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Investigations
It is defined as hypertension that develops for the first time in pregnancy after 20 weeks of gestation.
NOT accompanied by proteinuria
B.P returns to normal within 12 weeks post partum
Characterized by rise in B.P
Accompanied by Proteinuria & Edema
Physical examination
Laboratory test
Measurement of B.P – Key for identification & management of pre Eclampsia
Clinicians usually employ 140/90 mmHg as cut off for hypertension or an alternatively an increase in 30/15 mmHg from the base line
Mean Arterial Pressure
Roll over or Supine pressor test
Mean Arterial Pressure = Diastolic blood pressure + 1/3 (Pulse pressure)
MAP in second trimester (MAP-2) >90MAP in third trimester (MAP - 3) >105
Increased incidence of pre- Eclampsia & perinatal death
In second trimester usually fall in B.P
If MAP-2 > 90 – may predict future PIH based on the absence of vaso dilatation & should alert the physician for close follow up
Roll over test – 60% prediction rate for H.T/Pre-Eclampsia
Combination of MAP & Roll over – Prediction increased to 78%
Indicates the probability of developing hypertension in 90%
If increase in 20 mmHg of B.P is noted for administration of 8mg/kg body weight of angiotensin
Urine examination
Blood examination
Platelet count
Renal function test
Liver function test
Urine examination for albumin, sugar, hemoglobinuria, pus cells & casts
Estimation of 24 hr urinary protein
>300 mg / 24 hr urine sample dip stick values of 1+ or moreNot an encouraging prognosis
Calcium/Creatinine Ratio (CCR) : CCR in urine is also considered a predictor test, with a lower calcium excretion in pre-Eclampsia
CCR of less than 0.04 is significant
Hematocrit Increased Hematocrit level
Fall in Hematocrit level denotes clinical improvement
Maternal Serum Alpha Feto Protein : Levels > 2 multiples of median is associated with higher incidence of pre eclampsia
Serum HCG level : Serum HCG level above 5000 IU/ml at 13-20 weeks is predictive of PIH later in pregnancy
Fibronectin level : Raised Fibronectin levels
Thrombocytopenia
Platelet count less than 100,000 per cub.mm indicates severe disease
Serum Uric acid level Serum uric acid level rises four weeks before the onset of PIH (Correlate with development of pre Eclampsia severity of pre Eclampsia & increased perinatal mortality )Serum Creatinine level Increased – 1.3 to 1.4 mg/dl (Normal during pregnancy – 0.8 mg/dl)
Blood Urea Nitrogen (BUN) Increased – 20-25 mg/dl (Normal during pregnancy – 15 mg/dl)
Creatinine Clearance 100 ml/min is considered abnormal during gestation
Little or no change
In severe case – Increased SGPT, SGOT, LDH
SGPT & SGOT – Decrease rapidly after delivery (Within 5 th postpartum day)
LDH – Falls slowly (Within 8 – 10 postpartum day)
Hemoglobinuria
Elevated Liver enzymes
Low Platelet count
Early ultrasonic scan in the second trimester (24 wks) shows bilateral notching of the uterine artery in a women at a high risk of developing PIH in 80% cases
It is used to study the blood flow in the uterine artery, umblical artery, middle cerebral artery
It is simple, non invasive procedure
Criteria used are systolic/diastolic velocity ratio, high resistance index & pulsatile index
They show the effect of PIH on fetus, such as IUGR & poor biophysical profile
In pre-Eclamptic women, higher flow velocity waveform indices were found in placental end of the cord when compared to the fetal end, indicating increased placental impedence
Early diastolic notch precedes the onset of growth retardation
Cardiotocography
should be done in the last few weeks to look for chronic fetal distress
Ultrasound examination
Every fortnightly to monitor fetal growth
The Thyroid test, cardiac examination & vanillic mandelic acid level estimation may be required to rule out other causes