MANAGEMENT OF NON SEVERE PRE-ECLAMPSIA & ROLE OF EXPECTANT MANAGEMENT

BY: GOURAB DAS8TH SEMESTER

AGMC

What is Pre-Eclampsia?? A PREGNANCY SPECIFIC SYNDROME

CHARACTERIZED BY VARIABLE DEGREES OF PLACENTAL DYSFUNCTION AND A MATERNAL RESPONSE FEATURING SYSTEMIC INFLAMMATION.

Presenting features..

GESTATIONAL HYPERTENSION Systole: >(or=) 140 mm Hg

Diastole: >(or=) 90 mm Hg

RENAL INVOLVMENT: (PROTEINURIA)Protein > 0.3g / 24 hoursDipstick > 1 +PCR > 30mg / mmol

WHEN WE ARE CONSIDERING A CASE AS NON SEVERE???

Cases with sustained rise of blood pressure of more than 140/90 mm Hg but less than 160 mm Hg systolic or 110 mm Hg diastolic without significant protienuria (less than or equal to 2+) and without any signs of end organ injury/damage. Headache, Seizures, Visual disturbance.

Epigastric pain, Liver enzymes. Fetal growth. Clotting.Pre Eclampsia is a bad disease and the term mild is

discouraged.Classified as NON SEVERE and SEVERE PRE

ECLAMPSIA.

ManagementOBJECTIVES:To stabilize the HTN and to prevent

its progression to severe pre eclampsia.

To prevent complications.To prevent eclampsia.Delivery of healthy baby in optimal

time.Restoration of the health of the

mother.

Management

Management Blood pressure:

Should be recorded more frequently in women at high risk of PE Rapid increases warrant closer observation

Oedema:Rapidly increasing generalised, facial and/or periorbital oedema requires further assessment.

New onset of PE is suspected laboratory investigations to track progression: Haemocrit values Liver function tests Renal tests Coagulation screening Urinanalysis

ManagementFetal monitoring:

Antepartum surveillance (CTG’s) Symphyseal-fundal height measurements Record of fetal movements Ultrasonography:

Amniotic fluid index Fetal growth Biophysical profiles

Umbilical artery Doppler studiesUsed to monitor fetal growth and to ascertain the most

appropriate and safest time for delivery

ManagementIf DBP settles, protienuria becomes

insignificant then she will be adviced to take rest, have her BP checked regularly.

Report to the hospital if she develop significant swelling or develops other symptoms of severe pre-eclampsia.

ManagementIf there are any signs of fetal compromise,

labour is induced.If there is no fetal compromise, and the pre-

eclampsia doesnot worsen, pregnancy could be continued for another week.

ManagementExpectant Management:

No evidence that hospital admission for Non severe PE improves maternal or fetal outcomes

Admission to hospital is stressful, emotionally and financially costly

Women with Non severe PE without significant proteinuria may be treated as outpatient or admitted as a ‘day case’ for assessment and evaluation

ManagementExpectant Management:

Expectant management at home or hospital requires: Reduced activity

Woman may be advised to stop working May be advised to go on bed rest – although this is

logical it has not been proved to improve outcomes Careful recording and daily checking of:

Fetal activity Blood pressure Urine protein Any other signs and symptoms of PE

Management

The role is to:Recognise pre-eclampsia earlyMonitor the woman for evidence of

disease progression that would mandate either delivery of more intensive fetal surveillance

ManagementHospital Management:

May be necessary for woman who: Feel safer in hospital Hypertension worsens Presence of significant proteinuria Signs of end organ involvement There are concerns about fetal wellbeing

Baseline laboratory evaluations to monitor progression of disease

Crucial that an accurate fluid-balance chart maintained to ensure that renal impairment detected early

DEFINITIVE TREATMENT

THANK YOU