Book of Medical Disorders in Pregnancy - Tintash

Severe pre eclampsia at or remote from
term requires delivery of the fetus
(Tables 37.5 and 37.6). Expectant
management under these circumstances
is unusual, and requires careful patient
and family counseling Laboratory
studies utilized during expectant
management include 24 hours urine
collections for quantitative protein and
creatinine clearance, platelet counts,
liver function tests, serum fibrinogen, PT
and PTT
Labor/delivery:
The judicious use of fluid therapy and
careful, frequent assessment of maternal
vital signs is critical Continuous
electronic fetal heart rate monitoring is
necessary to evaluate fetal status.
Magnesium sulfate is the drug of choice
for seizure prophylaxis (Tables 37.7 and
37.8) Antihypertensive medications are
employed to maintain blood pressures
below 160/110 mmHg (Table 37.9).
Potential complications include oliguria,
pulmonary edema, HELLP syndrome
and seizures. Invasive hemodynamic
monitoring is infrequently needed. It
should be employed to provide specific
hemodynamic data to effect management
decisions in patients who are unstable or
in whom the volume status is uncertain
Postnatal:
Continue seizure prophylaxis in preeclamptic
approximately 24 h
postpartum. In patients who have revere
disease in the MID trimester, eclampsia
or HELLP syndrome, slow resolution of
the disease process may dictate close
monitoring and continuation of seizure
prophylaxis for 2-4 days Patients who
still require antihypertensive medication
on discharge from the hospital should be
evaluated weekly. A full work-up should
be initiated for those persistently
65
hypertensive at/or more than 6 weeks
postpartum.
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Sivasamboo, R. (1968) : J. Obstet.
Gyne. Brit. Cwith. 75:856
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Kellar. Butterworths,
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