Book of Medical Disorders in Pregnancy - Tintash

severe pre eclampsia and eclampsia
there is reduction in the plasma volume.
The hypervolemia is reduced following
both vasoconstriction and perhaps to
some extent, hypoproteinemia. This
means that values in hypertensive patients
are significantly depressed when
compared to normotensive patients.
There is a decrease in RBC mass but
only in cases of severe hypertension.
Alterations in coagulation:
mechanism:
Changes suggestive of disseminated intravascular
coagulation and red cell destructtion
occur at times in preeclampsia.
The rate of RBC destruction varies and
evidence of hemolysis usually clears
promptly after delivery.
Clinical features: The symptoms in preeclamptic
toxemia are generally a late
occurrence, therefore early detection is
necessary to prevent progression of this
disease further. The symptoms include
headache, visual disturbances, puffiness
of eyelids and fingers.
Edema:
Most normal pregnant women can be
shown to have postural edema of the
lower extremities. This disappears after
bed rest or merely by elevating the legs
for a brief interval. A weight gain
exceeding 500 gm (0.5 Kg) in one week
signifies acute water retention and may
be a manifestation of occult edema.
Pitting edema of the abdominal wall,
face, hands and sacral area indicates
abnormally excessive retention of water.
Sudden and excessive weight gain is an
important sign. Gain of 0.5 Kg per week
is accepted as normal but excess of 1 Kg
47
per week or 3 Kg per month is considered
abnormal. Steady weight gain is
acceptable in most instances but sudden
increase should be evaluated carefully.
The fluid retention occurs before the
development of edema.
Dependent edema of the lower extremities
appears to be universal in pregnancy
and is based on mechanical factors
relating to gravity, increased venous pressure,
and lymphatic obstruction. These
factors do not apply for edema appearing
in face and the hands.
Proteinuria - Great variations in patient
to patient and hour to hour suggest that
the problem is related to vasospasm and
may be absent or minimal in early preeclampsia.
This almost always follows
hypertension but can follow excessive
weight gain. In many normal pregnant
women, there is a trace or more of
protein in voided specimens of urine.
This is associated with orthostatic albuminuria
or contamination of the specimen
by vaginal discharge. Determinations
of total protein in 24 hour
collections are required for accurate
evaluation. Although limits of normal
are arbitrarily designated, it is generally
agreed that the maximum daily excretion
of protein should not exceed 300 mg in
normal gravidas. Appearance of protein
in the urine is the most common
manifestation of renal disease, there is
general clinical agreement that proteinuria
in pregnancy is ominous. However,
as noted above, protein may be
found in the urine of normal gravidas.
The quantity of protein in the urine
fluctuates widely and rapidly with time.
Certain circumstances tend to enhance
the amount of protein that appears in the
urine, including violent exercise, hard
work, and exposure to cold, cold