Preeclampsia resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Synonyms and keywords:

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Life threatening cause 1
• Life threatening cause 2
• Life threatening cause 3

Common Causes

• Common cause 1
• Common cause 2
• Common cause 3
• Common cause 4
• Common cause 5

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Gestational Hypertension.

Pregnant woman with history of Hypertension

Take complete history

Record the vitals: ❑ Blood pressure ❑ Temperature ❑ Respiratory rate ❑ Heart rate

Take obstetric history : ❑ Date of last menstrual period? ❑ Estimated date of delivery ❑ Confirm the gestational age, gravidity and parity. ❑ Check if this is a single or multiple gestation.

Ask about previous obstetric history if she was previous pregnant : ❑ Ask about previous pregnancies including miscarriages and terminations. ❑ Length of gestation. ❑ Ask about mode of delivery. ❑ Ask if there was similar complaints during previous pregnancy? ❑ Was there any complications throughout the pregnancy or during delivery such as shoulder dystocia, postpartum haemorrhage ?

Ask the following questions about menstrual history : ❑ Age of menarche ❑ Last menstrual period ❑ Is the menstrual flow normal? How many pads she has to use in a day? ❑ Is there any foul smell or colour change? ❑ How many days does the menstruation stay? ❑ Contraceptive history for example oral contraceptives, intrauterine device

See if following factors are present: ❑ History of hypertension ❑ Kidney disease ❑ Diabetes ❑ Hypertension with a previous pregnancy ❑ Mother's age younger than 20 or older than 40 ❑ Multiple fetuses (twins, triplets) ❑ African-American race

Ask about associated symptoms OF preeclampsia: ❑ Severe headaches ❑ Changes in vision, including temporary loss of vision, blurred vision or light sensitivity ❑ Upper abdominal pain, usually under ribs on the right side ❑ Nausea or vomiting ❑ Decreased urine output ❑ Decreased levels of platelets in your blood (thrombocytopenia) ❑ Impaired liver function ❑ Shortness of breath, caused by fluid in the lungs

PRE-ECLAMPSIA ❑ Blood pressure higher than 140/90 measured on two separate occasions, more than 6 hours apart. ❑ Absence of protein in the urine and diagnosed after 20 weeks of gestation.

Treatment

Shown below is an algorithm summarizing the treatment of severe preeclampsia.

Woman with severe pre eclampsia

❑ Admit to labor and delivery area. ❑ Maternal and fetal evaluation for 24 hours. ❑ Magnesium sulphate X 24 hours. ❑ Anti-hypertensives if systolic blood pressure ≥ 160mm Hg, Diastolic ≥110 mmHg and meant retrial blood pressure ≥125 mmHg

❑ Maternal distress ❑ Non-reassuring fetal status. ❑ Labor or rupture of membranes. ❑ >34 weeks of gestation.

Yes

No

❑ Magnesium Sulphate ❑ Delivery.

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Severe intrauterine growth restriction

Yes

No

←

Steroids

↑

←

33-34 weeks of gestation

23-32 weeks of gestation

<23 weeks of gestation

❑ Steroids at 24-32 weeks ❑ Anti-hypertensives if required. ❑ Daily maternal and fetal evaluation. ❑ Delivery at 34 weeks.

termination of pregnancy

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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