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) >90 MAP in third trimester (MAP - 3) >105 Increased incidence of pre- Eclampsia

& perinatal death

II trimester

Trophoblastic proliferation Dilatation of spiral arterioles

II trimester

II trimester

Drop in B.P

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

 Diastolic B.P (28-32 wks) In left lateral recumbent position

Then rolled to Supine postion

B.P taken immediately & after 5 min

Increase in B.P of at least 20 mmHg indicates positivity

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

Grade 1 & 2 Grade 3 Grade 4

A-V narrowing & spasm The stage of angiospasm

Above with edema, hemorrhage & exudates Pre Eclamptic retinopathy

Papilledema

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

mg / 24 hr urine sample dip stick values of 1+ or more Not an encouraging prognosis

>300

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

Ultrasound

examination

distress

Every fortnightly to monitor fetal growth

The Thyroid test, cardiac examination & vanillic

mandelic acid level estimation may be required to rule out other causes