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