Management of pre eclampsia

very useful to know about the pre eclampsia

1. MANAGEMENT OF PRE-
ECLAMPSIA

2. PREGNANCY
INDUCED
HYPERTENSION
Hypertension develops
as a direct result of
gravid state

3. GESTATIONAL
HYPERTENSION
A sustained raise of blood
pressure to 140/90mmHg or
more in two different
occasions 4 or more hours
apart beyond 20
th
week of
pregnancy or during first 24
hours of delivery in a
previously normotensive
woman

4. PRE-ECLAMPSIA
development of
hypertension-141/90
with proteinuria
after 20
th
week of
pregnancy
in previously
normotensive non
proteinuric patient

5. RISK FACTORS
Primigravidae
Family history
Placental abnormalities
New paternity
Thrombophilias
Pre-existing vascular
disease
Genetic
Immunologic

6. CLINICAL FEATURES
PEDAL OEDEMA

7. ALARMING SYMPTOMS
Headache
Sleep disturbance
Diminished urinary
output
Epigastric pain
Blurring or diminished
vision

8. Diagnostic
criteria
Hypertension
140/90
Oedema
Proteinuria

9. MANAGEMENT
Hospitalization
Rest
Diet-100gm protein, usual salt
intake, no fluid restriction, total
calorie 1600cal/day.
Sedatives
Antihypertensives

10. ANTIHYPERTENSIVES
Methyldopa
Labetalol
Propranalol
Hydralazine
Nifidipine

11. Methyldopa
250mg oral
250-500mg infusion
Watch for postural hypotension
Do investigation to identify the
hemolytic anemia
Avoid working with sharp
instruments and driving as the drug
will induce sleep

12. Labetalol
Orally-100mg t.i.d
1-2mg/min IV infusion.
Do the liver function test
periodically.

13. Hydralazine
100mg/4
th
hourly-orally
Watch for maternal
hypotension, tachycardia,
arrhythmia, palpitation.
Watch for sodium
retention.

14. Nifidipine
5-10mg-orally-t.i.d.
Resume to small activities.
Watch for hypotension.
Help the patient to get up from
the bed.
Use cautiously if there is any
possibility of using the MgSO4

15. Anticonvulsan
t therapy

16. Pritchard regime for the
antenatal management of
severe PIH

17. Zuspan regime for
antenatal management of
severe PIH

18. Magnesium sulfate
Vasodilation there by
reducing cerebral
ischemia
Magnesium sulfate is
now recommended drug
of choice for routine
anticonvulsant
management of
eclampsia.

19. Stop magnesium
sulfate if
Respiratory rate <
16/min
Urine output < 25 ml/h
Knee jerks are
sluggish / absent

20. If magnesium
toxicity is
suspected
Suggested by the
absence of reflexes
1 g IV of calcium
gluconate is given

21. Nurse`s
Responsibility
Hourly monitoring of deep
tendon reflexes
Hourly monitoring of
respiratory status and
oxygen saturation and it
should remain >14/mt and
>95% respectively.
Ensure availability of
calcium gluconate the
antidote of magnesium
toxicity