Present
Headache Absent Present
Visual distrubances Absent Present
Upper abdominal pain Absent Present
Oliguria Absent Present
Diminished fetal movement Absent Present

6. Eclampsia
• Characterized by convulsions and/or
coma
• Women has PIH
• Types antepartum, intrapartum and
postpartum.
• No lower limit of B.P. for eclampsia can
even occur at 120/80 mmHg

7. Fulminating Eclampsia
Symptoms :
• Severe headache
• Drowsiness
• Mental confusion
• Visual distrubances
• Epigastric pain
• Nausea, vomiting
• Decreased urinary output

8. Signs
• A sharp rise in B.P.
• Increased proteinuria
• Exaggerated knee jerk

9. Status Eclampticus
• Continuous convulsions
• Dangerous for mother and fetus
• Can lead to fetal and maternal
mortality

10. Stage of Eclampsia
• Premonitory
• Tonic
• Clonic
• Coma

11. Eclampsia
• Can occur regardless of severity of
hypertension
• Difficult to predict
• Tonic clonic
• Rapid sequence
• Can occur in the absence of hyper-
reflexia, headache and visual
disturbances.

12. D/D of Eclampsia
• Epilepsy
• Cerebral malaria
• Meningitis
• Encephalitis
• Tetanus
• Head injury

13. Effect on Mother
• Asphyxia
• Aspiration
• Pulmonary edema
• Bronchopneumonia
• Cardiac failure
• Brain hemorrhage
• Cerebral thrombosis
• Cerebral edema

14. Effect on Mother
• ARF
• HELLP
• DIC
• Temporary blindness
• Injuries
• Tongue bite

15. Effect on Fetus
• Hypoxia
* IUGR
* Stillbirth

16. High risk for Eclampsia
• Teenagers / elderly primi.
• Essential HT
• Twins
• Women with DM, polyhydramnios,
V. mole
• H/o eclampsia
• Obese women

17. Mortality due to Eclampsia
• Failure to monitor B.P. in ANC
• Failure to monitor proteinuria
• Lack of clear-cut mgt. strategy for PIH
• Lack of proper equipment and drugs.
• Late referral
• Failure to counsel women & her relatives
about S/s of PIH & ANC
• Failure to timely manage complications of
Eclampsia.

18. Diagnosis
• Pregnant women or PNC
complaints of severe headache,
blurred vision
• Unconscious
• Convulsions
• Elevated B.P.

19. Mgt. of PIH
• ANC
• Check B.P.
• Proteinuria
• Body edema
• Weight
• Regular ANC check-up
• Rise in B.P.
• Refer

20. Mild PIH
• B.P. 140/90 mmHg but less than
160/110 mmHg.
• < 37 wks
• > 37 wks
- TERMINATE

21. Mild PIH
< 37 wks.
• Bed rest
• Wkly visit
• Check B.P.
• Proteinuria
• Wt. Of the patient
• Body edema
• Exclude S/o severe PIH
• DFMC
• Check FHS

22. Mild PIH
BOOK THE PATEINT FOR
DELIVERY AT BEmOC CENTER.

23. Mild PIH
> 37 wks.
• Assess cervix
• Accelerate delivery
• Check B.P. 4 hrly.(2 hrly if severe
PIH)
• Bed rest
• Proteinuria B.D.
• Monitor FHS

24. Mild PIH
• Give sedation
• Give antihypertensive
• Only if diastolic B.P. is > 110
mmHg

25. Eclampsia
Six major steps :
1. Maintain airway
2. Control fits
3. Control B.P.
4. Deliver the pt.
5. Maintain fluid balance
6. Give after care of delivery

26. Eclampsia
Maintain airway :
1. LLP
2. Gentle section
3. Oxygen
4. Place padded tongue blade in her
mouth to prevent aspiration and
tongue bite
DO NOT ATTEMPT THIS DURING
CONVULSIONS

27. Eclampsia
Control fits :
MAGSULF THERAPY
• Dose – Inj. MgSo4 – 4 gm (20 ml of 20%
sol.) slow I.V. at the rate of 1 ml / min.
NOT TO BE GIVEN AS BOLUS
• Maintenances dose 5 gm deep I.M.
every 4 hrly.

28. Eclampsia
• If convulsions recur give additional 2 gm
magsulf (10 ml of 20% sol.) I.V. over 20
min.
• Wait for 15 min.
• If still convulsions recur – give
diazepam
REFER

29. Eclampsia
Monitoring of MgSo4 therapy
1. Output atleast 100 ml/4 hrs.
2. Knee jerk present
3. Respiratory rate 16 breath/min
POSTPONE THE NEXT DOSE IF
ABOVE CRITERIA NOT MET

30. Eclampsia
Precautions :
Do not give
1. 50% MgSo4 without diluting it to 20%
2. Rapid I.V. infusion as it may cause
respiratory failure and death
If respiratory depression occurs (RR <
16/min)
1. Discontinue MgSo4
2. Give calcium gluconate - 1 gm I.V. (10 ml of
10% solution) over a period of 10 min.

31. Eclampsia
Other options available are :
1. Diazepam (10 mg I.V. slowly over 2
min.)
2. Phenytoin sodium
3. Largactil
MgSO4 IS SUPERIOR TO ALL ABOVE
DRUGS IN ECLAMPSIA

32. Eclampsia
Controlling the B.P.
• Tab. Depine – 10 mg t.d.s.
• Tab. Labetelol – 50 mg b.d.
• Other drugs available – Hydralazine

33. Eclampsia
Controlling fluid balance :
1. Intake output chart
2. Output 100 ml/4 hrs.
3. 60 ml /hr fluid intake
4. Extra fluid if vomiting, excessive blood loss
or diarrhoea.
PROPER MAINTENANCE OF FLUID
BALANCE TO PREVENT WATER
INTOXICATION, DEHYDRATION,
HYPONATREMIA OR PULMONARY
EDEMA.

34. Eclampsia
DIURETICS SHOULD NOT BE
USED, IT IS DANGEROUS

35. Eclampsia
Delivering the baby
1. If PIH deliver within 24 hrs.
2. If eclampsia deliver within 12 hrs.
3. If vg. Delivery is not anticepated or Cx
is unfavourable or S/o fetal distress,
REFER

36. Eclampsia
Delivery
1. Before labour
- Control B.P.
- Control fits
REFER
2. Late 1st
stage / 2nd
stage
- Carry out Vg. delivery
REFER

37. Eclampsia
Difficult deliveries :
1. Labour not progressing quickly
2. Big size baby
REFER
GIVE MgSO4

38. Rule of Thumb
• Pt. with severe PIH comes
early 1st
stage of labour –
REFER
• Pt. comes in late labour or 2nd
stage – conduct delivery, give
MgSO4 – REFER
Rule of Thumb

39. Eclampsia – Postpartum Care
1. Refer pt. After one hr. of delivery after ruling
out PPH
2. If pt. Has fits, observe for 48 hrs. after
convulsions.
3. Closely observe her consciousness, output
4. Monitor B.P. every hrly.
5. Given anti-hypertensives till B.P. comes
down to 100 mmHg diastolic

40. Eclampsia – Postpartum Care
• Do not give excessive IV fluid
• If after 72 hrs. there are no convulsions,
output is good, and B.P. is 100 mmHg
diastolic – discharge the pt.
• Arrange for follow-up – 7 to 10 days
after delivery.
CONTINUED FITS – REFER WITHOUT
DELAY

41. Eclampsia – Postpartum Care
Following Eclampsia B.P. may :
1. Return to normal within 48-72
hrs.
2. Return to normal after a few
wks. May remain high
permanently.

42. Referral
• Should be
transported
by the
quickest
mode of
transport
• 3 delays

43. Through a team approach all of the skills
of the health care members involved can
be combined to provide the best possible
approach to meet the pregnancy’s need.
The role of patient education can not be
over emphasized. Incorporating the
mother as an active member in her health
care is an investment in time and effort
that is cost effective both during
pregnancy and labour.

44. A systematic & a well begun programme
with a positive thinking will definitely show
road to success to accept this challenge