PRE ECLAMPSITA IN ENGLISH

                                                       

                                             PRE ECLAMPSITA  IN ENGLISH

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PRE ECLAMPSIA-

Hypertensive disorders of pregnancy-

q  Gestational hypertension

q  Pre Eclampsia

q  Chronic hypertension

q  PreEclampsia superimposed on chronic hypertension

q  Eclampsia

Pre-eclampsia is an idiopathic  condition of pregnancy characterized by proteinuria and hypertension (>140/90 mmHg) presenting after 20 weeks of pregnancy in a woman who

previously had normal blood pressure.

Preeclampsia is defined as new onset of hypertension (≥140/90 mmHg) and proteinuria which occurs after 20 weeks of gestation in previously normotensive woman

 

CLINICAL MANIFESTATIONS-

• blood pressure: systolic >140 mmHg or diastolic >90 mmHg 

• proteinuria 

• edema – may be detectable on examination.

-Ankle edema initially and than more

 generalized edema that pits on pressure .

-Edema is seen on pre-tibial surface, face, hands, abdomen and sacrum.

 

CAUSES AND RISK FACTORS

Pre-eclampsia is an idiopathic  condition Risk factors includes-

• Maternal age (<20 and >40 years)

• Family history of pre-eclampsia

• Pre-eclampsia in a previous pregnancy

• Pregnancy after assisted reproductive technology

• Obesity

• Pre-existing diabetes mellitus type 1

 • Pre-existing hypertensive disease

• Pre-existing medical conditions, e.g. renal disease,

systemic lupus erythematosus (SLE), rheumatoid

Arthritis

• Developing a medical disorder during pregnancy,

e.g. venous thromboembolic disease (VTE), such as

antiphospholipid (Hughes) syndrome (APS),

gestational diabetes, gestational hypertension

• First pregnancy

• Multiple pregnancy

• Developing infection with inflammatory response

• Hydropic degeneration of the placenta

 

DIAGNOSTIC INVESTIGATIONS-

• Urine examination for protein

-Urine sample or 24 hour urine collection to quantify the proteinuria (>300 mg) and determine the ratio of protein to creatinine (>30 mg/mmol).

• Complete blood count

• Serum electrolytes

• Liver function test

• Serum Urea and Creatinine

• Ultrasound

• Doppler velocimetry

 

MANAGEMENT-

• Anti-hypertensives such as methyldopa

and nifedipine.

•In severe case hospital admission may be required with IV antihypertensive drugs.

• Magnesium sulphate prophylaxis may be added.

• expedite the birth of the baby and placenta.

• Induction of labour will be determined by the

obstetrician, and is likely to be at 37 weeks for mild preeclampsia 34–36 weeks for moderate pre-eclampsia and at 34 weeks for severe hypertension.

• Birth should be earlier in the event of uncontrolled blood pressure or fetal or antenatal complications, with caesarean section.

 

NURSING MANAGEMENT-

•        Nursing assesment including detailed history taking

•        Frequent BP monitoring as per order

•        Assessment of Urine output & reflexes

•        Fetal heart rate monitoring to assess fetal distress

•        Should administer prescribed drugs on time

•        Maintain fluid balance oral or IV as per order

•        Observe for seizures 

•        Provide psychological support

Provide health education to patient and family  about-

•        disease & warning signs

•        Diet: low salt, adequate protein and

•        Importance of regular ANC check-ups