Preeclampsia- Obstetrics& Gynaecology

PRECLAMPSIA IS A SNODITION MARKED BY HIGH BLOOD PRESSURE AND PROTEINURIA IN PREGNANT WOMEN. TO KNOW MORE CHECK SLIDE.

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2. INTRODUCTION

3. DEFINITION Preeclampsia is a multisystem disorder of unknown etiology characterized by development of hypertension to the extent of 140/90 mm Hg or more with proteinuria after the 20 th week in a privousley normotensive and non proteinuric women

4. Incidence Incidence of preeclampsia in hospital practice varies widely from 5% to 15% Primigravida is about 10% Multigravida 5%

5. Causes 1)Failure of trophoplast invasion 2)Increased production of antiangiogenic factors 3)Coagulation disturbance 4)Altered vascular reactivity 5) Retention of sodium

6. 6) Nutritional factors 7)Inflammatory mediators (cytokines) 8) Immunological intolerance between maternal and fetal tissues 9)Genetic factors 10) Abnormal lipid metabolism

7. Risk factor Primigravida Family history Placenatl abnormality – hyperplacentosis –excessive exposure to chorionic villi -Placental ischemia Obesity – BMI more than 35 kg/m2 , insulin resistence Pre existing vascular disease New paternity , pregnancy following ART Thrombophilias

8. Pathophysiology

9. Clinical types Non severe – blood pressure of more than 140/90 mmHg but less than 160 mm Hg systolic or 110mmHg diastolic without signficant proteinuria . Severe – peristent systolic blood pressure above or equal to 160 mmHg or diastolic pressure above 110mmHg Proteinuria Oliguria less than 400mL /24hour

10. Platelet count less than 100,000/mm3 Elevated liver enzyme Cerebral or visual disturbance Persistent severe epigastric pain Retinal hemorrhage ,exudates Intrauterine growth restriction of the fetus Pulmonary edema Serum creatinine more than1.1 mg /dl

11. Symptoms 1)Mild symptoms 2)Alarming symptoms-headache Disturbed sleep Diminished urinary output – less then 400ml Epigastric pain – results from hepatocelluler necrosis and stretching of liver capsule Eye symptoms – blurring , scotomata , dimness of vision on at times complete blindness vision is usually regained within 4-6 weeks following delivery due to spasm of retinal vessel

12. Investigation Urine – presence of hyaline cast , epithelial cells or even few red blood cell , protein Ophthalmoscopic examination – retinal edema , constriction of the arterioles , alteration of normal ratio of veins : arteriole diameter from 3:2, 3:1 ,hemorrhage .

13. Blood values – serum uric acid level of more than 4.5mg /dl , serum creatinine level may be more than 1mg /dl , thrombocytopenia , hepatic enzyme level may be increased. Antenatal fetal monitoring –daily fetal kick count , ultrasonography liquor pockets , cardiotocography , umbilical artery flow velocimetry and biophysical profile

14. Prediction and prevention of pre eclampsia Screening tests – Doppler ultrasound –high resistance index in the uterine artery Presence of diastolic notch – at 24 weeks gestation in the uterine artery Development of renal dysfunction – hyperuricemia and microalbuminuria

15. Absence of end diastolic frequencies – Average mean arterial pressure (MAP) in second trimester more than or equal 90mmHg Maternal serum level of sFlt -1 is increased Fetal DNA- detection of free fetal DNA in maternal plasma in early pregnancy Proteomics , metabolomics and transcryptomic marker Roll over test – an increase of 20mmHg in diastolic pressure

16. Prophylactic measures for prevention Regular antenatal checkup Antiplatelet agents –low dose aspirin 60mgdaily it inhibit cyclo oxygenase in platelet ,preventing formation of thromboxane Low molecular weight heparin in thrombophilias Calcium supplementation Antioxidants – vitamins c and E , magnesium ,zinc , fish oil and low salt diet Balance diet – increase protein ,reduce risk

17. Management of gestational hypertension and pre eclampsia Rest Diet Diuretics – furosemide 40mg ,orally after breakfast for 5 days in a week Antihypertensive drugs – methyldoma Labetalol Nifedipine Hydralazine

18. Management of preeclampsia

19. Management of severe preeclampsia Group 1 (24-26)-usual management fail to control ,pregnancy has to terminated after proper counseling Group 2(26-34)- depends on their clinical response ,antihypertensive and steroids are given for enhancement of fetal lung maturity , pregnancy is terminated anytime if parameter are unfavorable

20. Continue.. Group 3 (more than 34)- worsening of biophysical or biochemical parameter pregnancy is terminated ,NICU facility is must to reduce perinatal mortality

21. Methods of delivery Induction of labor Indication of labor – aggravation of preeclamptic feature along with epigaastric pain Hypertension persist inspite of medical treatment with pregnancy reaching 37 weeks Acute fulminating pre eclampsia Tendency of pregnancy to overrun the expected date

22. Cesarean section Indication – Urgent termination is indicated , cervix is unfavorable (unripe and closed) Associated complicating factors such as elderly primigravidae , contracted pelvis

23. Management during labor Patient should be in bed Antihypertensive drugs are given B.P and urinary output are to be noted Careful monitoring of fetal wellbeing

24. Complication Maternal –during pregnancy 1 . Eclampsia 2. Accidental hemorrhage 3. Oliguria and anuria 4. Dimness of vision and even blindness 5 . preterm labor 6. HELLP syndrome

25. Continue.. During labor – eclampsia ,postpartum hemorrhage Puerperium – eclampsia , shock , sepsis FETAL – intrauterine death intrauterine growth restriction Asphyxia

26. Nursing management

27. Summary and conclusion

28. Thank you

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