Book of Medical Disorders in Pregnancy - Tintash

Prevention - The student must realize
that there is very high fetal and maternal
mortality associated with this complication,
especially if eclampsia is allowed
to develop. Eclampsia is preventable
if the disease process leading to
this complication can be identified early
and treated in very early stages. The
disease is asymptomatic in its early
stages therefore one must look for clues
of pre-eclampsia in the high risk group
of patients such as the primi gravidas,
those with family history of eclampsia/pre-eclampsia.
Women with fam-ily
history of chronic hypertensive disorders,
in multiple pregnancies and those
with molar pregnancy. Rapid weight
gain in the latter half of pregnancy and
an upward trend of blood pressure
should forewarn the physician, that the
patient may develop pregnancy induced
hypertension. Good antenatal care,
where such screening is constantly
reinforced can reduce the incidence of
severe pre-eclampsia and should be able
to abolish the development of eclampsia
altogether. The main objectives of
modern therapy are to prevent convulsions
and to deliver a healthy baby,
inflicting minimal trauma to the mother
and prevent residual hypertension.
A number of studies in the literature
have shown that attempts to improve
nutrition have resulted in decreasing
PET, prematurity and peri-natal
mortality rates. Excessive weight gain
alone is not associated with a high
complication rate and pregnancy is
surely not the time to carry out weight
reduction programmers. Insufficient
protein intake is harmful both to the
fetus and the mother. 2,200 calories
usually satisfy the needs of both and less
than this can be dangerous in some
cases. Weight gain has been shown to
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positively correlate with birth weight of
the baby. Inadequate caloric intake
exposes the fetus at risk to hypoglycemia
and ketosis in the mother.
Ambulatory treatment:
There is little place for ambula-tory
treatment in any but the mildest degrees
of pre eclampsia. Bed rest is mandatory;
patient should be advised to lie in left
lateral position. It is best accomplished
in well controlled hospital surroundings.
Sedation is an important adjuvant to bed
rest. It relieves anxiety component and
reduces physical and neural activity. In
addition to the potential of lowering
arterial pressure, bed rest may also
reduce extravascular fluid volume by its
natriuretic and saluretic effect and
increase uteroplac-ental blood flow by
decreasing the de-mands of activity
related organs and structures. In a
number of instances a sharp increase in
plasma estriol con-centrations with bed
rest alone has been reported.
Bed rest - The patient is encouraged to
lie in left lateral position, high protein
and caloric diet should be given.
Sedation - There are a number of
sedatives available in the market but the
time honored barbiturate, the Phenobarbitone
remains the drug of choice in our
centre.
Phenobarbitone - This drug is most
commonly used. Its long term use has
shown that it is safe to give during
pregnancy. The dosage is 120 to 240 mg
per day in mild to moderately severe
cases of PET. Adverse effects of this
drug include sleepy babies and sleepy
mothers. There is a reduction of Vitamin
K dependent coagulation factors in some