Pre-eclampsia (Pregnancy induced Hypertension)
Hypertension is one of the common problems in pregnancy and it causes morbidity and mortality to both mother and the child. Pre-eclampsia is a condition that is caused by pregnancy. Pre-eclampsia usually comes after 20th week of pregnancy and is associated with hypertension (140/90 mm Hg or more), edema (swelling of the body due to retention of fluid) and /or proteinuria (protein present in the urine).Pre-eclampsia occurs in 5-8% of all the pregnancies.
What are the causative factors (high risk factors) for pre-eclampsia?
What are the features present in the patient who is having pre-eclampsia?
- Elderly or young primigravidae(first time mothers)
- Family history of pre-eclampsia
- Poor and under-privileged sector
- Pregnancy complications like hydatidiform mole, multiple pregnancy
- Medical disorders like hypertension, kidney disease, diabetes
Pre-eclampsia frequently occurs in primigravidae (70%). It is more often associated with multiple pregnancy, polyhydramnios, pre-existing hypertension, diabetes etc. The clinical manifestations appear usually after 20th week of pregnancy.
What are the diagnostic tests for pre-eclampsia?
- Initially there will be slight swelling over the ankles or tightness of the ring in the finger. Gradually there may be swelling over the face, abdominal wall and even the whole body.
- Head ache
- Disturbed sleep
- Epigastric pain
- Reduced urine output
- Blurring or dimness of vision
- Abnormal weight gain - a rapid gain of weight of more than 5 pounds a month or more than one pound a week in later months of pregnancy is significant
- Rise in blood pressure
What are the complications of pre-eclampsia?
- Urine examination is done for the presence of proteins.
- Eye examination.
- Serum uric acid.
- Fetal monitoring - for looking the status of the baby inside the womb.
How do you prevent pre-eclampsia?
- May turn into eclampsia ( pre-eclampsia associated with epilepsy)
- Antenatal hemorrhage (Bleeding through the vagina before the delivery of the baby)
- Diminished vision
- Pre-term labor
- Post partum hemorrhage
- Intrauterine death of baby
- Growth retardation of the baby
- Premature baby
Pre-eclampsia is not a totally preventable disease. The high risk factors leading to pre-eclampsia can be identified and modified. The following regime should be followed in such high risk patients to prevent pre-eclampsia.
- Regular antenatal checkup from the beginning of pregnancy to detect rapid gain in weight, rising blood pressure.
- The patient is advised to take adequate rest in bed on her left side at least extra 2 hours at noon from 20th week of pregnancy
- Well balanced diet should be taken.
- Restriction of salt is not helpful in preventing pre-eclampsia
- Low dose aspirin seems to be helpful
- hat is the treatment for pre-eclampsia?
Ideally all patients with pre-eclampsia are to be admitted in the hospital for effective treatment. There is no place for treatment in the home.
- Rest: The patient is advised to take rest in left lateral position.
- High protein diet: The diet should contain about 100 grams of protein.
- Sedation at bed time is helpful to cut down the emotional factor. Diazepam at bed time is useful.
- If patient is constipated, mild laxatives can be given
- If persistent hypertension is present, antihypertensive drugs like methyldopa, and beta blockers are given
If the pregnancy is beyond 37 weeks, termination of pregnancy is considered without delay by induction or caesarean section. If the patient is in early pregnancy, after discharge from hospital she is advised to come for check up once in a week regularly till term.
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