(PIH)
Prepared by:
• Elevation of BP >140/90mmHg
or
• Elevation of systolic >30mmHg or diastolic >15mmHg
or
• MAP>105mmHg or elevation of MAP>20mmHg
2
Classification…
3
…Classification
• Mediators: TXA2>PGI2
– TXA2=Vasoconstrictor/Platelet aggregator
– PGI2=Vasodilator/Platelet aggregation inhibitor
5
Proteinuria
• Normal=
<300mg/24hrs
• Dipstick test:
– Trace=100mg/L
– 1+ =300mg/L
– 2+ =1gm/L
– 3+ =3gm/L
– 4+ =10gm/L
6
Risk factors
1. Primigravida (young or elderly)
2. Hyperplacentosis
• Multiple gestation
• DM
• Rh-incompatibility
3. Molar pregnancy
4. Chronic HTN
5. F/H of HTN
6. Antiphospholipid syndrome
7
Clinical features
• Swelling/Abnormal • Diastolic BP =
wt.gain >110mmHg
• Headache • Oliguria<400ml/24hrs
• Persistent epigastric pain • Proteinuria=>5gm/day
• Cerebral/Visual • Plateletes<100,000/cmm
disturbance • Uric acid>4.5mg/dl
• IUGR • Retinopathy:
• Pulmonary edema – A-V nicking
– Hemorrhage
– Exudate
– Papilledema
8
Maternal Complication
1. HELLP Syndrome 7. Hepatic rupture
2. Abruptio placentae 8. Electrolyte imbalance
3. Pulmonary 9. Preterm labor
edema/ARDS/Pneu
10. PPH
monia
11. Shock/ Postpartum
4. ARF
collapse
5. Cerebral bleeding
12. Sepsis
6. Visual disturbance &
blindness
9
Maternal mortality
1. Eclampsia
2. Accidental hemorrhage
3. ARF
4. Pulmonary edema
5. DIC
6. HELLP syndrome
10
Fetal Complication
1. IUFD
2. IUGR
3. Asphyxia
4. Prematurity
11
Tests
1. Urine:- Protein
2. Blood:-
– Grouping, VDRL, Suger, Hb,
– Platelets, Uric acid
– RFT(Urea,Cr,Na+K+), LFT
3. USG:-
– Fetal growth
– Placenta
– Gestational age
4. Ophthalmoscopy
5. Fetal monitoring:-
– BPP
– Daily fetal kick count
12
Antenatal management
Preventive measures:
1. Regular check up
13
Antenatal management
Therapeutic measures:
1. Hospitalisation
2. Rest
3. Sedation: Phenobarbitone 60mg OD or BD
4. Antihypertensives: P/O
– Methyl dopa 250-500mg TID
– Nifedipine 10-20mg BD
– Labetalol 250mg TID
– Hydralazine 10-25mg BD
14
5. Hypertensive crisis: I/V
– Nitroglycerine: 5microgm/min
– Na+nitropruside: 0.25-5microgm/kg/min
15
Management of PET without
complication
1. Frequent check up
4. If >37weeks: Induction
16
Labor management
C/S:
1. Complication with
1. Sedation unfavourable Cx
17
18
Fulminant PET/Imminent eclampsia
Symptoms:
1. Headache
2. Visual disturbance
3. Epigastric pain
4. Nausea and vomiting
5. Restlessness/Tremulousness/Twitching
6. Swelling
7. Low urine output
19
Fulminant PET/Imminent eclampsia
Signs:
1. Agitation
2. Hyperreflexia
20
Management
1. MgSO4 therapy
2. Antihypertensives
21
Eclampsia
• PET + Convulsion or Coma
• Causes
– Anoxia
– Cerebral edema
– Decreased seizure threshold
22
C/F:
1. Premonitory stage
2. Tonic stage
3. Clonic stage
4. Stage of coma
23
D/D:
1. Epilepsy
2. Cranial pathology:
– Meningitis
– Encephalitis
– Cerebral malaria
– Brain tumor
– Cerebral thrombosis
– Stroke
3. Electrolyte imbalance
– Hyponatremia
– Hypo calcemia
– Hypomagnesemia
4. Poisoning
5. Functional
24
Principle of management
1. Resuscitation:
– Airway
– Breathing
– Circulation: I/V line
– Catheter
2. Oxygen
3. Control convulsion
4. Control BP
5. Ventilatory support
6. Appropriate tests
7. Plan for early delivery
8. Antibiotics prophylaxis
25
MgSO4 Therapy
4gm I/V in 100 mL of fluid over 3-5min
OR
27
Monitor MgSO4 Therapy
1. Knee jerk
28