Preeclampsia

HTN ≥ 140/90 ( mild ) or ≥ 160/100 ( severe ) + proteinuria > 0.3 gm/ 24hrs after 20
wks GA

Criteria for the diagnosis of preeclampsia:

Systolic Blood pressure ≥140 mmHg or diastolic Bp ≥90 mmHg on at least. 2 occasions apart
after 20 weeks of gestation in previously normotensive patient & the new onset of 1 or more
of the following:

 Proteinuria ≥0.3 g in a 24-hour urine specimen or protein/ creatinine ratio ≥0.3 (mg.mg)
or dipstick. ≥2+
 Platelet count ¿ 100,000/ microL
 Serum creatinine > 1.1 mg/dL or doubling of the creatinine concentration in the absence
of other renal disease
 Liver transaminases at least 2x the upper limit
 Pulmonary edema
 New onset and persistent headache
 Visual symptoms (Blurred vision, flashing lights or sparks or scotomata)

Maternal Risk factors Factors:

1. Age ( ex < 18 or > 40)
2. Parity. (Primigravida or nulliparity )
3. Past or family history of pre-eclampsia
4. Maternal diseases. Chronic HTN, chronic renal disease, DM, obesity, connective
diseases as SLE, antiphospholipid antibody syndrome, mir

Fetal Factors
1. Multiple pregnancy
2. Hydatidiform mole,
3. Hydrops fetalis (immune and nonimmune)
4. Polyhydramnios

Clinical picture:
Alarm findings:
●Persistent and/or severe headache ( often frontal but may be occipital)
●Visual abnormalities (scotomata, photophobia, blurred vision, or temporary
blindness [rare])
●Upper abdominal, retrosternal, or epigastric pain due to enlargement of the liver
& stretching of its capsule.
●Altered mental status

●New dyspnea, orthopnea

Investigations : laboratory & imaging

1. Complete blood count with platelets

2. Urinary protein determination (protein to creatinine ratio in a random
urine specimen or 24-hour urine collection for total protein)
3. Kidney function tests: serum creatinine, urea.
4. Liver chemistries (aspartate aminotransferase [AST], alanine
aminotransferase [ALT])
5. Coagulation studies (prothrombin time, partial thromboplastin time,
fibrinogen)

Ultrasound is indicated to evaluate amniotic fluid volume and estimate fetal

weight given the increased risk for oligohydramnios and fetal growth restriction
(FGR).

Complications
Maternal
1. Eclampsia
2. Cerebral hemorrhage
3. Heart failure and pulmonary edema .Liver failure, Renal failure
4. Placental abruption
5. Retinal detachment
6. Hemolytic anemia ,DIC

Fetal:
1. Intrauterine growth restriction.
2. Intrauterine fetal death due to multiple placental. Infarctions
3. Prematurity and its complications as respiratory distress syndrome, hemorrhage
Anti-HTN Drugs:
1. Labetalol: It is an alpha & beta blocker. 200 mg orally 3x a day
2. Methyldopa ( Aldomet): It inhibits the release of noradrenaline by acting on the
vasopressor centers in the brain stem ( central action). Leading to vasodilation and
decrease in peripheral resistance. Causes PP depression
3. Hydralazine ( Apresoline) Causes arteriolar dilation and decrease in peripheral
resistance, increases CO and renal blood flow.
4. Nifedipine: calcium channel blocker

Recommend magnesium sulfate as the drug of choice for the prevention of

eclampsia, initiated at the onset of labor or induction, or prior to and throughout
the duration of a cesarean delivery 
5.

Follow up— platelet count, serum creatinine, and liver chemistries. These tests
should be repeated at least twice weekly 

Fundus and neurological examination

Tests to assess fetal growth & well-being:
- Fetal growth by Ultrasound every 3 weeks
- Fetal well-being is assessed by daily fetal movements count.
- CTG and doppler ultrasound to study the flow of uterine and umbilical arteries.
- non stress test which is done 2x weekly or daily according to the severity.

General approach
- Term pregnancies: Delivery — recommend delivery of women with
preeclampsia at ≥37+0 weeks of gestation, even without features of severe
disease