Management of

PreEclampsia

By Anand Jaiswal
19
Objectives
1. To stabilize hypertension and to prevent its progression to severe
preeclampsia.
2. To prevent the complications
3. To prevent eclampsia.
4. Delivery of a healthy baby in optimal time.
5. Restoration of the health of the mother in puerperium.
Hospital Management
Rest
• increases renal blood flow diuresis,
• increases uterine blood flow
• improves placental perfusion,
• reduces the blood pressure.

Diet
• The diet should contaittn adequate
amount of daily protein (about 100 g).
• Usual salt intake is permitted. Fluids
need not be restricted.
• Total calorie approximate 1,600 cal/day.
Diuretics
The diuretics should not be used
injudiciously, as they cause harm to the
baby by diminishing placental perfusion
and by electrolyte imbalance. The
compelling reasons for its use are—
1. Cardiac failure,
2. Pulmonary edema,
3. Along with selective antihypertensive
drug therapy (diazoxide group)
where blood pressure reduction is
associated with fluid retention,
4. Massive edema
Anti-Hypertensives

The indications are:

(1) Persistent rise of blood pressure

especially where the diastolic pressure is
over 110 mm Hg. The use is more urgent
if associated with proteinuria.

(2) In severe preeclampsia, to bring down

the blood pressure during pregnancy and
labor
Drugs in preeclampsia
Methyl-dopa
● Its sold under the name of Aldomet.
● It belongs to centrally acting alpha agonists.
● Given both orally & intra venous.
● Methyldopa crosses the placenta, and may cause mild hypotension in
neonates of treated mothers.
● The common side effects are constipation, galactorrhea, postpartum
depression and altered sleep pattern.
● Dose - 250mg or 500mg tablet orally 2 to 3 times in a day.
Labetalol
● It belongs to beta adrenergic blockers.
● Labetalol is excreted in human breast milk. Therefore, it should be used
cautiously in nursing mothers because of the risk that the infant may develop
a slow heart rate.
● Rarely causes postural hypotension in mother.
● abnormal heart rhythm,
● slow heart rate,
● liver failure, and
● allergic reactions.
● Dose - 100mg 3 to 4 times day given orally
Nifedipine
● It belongs to class Calcium Channel Blockers
● Common brand name is adalat.
● Dizziness, flushing, weakness, swelling ankles/feet, constipation, and
headache may occur.
● Dose - 10 to 20mg twice a day
Hydralazine
● It belongs to vasodilators.
● Dilates arterioles thereby decreasing vascular resistance
● Given intra venous
● Its is excreted in breast milk
● Side effects same as other previous drugs
● Dose - 10 to 25mg twice a day
Progress Chart
The effect of treatment should be evaluated by maintaining a chart which records
the following:

• Daily clinical evaluation for any symptoms (e.g. headache, right upper
quadrant or epigastric pain, visual disturbances, oliguria).

• Blood pressure: at least four times a day.

• State of edema and daily weight record.

• Fluid intake and urinary output.

• Urine examination for protein daily and if present, to estimate its amount in 24
hours urine.
Progress Chart
• Blood for hematocrit, platelet count, uric acid, creatinine and liver enzymes,
coagulation profile at least once a week.

• Ophthalmoscopic examination on admission

• Fetal well-being assessment

Methods of Delivery
● Induction of Labor
● Cesarean Section
 Induction of Labor
Indications:

● Aggravation of the preeclamptic features in spite of medical treatment and/or

appearance of newer symptoms such as epigastric pain.
● Hypertension persists in spite of medical treatment with pregnancy reaching
37 weeks or more.
● Acute fulminating preeclampsia irrespective of the period of gestation
● Tendency of pregnancy to overrun the expected date.
Cesarean Section
Indications:

● When an urgent termination is indicated and the cervix is unfavorable (unripe

and closed).
● Severe preeclampsia with a tendency of prolonged induction—delivery
interval.
● Associated complicating factors, such as elderly primigravidae, contracted
pelvis, malpresentation, etc.
Management during labor
● Antihypertensive drugs are given if the blood pressure becomes high.
● Blood pressure and urinary output are to be noted frequently so as to detect
imminent eclampsia.
● Prophylactic MgSO4 is started when systolic BP >160 diastolic >110
● Careful monitoring of the fetal well-being is mandatory.
Puerperium
● The patient is to be watched closely for at least 48 hours, the period during
which convulsions usually occur.
● Antihypertensive drug treatment should be continued if the BP is high
(systolic >150 mm Hg or diastolic >100 mm Hg).
● The patient is to be kept in the hospital, till the blood pressure is brought
down to a safe level and proteinuria disappears.
Summary
Thankyou