Pre eclampsia

It is a form of hypertensive disorders in pregnancy characterized by elevated blood pressure which is associated with protein in urine.

Types

Mild/Moderate Pre-Eclampsia

Blood pressure not exceeding 160/110 mmHg.

Protein in urine is 1+ or less, less than 5 grams in a 24 hour urine collection

Severe Pre-Eclampsia

BP is above 160/110 mmHg

Protein in urine is 2+ or above

Severe persistent headache

Visual disturbances

Epigastric and right upper abdominal pain

Excessive body swelling

Hyperreflexia

Investigations

Urine for protein

Obstetric USS

Fundoscopy

Renal function test

Liver function test

Treatment

Hydralazine (IV) 5 mg in 10ml sterile water over 4 minutes’ initial dose. Then  5–10mg  bolus as needed every 20 minutes until when the diastolic BP is less than 110 mmHg.

AND Methyldopa (PO) 500mg 8 hourly

AND Nifedipine (PO) 20mg 8 hourly until BP is stabilized.

If hypertension is refractory to hydralazine

Give:

Labetalol (IV bolus)10–20 mg stat repeat each 10–20 minutes, with doubling doses not exceeding 80 mg in any single dose for maximum total cumulative dose of 300 mg.

Antenatal corticosteroids (dexamethasone Inj. 6mg 12 hourly for 48 hours) if pregnancy is below 34 weeks.

Prophylaxis for Seizures

Magnesium sulfate (IV) 1g hourly in 250 mils of RL (OR 5g of 50% MgSO4 4 hourly or alternate buttocks) for 24 hours if GA is ≤34 weeks or until 24 hours post-delivery if GA is≥34 weeks.