Pre-eclampsia

Introduction

Pre-eclampsia is a disease specifically associated with pregnancy.
It usually occurs in the second half of pregnancy and it is characterized by hypertension and proteinuria.
The presence of pedal oedema or excessive weight gain may also be a feature of pre-eclampsia.
Blood pressure monitoring every 4 hours together with daily weighing of the patient are essential in the management of pre-eclampsia alongside the recommended investigations.
While blood pressure reduction is essential, lowering the blood pressure below 140/90mmHg may cause foetal distress and should be avoided.

Causes of pre-eclampsia

The cause of pre-eclampsia is unknown but the disease is more commonly with the following:

  1. Primigravidae
  2. Maternal age (women < 18 or > 35 years)
  3. Multiple pregnancies
  4. Hydatidiform mole
  5. Medical disorders e.g. polycystic ovaries, chronic hypertension, diabetes mellitus, kidney disorders
  6. First pregnancy with a new partner
  7. Previous history of pre-eclampsia
  8. Family history of pre-eclampsia

Symptoms of pre-eclampsia

  • Patients with pre-eclampsia are often asymptomatic
  • Swollen feet

Signs of pre-eclampsia

Signs in mild cases

  1. Systolic blood pressure between 140 and 159 mmHg
  2. Diastolic blood pressure between 90 and 109 mmHg
  3. Proteinuria of 1+ or 2+
  4. Pedal oedema

Signs in aevere cases

  1. Systolic blood pressure 160 mmHg or higher
  2. Diastolic blood pressure 110 mmHg or higher
  3. Proteinuria of 3+ or 4+
  4. Pedal or generalised oedema

Investigations

  • FBC
  • Serum Uric Acid
  • BUE and Creatinine Urinalysis and culture
  • Liver function tests
  • Random blood glucose
  • Daily assessment of urine proteins
  • Ultrasound scan for close foetal growth monitoring

Treatment for pre-eclampsia

Treatment objectives

The treatment objectives of pre-eclampsia are:

  1. To reduce elevated blood pressure, but not less than 140/90 mmHg
  2. To prolong the pregnancy as much as possible to allow the foetus to grow and mature for delivery
  3. To prevent foetal distress
  4. To prevent or treat any complications that may arise
  5. To prevent eclampsia

Non-pharmacological treatment

  • Admit for rest if possible
  • Encourage patients to lie on their sides to avoid supine hypotension

Pharmacological treatment A.

Mild pre-eclampsia

There is no need for drug treatment of the hypertension unless the BP rises above 150 mmHg systolic or 100 mmHg diastolic or the patient becomes symptomatic of imminent eclampsia
Evidence Rating: [B]
Methyldopa, oral,

  • 250-500 mg 8-12 hourly (max. 2 g/day)

Or

Nifedipine retard, oral,

  • 10-40 mg 12 hourly

Or

Nifedipine slow release, oral,

  • 30-60 mg daily