Pre Eclampsia jk"Vhª; xkzeh.
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l BP≥140/90 mm Hg on 2 occasions, 4 hours apart l Urine proteinuria ≥ traces or ≥ 300 mg/24 hrs sample l Period of gestation>20 weeks
Mild Pre eclampsia Severe Pre eclampsia
l BP ≥ 140/90 mm Hg l BP ≥ 160/110 mm Hg
l Protienuria ≥ traces to 2 + or ≥ 300 mg/24 hrs l Proteinuria ≥ 3 + by dipstick or ≥ 5 gm/24 hrs
l Headache, epigastric pain, blurring of vision, oliguria, pulmonary odema, thrombocytopenia, IUGR. Creatinine >1.2 mg/dl, serum
transaminase levels, S LDH>600 IU/L
l Hospitalize to evaluate and investigate
l Reassure, no restriction on routine salt intake l Urgent hospitalization
l Rest with limited activity l Start anti hypertensive
l Start anti hypertensive when DBP ≥ 100 mm Hg l Oral Nifedepine 10 mg stat, repeat after 30 minutes if needed OR
l Tab Alpha Methyl Dopa 250–500 mg 6-8 hourly l Inj Labetalol 20 mg IV bolus, repeat 40 mg after 10 minutes if BP not controlled again repeat 80 mg every 10 minutes (max 220 mg) with
(max 2 gm/day) OR cardiac monitoring
l Tab Labetalol 100 mg BD (max 2.4 gm/day)
l Investigate — Hgm, LFT, KFT, S Uric acid,
S LDH and fundus exam l Continue Tab Nifedepine 10 mg TDS (max 80 mg/day) OR Tab Labetalol 100 mg BD (max 2.4 gm/day)
l BP and urine output monitoring l Investigate — Hgm, LFT, KFT, S Uric acid, S LDH and fundus exam
l Urine output charting
l BP Monitoring
l Continue OPD management in mild disease
l Continue hospitalization in worsening < 24 weeks ≥24 -<34 weeks ≥34 weeks ≥37 weeks
hypertension/proteinureia
l Regular foetal+maternal surveillance (foetal Treatment should be individualised
movement count, NST, AFI, wt gain, BP and
urine output monitoring, weekly Hgm, LFT, KFT,
S Uric acid and S LDH) Foetal salvage difficult Inj. Betamethasone BP controlled BP uncontrolled
l 12 mg IM l Explain maternal and foetal l Worsening of clinical /
l Repeat 12 mg adverse effect to relatives biochemical parameters
after 24 hours l Regular maternal + foetal l Signs of foetal compromise
l Maintain DBP If disease severe, surveillance
90-100 mm Hg manage as severe
l No foetal compromise pre eclampsia
Terminate at 37 weeks
l Deliver at 38-39 weeks l Terminate pregnancy
l Induction of labor as per Bishop score and give Magsulf as in Eclampsia
No role of diuretics
For use in medical colleges, district hospitals and FRUs
