INTRODUCTION OF THE DISEASE

PREECLAMPSIA

High blood pressure plus symptoms of damage to another organ system,

most commonly the liver and kidneys, describe preeclampsia, a
pregnancy complication. Preeclampsia commonly develops after 20
weeks of pregnancy in women who previously had normal blood
pressure.

Both you and your baby may experience major even deadly difficulties as
a result of preeclampsia. The most effective treatment for preeclampsia is
to deliver your baby. Even after the baby is delivered, it may take some
time for you to feel better.
You and your doctor confront a difficult task if you're diagnosed with
preeclampsia too early in your pregnancy to birth your baby. Your baby
will need extra time to mature, but you must take care not to put yourself
or your baby in danger.

ETIOLOGY

Preeclampsia is sometimes dismissed as a purely maternal condition with

varying degrees of fetal involvement. The particular immunogenetic
maternal–paternal link, as well as the special 'genetic struggle' that is
characteristic of haemochorial disease, are being increasingly recognized.

Risk factors include the following:

 Nulliparity
 Preexisting chronic hypertension

 Vascular disorders (eg, renal disorders , diabetic vasculopathy)

 Preexisting or gestational diabetes

 Older (> 35) or very young (eg, < 17) maternal age

 Family history of preeclampsia

 Preeclampsia or poor outcome in previous pregnancies

 Multifetal pregnancy

 Obesity

 Thrombotic disorders  (eg, antiphospholipid antibody syndrome  )

SIGNS AND SYMPTOMS:

PREECLAMPSIA

SIGNS/SYMPTOM MILD SEVERE

S PREECLAMPSI PREECLAMPSIA
A
Blood Pressure 140/90 Diastolic is 110 mmHg
Diastolic BP is more or higher
than 100 mm/Hg
Proteinuria +1 to +2 by dipsticks +2 to +4
300 mg/24 hour 5g/24 hour urine
urine collection collection
Liver enzymes Slightly elevated Marked elevated
Laboratory studies Normal hematocrit, Increased
uric acid , creatinine hematocrit,creatinine,
 and uric acid
> liver enzyme are
markedly elevated
> and thrombocytopenia
may be present
Fetus No IUGR IUGR present
Edema Digital edema Pitting edema (4+)
Dependent edema Generalized edema
Weight Gain 2 lb/week More rapid weight gain
Urinary Output Not less than 400 Less than 400 ml/24
Ml/24 hours Hours
Cerebral Occasional headache Severe frontal headache
Disturbances photophobia,blurring,spo
ts before the eyes
(scomata), nausea,
vomiting.
Reflexes Normal to 3+ Hyperreflexia, 4+
Epigastric Pain Absent Right upper quadrant
pain (aura to convulsion)
due to swelling of
hepatic capsule

ANATOMY AND PHYSIOLOGY OF PREECLAMPSIA:

Preeclampsia can effect the lungs, kidneys, liver, heart, and nervous
system, among other organ systems. Preeclampsia puts women at risk for
placental abruption, which is the detachment of the placenta from the
uterine wall, resulting in vaginal bleeding. Preeclampsia can cause the
fetus to grow slowly.It may cause the amount of amniotic fluid
surrounding the fetus in the uterus to decrease. You may have your baby
monitored with ultrasounds on a regular basis to look for signs of poor
growth, irregular blood flow patterns in the umbilical cord, and a lack of
amniotic fluid.Women who have preeclampsia are at a greater risk of
developing cardiovascular difficulties later in life, so it's critical that they
get regular medical checkups.

Researchers have known for decades that preeclampsia increases the risk
of heart failure, heart attack, and stroke in moms who have had it but
recovered — but how and why this risk happens has remained a mystery.
Researchers say a heart imaging study of scores of pregnant women with
the most severe and dangerous form of a blood pressure disorder has
added to evidence that the condition —  known as preeclampsia —
mainly damages the heart’s ability to relax between contractions, making
the organ overworked and poor at pumping blood.

Preeclampsia is a condition marked primarily by high blood pressure and

organ damage. It occurs in an estimated 5 to 8 percent of pregnant
women, and in developing countries it causes up to 60 percent of all
maternal deaths as well as premature births. In recent decades,
researchers have been aware that preeclampsia also significantly
increases the risk of heart failure, heart attack and stroke in mothers who
had it but recovered — just how and why this risk occurs has been
unclear.

PATHOPHYSIOLOGY:

Preeclampsia is poorly understood. Factors may include poorly

developed uterine placental spiral arterioles (which decrease
uteroplacental blood flow during late pregnancy), a genetic abnormality
on chromosome 13, immunologic abnormalities, and placental ischemia
or infarction. Lipid peroxidation of cell membranes induced by free
radicals may contribute to preeclampsia.

Complications

Fetal growth restriction or fetal death may result. Diffuse or multifocal

vasospasm can result in maternal ischemia, eventually damaging
multiple organs, particularly the brain, kidneys, and liver. Factors that
may contribute to vasospasm include decreased prostacyclin (an
endothelium-derived vasodilator), increased endothelin (an
endothelium-derived vasoconstrictor), and increased soluble Flt-1 (a
circulating receptor for vascular endothelial growth factor). Women who
have preeclampsia are at risk of abruptio placentae in the current and in
future pregnancies, possibly because both disorders are related to
uteroplacental insufficiency.

The coagulation system is activated, possibly secondary to endothelial

cell dysfunction, leading to platelet activation. The HELLP syndrome
(hemolysis, elevated liver function tests, and low platelet count)
develops in 10 to 20% of women with severe preeclampsia or
eclampsia; this incidence is about 100 times that for all pregnancies (1
to 2/1000). Most pregnant women with HELLP syndrome have
hypertension and proteinuria, but some have neither.

LABORATORY:

DRUG STUDY:

TRAMADOL -
Tramadol is a strong painkiller. It's used to treat moderate to severe pain

Tramadol is contraindicated in patients who have had a hypersensitivity reaction to

any opioid. Patients under the age of twelve should not use the medication.
Patients under the age of eighteen should not be given the medication if they
have had a history of tonsillectomy or adenoidectomy and also do not use
tramadol if have severe asthma or breathing (respiratory depression) or lung
problems, a bowel blockage or narrowing, or an allergy to tramadol. Do not
use tramadol if you have taken a monoamine oxidase inhibitor (MAOI), a type
of drug for depression, in the last 14 days.

KETOROLAC -

TORADOL (ketorolac tromethamine)  is indicated for the short-term ( ≤ 5

days) management of moderately severe acute pain that requires analgesia at the
opioid level, usually in a postoperative setting.
  TORADOL (ketorolac tromethamine) is contraindicated in patients
with active peptic ulcer disease, in patients with recent gastrointestinal bleeding or
perforation, and in patients with a history of peptic ulcer disease or gastrointestinal
bleeding.

PARACETAMOL -

Paracetamol is a mild analgesic and antipyretic, and is recommended for

the treatment of most painful and febrile conditions, for example, headache
including migraine, toothache, neuralgia, colds and influenza, sore throat, backache,
rheumatic pain and dysmenorrhoea.

Contraindications to the use of acetaminophen include hypersensitivity to

acetaminophen, severe hepatic impairment, or severe active hepatic disease.

TRANEXAMIC ACID -

Tranexamic acid is a medication used to treat or prevent excessive blood

loss from major trauma, postpartum bleeding, surgery, tooth removal, nosebleeds, and
heavy menstruation. It is also used for hereditary angioedema. 

Tranexamic Acid is contraindicated in patients with active intravascular

clotting. Tranexamic acid is an antifibrinolytic and may increase the risk of
thromboembolic events. Venous and arterial thrombosis or
thromboembolism has been reported in patients treated with tranexamic
acid.

CEFUROXIME -

Cefuroxime is an antibiotic used to treat and prevent a number of bacterial

infections.

Cefuroxime is contraindicated in patients with cephalosporin hypersensitivity

or cephamycin hypersensitivity. Cefuroxime should be used cautiously in patients
with hypersensitivity to penicillin.
CELECOXIB -

Celecoxib, sold under the brand name Celebrex among others, is a COX-2
inhibitor and nonsteroidal anti-inflammatory drug. It is used to treat the pain and
inflammation in osteoarthritis, acute pain in adults, rheumatoid arthritis, ankylosing
spondylitis, painful menstruation, and juvenile rheumatoid arthritis.

Celecoxib is contraindicated in the following:

> known hypersensitivity

> History of asthma, urticaria, or other allergic-type reaction after taking aspirin or
other NSAIDs. Severe, sometimes fatal , anaphylactic reactions to NSAIDs.

> In the setting of CABG surgery

> In patients who have demonstrated allergic-type reactions to sulfonamides