Clinical features

• Abnormal vasculogenesis and angiogenesis and releasing of anti-angiogenic factors results in • Vasospasm• Endothelial dysfunction

• Etiology of various clinical signs and symptoms

So, Preeclampsia usually develops

Abnormal placentation Endothelial dysfunction

Clinical diagnosis of Preeclampsi

aACOG Task Force on

Hypertension in Pregnancy 2013

Classification of Preeclampsia1. Preeclampsia-eclampsia

2. Chronic hypertension

3. Chronic hypertension with superimposed preeclampsia

4. Gestational hypertension

Preeclampsia-eclampsia 2013

HYPERTENSION

PROTEINURIA

SEVERE FEATURES

OR

**edema, IUGR, oligohydramnios, 24 hour proteinuria > 5 gms/day

NOT i l d i di ti it i

Not always necessary

Systolic BP 140Diastolic BP 90

HYPERTENSION

(4 hours apart)

PROTEINURIA

24 hours ≥ 300 mgUrine dipstick ≥ 1+

SEVERE FEATURES Severe hypertension (≥ 160/110 mmHg) Low platelet count (< 100,000/cu.mm.) Abnormal liver function

(Increase AST/ALT 2 folds or RUQ pain) Abnormal renal function

(Cr > 1.1 mg/dl or 2 folds of baseline level) Pulmonary edema Symptoms of nervous system and vision

CBC with platelet, AST, ALT, LDH, Creatinine, Bilirubin, Uric acid

Mild preeclampsiaPreeclampsia without severe features

Severe preeclampsiaPreeclampsia with severe features

ECLAMPSIA

during pregnan

cy38-55%

during labor

18-36%

11-44%POSTPARTUMMOSTLY WITHIN

48 HOURS

Can Preeclampsia-eclampsia

be prevented?

ASPIRIN

Low dose aspirin (60-80 mg) for high risk groupbeginning in the late first trimester

ASPIRIN

Previous preeclampsia, diabetes, hypertension, renal disease, autoimmune disease, multiple pregnancy

High risk group

Preeclampsia-eclampsiaPrinciple of management

1. Controlling or prevention of

eclampsia

2. Lowering blood pressure

3. Adequate hydration

4. Termination of pregnancy

Preeclampsia-eclampsia

MgSO41

Preeclampsia with severe features

Eclampsia

MgSO4Dosage :

20% MgSO4 2-6 gram IV loading dose in 10-15 min, then50% MgSO4 40 gram + 5%DW 920 mL IV drip 2 gram (50 mL)/hr

Monitor : urine output, reflex,

respiratory rate, blood pressure

Antidote : 10% Calcium gluconate 10 mL (1gram) IV

Therapeutic level : 4.8-8.4 mg/dL

1

Antihypertensive

Labetalol

Hydralazine

Nifedipine

2 BP ≥ 160/110 mmHg

Antihypertensive2 BP ≥ 160/110 mmHg and viable fetus

Labetalol 20 mg IV over 2 minutes

Hydralazine 10 mg IV over 2 minutes

Labetalol 40 mg IV over 2 minutes

10 minutes

Labetalol 80 mg IV over 2 minutes

10 minutes

10 minutes

ACOG Committee opinion; FEB 2015

Consultor

Surveillance

Antihypertensive2Hydralazine 5-10 mg

IV over 2 minutes

Labetelol 40 mg IV over 2 minutes

Hydralazine 10 mg IV over 2 minutes

20 minutes

Labetelol 20 mg IV over 2 minutes

20 minutes

10 minutes

BP ≥ 160/110 mmHg and viable fetus

ACOG Committee opinion; FEB 2015

Consultor

Surveillance

Antihypertensive2Nifedipine 10 mg

PO

Labetelol 40 mg IV over 2 minutes

Nifedipine 20 mg PO

20 minutes

Nifedipine 20 mg PO

20 minutes

20 minutes

BP ≥ 160/110 mmHg and viable fetus

ACOG Committee opinion; FEB 2015

Consultor

Surveillance

Special precaution• Do not prescribe diazepam (valium®)

in case of preeclampsia-eclampsia • Unless status epilepticus was observed

2

Limited IV access

3

Termination as soon as possible

Preeclampsia without severe features37 weeks gestation

4

Preeclampsia with severe featuresat least 34 weeks gestation

Termination as soon as possible

Expectant management should be consideredIf GA >24 to < 34 weeks gestation and available NICU

Corticosteroids are recommendedif GA < 34 weeks gestation

4

Termination as soon as possible4Delivery after completion of 4 doses of corticosteroids

- PPROM- Labour- Platelet < 100,000- Abnormal LFT- Renal dysfunction- Fetal growth restriction- Severe oligohydramnios- Abnormal doppler study

- reversed end diastolic flow (umbilical a)

Termination as soon as possible

Prompt delivery after maternal stabilization regardless of GA if- uncontrolled BP- eclampsia- pulmonary edema- abruptio placentae- disseminated intravascular coagulation- evidence of nonreassuring fetal status- intrapartum fetal demise

4

Postpartum surveillance- Treatment if BP ≥ 150/100 mmHg (4-6 hrs apart)- Prompt treatment if BP ≥ 160/110 mmHg

Postpartum surveillance- BP monitoring for 72 hrs- BP follow up 7-10 days postpartum