Pre-Eclampsia is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine. The condition begins after 20 weeks of pregnancy.
It is characterized by development of hypertension with oedema or proteinuria or both.
It is unknown.
Following are predisposing factors-
- Elderly and young primigravida.
- Pregnancy with complications like multifetal pregnancy, hydatidiform mole, hydramnios and Rh incompatibility.
- Abnormal Placentation (Formation and development of the placenta)
- Medical diagnosis like Nephritis and Diabetes mellitus
- Women from low socio-economic backgrounds
- Environmental factors, e.g. Air pollution
- Family history of pre-eclampsia
- Having Donated a kidney
Current theories regarding the aetiology are-
- Vasospasm resulting from an increased sensitivity to circulating pressers, such as angiotensin II and prostaglandin PGE2, vasodilator is depressed.
- Endothelial cell dysfunction results from decreased placental perfusion.
- Pre-eclampsia may be an immune complex disease in which the maternal antibody system in overwhelmed from excessive foetal antigens.
- Diet inadequate in proteins, calcium, magnesium and vitamin E & A.
- In mild pre-eclampsia blood pressure is persistently at and above 140/90 mm Hg. But below 160/110 mm Hg. There is oedema and or proteinuria.
- In severe pre-eclampsia blood pressure is persistently at and above 160/110 mm Hg, increase in proteinuria, oedema is marked, headache and visual disturbances occur.
1. More frequently seen in primigravida in late pregnancy.
2. There is a typical triad of signs and symptoms.
- Blood pressure rises to 140/90 mm Hg to over 160/90 mm Hg.
- Visible-pitting oedema of feet ankles, legs, hands, face, abdominal wall, vulva and generalized oedema.
- Proteinuria ranging from traces to 3+ (solid on boiling).
3. Sudden weight gain—0.75 kg and above per week.
4. Severe Headaches
5. Epigastric pain
6. Decrease urine output
7. Impaired liver function
8. Shortness of breath
9. Grave symptoms include headache, disturbed sleep, diminished urinary output, epigastric pain and eye symptoms like blurring of vision.
- To provide rest and a tranquil environment.
- To monitor the condition and to prevent worsening by giving appropriate care.
- To prolong the pregnancy until the foetus is mature.
- Regular antenatal check-up to detect pre-elampsia at the earliest.
- Bed rest is encouraged in the left lateral position.
- All the necessary equipment like airway, equipment for catheterization, administration of oxygen, suction apparatus and emergency medicine tray should be readily available.
- Sedatives like phenobarbitone 60 mg or diazepam 5 mg orally at bed time and in severe cases, injection largactil 25 mg with phenargan 25 mg intramuscularly or inj. diazepam 10 mg with Antihypertensive drugs like reserpine 0.1 mg, aldomet 250 mg is given as per direction.
- The intrapartum and postpartum administration of Magnesium Sulfate is recommended in sever pre-eclampsia for prevent of eclampsia
- Ensure proper drainage of indwelling catheter and monitor urinary output.
- Daily recording of weight, blood pressure and testing of urine is done.
- Woman should never be left alone.
- To raise the foot end of the bed to promote drainage of secretions.
- Frequent observations for ominous symptoms like headache, epigastric pain and blurring of vision (signs and symptoms of impending eclampsia).
- Watch for signs of labour.
- If the pregnancy is beyond 37 weeks completed, termination to be considered without delay. In severe cases caesarean section is usually done.
- In severe cases the woman is admitted in obstetrical critical care unit.