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By ULY CLINIC

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Pre-eclampsia 

 

Introduction

 

Is diagnosed when blood pressure is ≥ 140/90 mmHg after 20 weeks of pregnancy plus proteinuria of 300 mg per 24 hours or >2+ on urine dipstick 

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 Diagnostic Criteria

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  • Most patients are asymptomatic, but symptoms may include headaches, dizziness, blurred vision, and epigastric pain.

  • Blood pressure of ≥ 140/90 mmHg 

  • Proteinuria (≥ 300mg per 24 hours) 

  • Generalized edema

 

 Investigations

 

  • Proteinuria (qualitative/quantitative 24 hour urine collection) 

  • Obstetrical Ultrasound and Doppler 

  • Urea, creatinine, electrolytes, liver function test and uric acid 

  • FBC and clotting profile

  • Funduscopic 

 

Mild pre–eclampsia 

 

This is diagnosed when 90 mmHg ≤ diastolic BP < 110 mmHg; Proteinuria 1+ or 2+  

 

Non–pharmaceutical Management 

 

Pregnancy < 37 weeks of gestation 

  • Hospitalization and close monitoring 

  • Bed rest 

  • Monitoring BP, diuresis, proteinuria, fetal movement and fetal heart beats (every day)

  • Antenatal corticosteroids (dexamethasone Inj. 6mg 12hourly for 48hours) if indicated

 

Pregnancy >37 weeks of gestation: admission and deliver. 

 

Severe pre-eclampsia (critical care):

 

 

This is diagnosed when BP ≥ 160/110 mmHg (especially diastolic ≥110 mmHg), Proteinuria ≥+++or ≥ 1g/24h, severe headache, epigastric pain, blurring of vision +/_vomiting 

 

Pharmacological Treatment 

 

  • Hydralazine injection: initial dose of 5 mg IV in 10ml sterile water over 4 minutes. Followed by boluses 5–10mg as needed every 20 minutes until when the diastolic BP is less than 110mmHg)

 OR

  • Nefedipine: 20 mg (PO) 8 hourly until BP is stabilized   

OR

  • Nefedipine: 10 mg (PO) short acting if diastolic blood pressure is ≥ 110mmhg 

OR

  • Labetalol if hypertension is refractory to hydralazine Give 10–20mg intravenously bolus repeat each 10–20 minutes, with doubling doses not exceeding 80 mg in any single dose for maximum total cumulative dose of 300 mg. 

 

Prophylaxis for Seizures

 

Anti-convulsion treatment of choice is magnesium sulfate (Refer to eclampsia section) LoE=1  Obstetrical Management  If at term deliver immediately when stable, preferably vaginal delivery

 

Updated on, 3.11.2020

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References

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1. STG

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