Pre-Eclampsia – ED

Preeclampsia:

  • new onset of hypertension and proteinuria or
  • the new onset of hypertension and significant end-organ dysfunction with or without proteinuria
  • after 20 weeks of gestation in a previously normotensive woman
    • Proteinuria ≥0.3 g in a 24-hour urine specimen or protein/creatinine ratio ≥0.3 (mg/mg) (30 mg/mmol) in a random urine specimen or dipstick ≥2+ if a quantitative measurement is unavailable
    • Platelet count <100,000/microL
    • Serum creatinine >1.1 mg/dL (97.2 micromol/L) or doubling of the creatinine concentration in the absence of other renal disease
    • Liver transaminases at least twice the upper limit of the normal concentrations for the local laboratory
    • Pulmonary edema
    • New-onset and persistent headache not accounted for by alternative diagnoses and not responding to usual doses of analgesics
    • Visual symptoms (eg, blurred vision, flashing lights or sparks, scotomata)

1. In a pregnant patient who presents with unexplained symptoms (e.g., abdominal pain, altered sensorium, headache) consider the diagnosis of pre-eclampsia even if the blood pressure is normal.

Pre-eclampsia symptoms: Headache, vision changes (scotoma), abdominal pain

  • may occur up to 6wk postpartum
  • check labs to rule HELLP (Hemolysis, Elevated LFT, Low Platelet) – Normal INR/PTT

2. In a pregnant patient who may have pre-eclampsia, assess in a structured fashion (e.g., risk factors, symptoms, signs, change in BP from baseline, blood tests) to try to rule in or rule out the diagnosis expeditiously.

Risk factors:

  • Past hx of pre-eclampsia
  • Family hx of pre-eclampsia
  • Extreme of maternal age
  • Primigravid (even if it is the first pregnancy with a new partner),
  • diabetes, HTN
  • Obesity, CKD
  • either very short (<2yr) or very long (>10yr) time in between pregnancies
  • Multi-fetal pregnancy
  • Fertility Tx

3. In a pregnant patient with non-specific symptoms such as nausea and vomiting or abdominal pain, rule out HELLP syndrome before diagnosing any other cause.

4. In a patient with pre-eclampsia, start initial management (e.g., BP management, seizure precautions), monitor the mother and fetus for complications, and ensure urgent evaluation for the timing and manner of delivery.

MgSO4 4g IV for eclampsia

Posted in ENT, Uncategorized

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