INTRODUCTION: likely to develop preeclampsia than a woman in

INTRODUCTION:           Preeclampsia, the most common form of high blood pressure (BP) that complicates pregnancy usually after 20 weeks of gestation and is primarily defined by the occurrence of new-onset hypertension, new-onset proteinuria and pedal edema.1IMPACT OF PREECLAMPSIA:• Each year Ten million women around the world develop preeclampsia. Worldwide about 76,000 pregnant women and 500,000 babies die per annum from preeclampsia and related hypertensive disorders.• A woman in developing country is 7 times more likely to develop preeclampsia than a woman in a developed country. From 10-25% of these cases will result in maternal death.2• If undetected, preeclampsia can result in eclampsia that is one of the pinnacle 5 causes of maternal and infant illness and death, inflicting an estimated 13% of all maternal deaths global or literally a maternal death every 12 minutes.• In 2002, 6.6 miilion women are suffered from preeclaampsia i.e., approximately 5 to 8 percent of pregnancies are affected by the disease.• In the U.S., preeclampsia is liable for approximately 18% of all maternal deaths.• Main reason doctors decide to deliver a baby prematurely is because Preeclampsia causes 15% of premature births in industrialized countries.3RISK FACTORS OF PREECLAMPSIA:• Maternal specific Risk Factors:45o Maternal age (years), maternal height (cms), maternal 7BMI o Past history of preeclampsia in multiparous women.o Maternal blood groupo Interval between pregnancieso Number of previous abortionso Sex of new borno Medical history of any autoimmune diseaseo Gestational diabeteso Medical history of diabetes mellituso Family history of hypertension or diabetes mellitus among first blood relationso Family history of preeclampsia• Pregnancy specific risk factors:o Urinary tract infectionso Fetal malformationso Partner related exposureo Limited sperm exposureo Husband’s age• Exogenous risk factors:o Smokingo Stress and working women statusCOMPLICATIONS OF PREECLAMPSIA: 678• Central nervous systemo Eclampsia (seizures)o Cerebral haemorrhage (stroke)o Cerebral oedemao Cortical blindnesso Retinal oedemao Retinal blindness• Renal systemo Renal cortical necrosiso Renal tubular necrosis• Respiratory systemo Pulmonary oedemao Laryngeal oedema• Livero Jaundiceo HELLP syndrome (haemolysis, elevated liver enzymes, and lowered platelets)o Hepatic rupture• Coagulation systemo Disseminated intravascular coagulationo Microangiopathic haemolysis• Placentao Placental infarctiono Placental abruption• Babyo Deatho Preterm birtho Intrauterine growth restrictionMANAGEMENT OF PREECLAMPSIA:Delivery is the ultimate treatment option for preeclampsia. Vaginal delivery is preferable to avoid added physiologic stressors of cesarean.9During labor, primary goal of management is to prevent seizures and control hypertension.• Magnesium Sulfate: Magnesium sulfate is the drug of choice for prevention and treatment of seizures in women with severe preeclampsia. Dosage regimen commonly opted is 6g loading dose followed by continuous infusion at rate of 2g per hour.• Anti Hypertensive drug therapy: Antihypertensive drug therapy is recommended for pregnant women with systolic blood pressures of 160 to 180 mm Hg or higher and diastolic blood pressures of 105 to 110 mm Hg or higher.• According to updated Cochrane systemic review of 35 trials, there was no significant difference between labetalol, hydralazine and nifedipine. Results of these trials suggest hydralazine, labetalol, or nifedipine can be used during severe hypertension in pregnancy by considering dosage regime, expected onset time of actions, contraindications and potential adverse effects.10o Hydralazine: Direct peripheral arteriolar vasodilator agent. Hydralazine was used as primary drug of choice in acute hypertensive disorders in the past. Hydralazine is associated with worse maternal and perinatal side effects than nifedipine and labetalol.1112o Labetalol: Selective alpha blocker and non-selective beta blocker agent. Labetalol slows heart rate, reducing myocardial oxygen consumption and decreases supraventricular rhythm. Labetalol is safe and effective drug to use in pregnancy induced hypertension as it controls high blood pressure faster. 13o Nifedipine: Calcium channel blocker. Nifedipine blocks calcium entry into cells induces vasodilation by acting on arteriolar smooth muscle. As nifedipine is oral calcium channel blocker hence easy to administer, convenient and more predictable.14o Sodium nitroprusside: Nitroprusside causes vasodilation by releasing nitric acid. Sodium nitroprusside is used in severe hypertensive emergency, when other medications are not effective. 10