Best practice available for the management of pre eclampsia

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Acknowledgement

I would first like to express my gratitude for my research supervisor, colleagues, peers and family whose immense and constant support has been a source of continuous guidance and inspiration.

DECLARATION

I [type your full first names & surname here], declare that the following dissertation/thesis and its entire content has been an individual, unaided effort and has not been submitted or published before. Furthermore, it reflects my opinion and take on the topic and is does not represent the opinion of the University.

Signed __________________ Date _________________

Abstract

Preeclampsia is a serious maternal-fetal disease that affects 2-7% of pregnancies. The etiology of preeclampsia likely involves an interaction between impaired placental development, maternal constitutional factors, genetic susceptibility, inflammation, oxidative stress, and endothelial dysfunction. Regular exercise during the year prior to conception may protect against preeclampsia, whereas regular exercise during early pregnancy does not alter preeclampsia risk in general, but may reduce preeclampsia risk in specific sub populations or at specific dosages. The risk of severe preeclampsia is increased among women who exercise more than 270 minutes/week in early pregnancy, compared to sedentary controls.

Contents

Background6

Problem statement6

Rationale6

Research question7

Reliability and Validity7

Generalizability8

Ethical Considerations8

LITERATURE REVIEW10

Definition and Classification10

Etiology10

Immune Maladaptation13

Epidemiology14

Mortality Risk14

Pathophysiology15

Cardiovascular System17

Respiratory18

Central Nervous System18

Renal20

Coagulation20

Hepati21

Fetus21

Prediction Of Pre Eclampsia21

Prevention22

Management22

Hospitalization23

Bed Rest23

Control of Blood Pressure24

Fluid Therapy24

Treatment Of Oliguria25

Cardiovascular system26

Haematological system26

Renat system27

Bitary system28

Neurotogicat system29

Fetal well being30

Management30

Delivery or expectant management30

Antihypertensives31

METHODOLOGY34

Search Technique35

Literature Search36

Inclusion and exclusion criteria37

Search terms - key terms37

Additional Online searches38

Management38

Search rationale38

Critical Appraisal tool38

Appraisal limitations38

DISCUSSION40

Management of Eclampsia40

Hellp Syndrome40

Anaesthetic Considerations41

Choice Of Analgesia42

Post Delivery Care42

The Role Of Spinal (Subarachnoid) Anaesthesia42

General Anaesthesia43

Problems with Intubation43

Pressor Response to Intubation And Extubation44

Induction and Maintenance of General Anaesthesia44

Monitoring44

Post Delivery Management45

CONCLUSION46

Introduction

Background

Preeclampsia is a serious maternal-fetal disease that affects 2-7% of pregnancies, and is diagnosed after 20 weeks gestation on the basis of new onset hypertension (blood pressure > 140/90 mm Hg for two consecutive readings) and proteinuria (24 hour urinary protein level of at least 0.3 g/day). Preeclampsia should also be suspected without proteinuria if the patient presents with new onset hypertension and other symptoms of major organ dysfunction including thrombocytopenia, elevated liver enzyme activities, persistent headaches, visual disturbances, or epigastric pain.

Problem statement

A diagnosis of preeclampsia can have serious implications for both mother and fetus. Preeclampsia accounts for 15% of pre-term births and their associated morbidities and mortality, and can also lead to intrauterine growth restriction and death. Maternal complications include an increased risk of abruptio placentae, renal failure, pulmonary edema, cerebral hemorrhage, stroke and circulatory collapse. Careful management has led to a decrease in maternal mortality resulting from preeclampsia in developed countries, however, the associated maternal mortality rate in the developing world remains high.

Rationale

Other than delivery, there are no proven interventions to treat preeclampsia or to prolong gestation. However, recent attention has focused on the potential benefits of regular exercise in preventing preeclampsia. Retrospective case-control studies indicate that women who exercise regularly are 25-60% less likely to develop preeclampsia, while a prospective epidemiological study observed a 45% reduction in preeclampsia risk among women who participated in any regular exercise during the year prior to ...