Pre eclampsia - a pregnancy condition in which high blood pressure (140/90mmHg) and protein in the urine (300mg/24hrs or dipstick value of traces of atleast 1+) develop after the 20 th week of pregnancy

Preeclampsia Pregnancy specific syndrome Reduced organ perfusion secondary to vasospasm and endothelial activation Proteinuria is the most important sign

Preeclampsia –from glen MILD BP > 140/90 mmHg after 20 weeks’ gestation Proteinuria > 300 mg/24hrs or > +1 dipstick BP > 140/90 mmHg after 20 weeks’ gestation Proteinuria > 300 mg/24hrs or > +1 dipstick SEVERE BP > 160/110 mm Hg Proteinuria > 2 g/24 hrs or > +2 dipstick Serum creatinine > 1.2 mg/dL unless known to be previously elevated Platelets < 100,000 m 3 Microangiopathic hemolysis Elevated AST or ALT Persistent headache or other cerebral or visual disturbances Persistent epigastric pain BP > 160/110 mm Hg Proteinuria > 2 g/24 hrs or > +2 dipstick Serum creatinine > 1.2 mg/dL unless known to be previously elevated Platelets < 100,000 m 3 Microangiopathic hemolysis Elevated AST or ALT Persistent headache or other cerebral or visual disturbances Persistent epigastric pain

Risk Factors Associated w/ the pregnant woman First pregnancy Age under 20 or over 35 High blood pressure before pregnancy Previous pre-eclamptic pregnancy Short inter-pregnancy interval Family history of pre eclampsia Obesity Diabetes, kidney disease, rheumatoid arthritis Low socio-economic status Poor protien or low calcium status First pregnancy Age under 20 or over 35 High blood pressure before pregnancy Previous pre-eclamptic pregnancy Short inter-pregnancy interval Family history of pre eclampsia Obesity Diabetes, kidney disease, rheumatoid arthritis Low socio-economic status Poor protien or low calcium status Associated with the pregnant woman’s husband or partner First time father Previously fathered a pre- eclamptic pregnancy First time father Previously fathered a pre- eclamptic pregnancy Associated with the fetus Multifetal pregnancy Hydrops/ triploidy Hydatidform mole Multifetal pregnancy Hydrops/ triploidy Hydatidform mole

Signs and Symptoms Mild Pre eclampsia: BP 140/90mmHg Proteinuria: 300mg/24hrs; dipstick values 1+ Edema hands and face Weight gain – More than 2 pounds per week – Sudden weight gain over days

Signs and Symptoms Severe Pre eclampsia: BP 160/110mmHg Protenuria: 400mg/24hrs; dipstick values 2+ to 4+ Oliguria of less than 400cc/day Severe headache or visual disturbances Pulmonary edema or cyanosis IUGR Epigastric or RUQ pain Increased serum LDH, hemoglobinuria, hyperbilirubinemia Elevated liver enzymes Low platelet count (thrombocytopenia)

Treatment Cardinal Principles – control convulsions – control hypertension – delivery at an optimum time and mode

Treatment MgSo4

Prevention