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Management of Pre Eclampsia by Ibrahim
The definitive treatment of pre eclampsia is delivery to prevent development of maternal or fetal complications from disease progression.
Mild pre-eclampsia At term, women are induced if there are no contraindications to vaginal birth. This minimizes the risk of progression to severe disease and its complications -- There is no reason to delay induction of women who are at least 37 weeks of gestation and have a favorable cervix (Bishop score greater than 6).
Hospital Admission -- Close maternal monitoring upon diagnosis is important for disease severity and the rate of progression. Hospitalization is useful for making these assessments & facilitates rapid intervention in the event of fulminant progression to eclampsia, hypertensive crisis, abruptio placenta, or HELLP syndrome.
Lab Follow up -- platelet count, serum creatinine, serum ALT and AST should be repeated once or twice weekly.
Assessment of fetal well-being & fetal growth Ultrasound Doppler and Biophysical profile.
Antenatal corticosteroids -- to promote fetal lung maturity should be administered to women less than 34 weeks of gestation.
Expectant Management of Pre Eclampsia:
In women with severe preeclampsia remote from term, the decision to continue pregnancy beyond that interval required for the administration of corticosteroids depends upon daily maternal and fetal assessment with continual review of the ongoing risks of conservative management versus the benefit of further fetal maturation. Such women should be cared for in a hospitalized setting and by, or in consultation with, a maternal-fetal medicine specialist.
Hospitalize until delivery.
Keep the patient at bed rest, except for bathroom privileges.
Monitor blood pressure every 2 to 4 hours while awake.
Assess maternal symptoms every 2 to 4 hours while awake.
Strict recording of fluid intake and urine output.
Complete blood count, electrolytes, and liver and renal function tests twice weekly.
Antenatal corticosteroids if not previously given.
Regular assessment of fetal wellbeing.
Elective delivery after 34 weeks.
Management of Pre Eclampsia:
Sodium restriction and diuretics have no role in routine therapy.
L-arginine supplementation lowered blood pressure or improved kidney function in pre eclamptic women. Effect of L-arginine therapy on the glomerular injury of preeclampsia:
--- a randomized controlled trial Hladunewich MA; Derby GC; Lafayette RA; Blouch KL; Druzin ML; Myers BD Obstet Gynecol. 2006 Apr;107(4):886-95
Anti Hypertensive Treatment -- initiating antihypertensive therapy in pre-eclamptic/eclamptic women when the systolic blood pressure is >150 mm Hg & diastolic >100 mm Hg.
Acute Therapy:
Labetalol Intermittent or continuous infusion fall in blood pressure begins within 5 to 10 minutes and lasts from 3 to 6 hours.
Hydralazine -- The fall in blood pressure begins within 10 to 30 minutes and lasts from 2 to 4 hours.
Calcium channel blockers Nifedipine & Nicardipine.
Diazoxide used when BP control is not archived with Labetalol & Hydralazine
Drugs contraindicated in pregnancy:
Sodium Nitroprusside
ACE Inhibitors
ARB's
Target blood pressures:
Systolic b/w 130 to 150 mmHg
Diastolic b/w 80 to 100 mm Hg
Breastfeeding mothers:
Beta-adrenergic blockers & calcium channel blockers enter breast milk; but considered "compatible" with breastfeeding by the American Academy of Pediatrics.
ACEi & ARB's are generally avoided during lactation in the neonatal period. Diuretics reduces milk volume.
Effects of BP Control on Fetus:
A 10 mmHg fall in mean arterial pressure was associated with a 176 g decrease in birth weight. This effect was unrelated to the type of hypertension or choice of medication.
Most experts agree that severe hypertension should be treated to prevent maternal vascular complications. However, there is no consensus as to the optimal blood pressure threshold for initiating therapy. We initiate antihypertensive therapy in adult women at systolic pressures between 150 and 160 mm Hg and diastolic blood pressures between 100 and 105 mm Hg.
Complications of Pre-eclampsia:
Outcome measureNormal blood pressure, (percent)Mild preeclampsia (percent)Severe preeclampsia (percent)
Maternal
Outcome measure, Normal blood pressure, (percent), Mild preeclampsia (percent), Severe preeclampsia (percent)
Maternal
Liver dysfunction, 0.2, 3.2, 20.2
Kidney dysfunction, 0.3, 5.1, 12.8
Placental abruption, 0.7, 0.5, 3.7
Induced labor, 12.1, 41.5, 58.7
Cesarean delivery, 13.3, 30.9, 34.9
Delivery
Dr. Syed Mujtaba H. Bilgrami, Resident Family Medicine (AKUH). He has written on a range of related issues as pregnancy planning, Pre Eclampsia and Pre Pregnancy stage.
Article Source: http://www.earticlesonline.com/Article/Management-of-Pre-Eclampsia/176484
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Check out these fine shops that offer Fetal Doppler Rentals products:
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Huntleigh Fetal Dopplex I Plus with 2MHZ Probe $1022 Huntleigh Fetal Dopplex I Plus Doppler |
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MedaSonics TRIA Fetal Doppler System with Interchangeable 2.3 MHz Fetal Probe $744 Features of the MedaSonics TRIA Fetal Doppler System: The MedaSonics® TRIA™ product line combines many tried and true features of the leading Dopplers with new Sensitec Signal Processing™ and Blended Beam® technology for even better performance to satisfy a variety of customer and patient needs. Detect fetal life early in pregnancy. Assess the rate and rhythm of the fetal heart. Sensitec Signal Processing™ provides pure, clear sound for greater accuracy in patient diagnosis. Included: Blended Beam® technology, a dual-crystal system designed for rapid signal acquisition. 2.3-MHz Doppler probe. Integrated speaker unit. Gel, battery, and soft carrying case. Product Specifications: Outputs: One 3.5 mm jack to connect to a headset or audio recording device. Power source: One 9V lithium battery. Weight: 8.75 oz. (245 gm). Dimensions: 5.25 x 2.6 x 1.75 in (13.3 x 6.6 x 4.5 cm). |
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MedaSonics FP3B Handheld Fetal Doppler Ultrasound Stethoscope System $829.04 Features of the MedaSonics FP3B Handheld Fetal Doppler Ultrasound Stethoscope System: To detect a fetal heartbeat during the earliest stages of pregnancy (nine to 12 weeks) and to assess the rate and rhythm of the fetal heart during pregnancy and labor, choose these pocket-sized ultrasound systems. The MedaSonics FP3B fetal Doppler has a classic, rugged design well suited for labor and delivery suites. Practical and easy-to-use, the FP3B allows for discreet screening when coupled to a stethoscope. Classic, rugged design known for reliability and consistency. Single-device design incorporates the Doppler and probe into an easy-to-use system. Stethoscope allows discreet screening of fetal condition without alarming the patient. Narrow vs broad beam Doppler signal allows increased sensitivity. Doppler-based ultrasound is the safest, noninvasive method of monitoring fetal heart rate and health. Frequency: 2.25 MHz. Power source: 1 9V alkaline battery. Weight: 4.7 oz (133 gm). Dimensions: 4.95 x 2.5 x 1.0 in (12.6 x 6.4 x 2.5 cm).Includes:- Doppler.- Stethoscope headset.- Gel.- Battery.- Soft carrying case. |
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Summit Doppler FetalGard Lite Fetal Monitor, Twins Tranducer $5254.69 Features of the Summit Doppler FetalGard LITE Fetal Monitor: The FETALGARD LiteTM is one of the highest quality fetal monitors available. The monitor offers complete flexibility in configuring a system that fits your needs and budget. It can be purchased in a package or configured independently. The system offers unique multifunctional features that make it ideal for fetal monitoring in the clinic, office or home. The system is designed and manufactured in the US with quality, dependability, performance and sensitivity. Mobile, lightweight and durable monitor. Wide-beam, sensitive twins tranducers and advanced signal processing. High speed recorder (printer) on easy-to-load Z-fold paper (accepts other manufacturers' paper). Tocotonometer, belts and ultrasound gel. Patient event marker. Full 2 year product warranty. |
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Summit Doppler LifeDop Display Hand-Held Doppler with 3MHz Obstetrical Probe $590 Features of the Summit Doppler LifeDop Display Hand-Held Doppler: The LifeDop 250 features a display, hand-held Doppler with superior sound quality, extended battery life, enhanced probe sensitivity, interchangeable probes and a one-year full warranty. The large, informative display shows battery life, signal quality and extended 50 to 220 bpm heart rate. The 3 MHz obstetrical probe is optimized for early fetal heart detection and designed for use during the entire pregnancy. (It is the best general purpose obstetrical probe). |
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Summit Doppler Pinnacle TableTop Display Doppler with Recharger & 3MHz Obstetrical Probe $782.09 Features of the Summit Doppler Pinnacle TableTop Display Doppler with Recharger: The Pinnacle 350R features a table-top, display Doppler with superior sound quality, PC-style cable locking system, extended battery life, enhanced probe sensitivity, interchangeable probes and a one-year full warranty. The large, informative display shows battery life, signal quality and extended 50 to 220 bpm heart rate. It includes a battery recharging system where you don't have to worry about overcharging or draining the batteries. The 3 MHz obstetrical probe is optimized for early fetal heart detection and designed for use during the entire pregnancy. (It is the best general purpose obstetrical probe). |
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MedaSonics TRIA Doppler System with Interchangeable 2.3 MHz Fetal & 5 MHz Vascular Probes $990 Features of the MedaSonics TRIA Doppler System:The MedaSonics® TRIA® product line combines many tried-and-true features of the leading Dopplers with new Sensitec Signal Processing™ and Blended BeamÒ technology for even better performance to satisfy a variety of customer and patient needs.Fetal probe facilitates detection of fetal life early in pregnancy. Also permits the assessment of the rate and rhythm of the fetal heart.Vascular probe aides in locating vessels and assessing vessel potency and calculation of ankle-brachial index.Interchangeable fetal and vascular probes.Sensitec Signal Processing™ provides pure, clear sound for greater accuracy in patient diagnosis.Includes Blended Beam® technology, a dual-crystal system designed for rapid signal acquisition.Includes:One 2.3-MHz and one 5-MHz Doppler probe.Integrated speaker unit.Integrated Accu-Rate display.Gel, battery, carrying case, and belt clip.Product Specifications:Outputs: One 3.5 mm jack to connect to a headset or audio recording device.Power Source: One 9v lithium battery.Weight: 8.75 oz. (245 gm).Dimensions: 5.25 x 2.6 x 1.75 in (13.3 x 6.6 4.5 cm). |
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Summit Doppler LifeDop Non-Display Hand-Held Doppler with 3MHz Obstetrical Probe $434.91 Features of the Summit Doppler LifeDop Non-Display Hand-Held Doppler: The LifeDop 150 features a non-display, hand-held Doppler with superior sound quality, extended battery life, enhanced probe sensitivity, interchangeable probes and a one-year full warranty. The 3 MHz obstetrical probe is optimized for early fetal heart detection and designed for use during the entire pregnancy. (It is the best general purpose obstetrical probe). |
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Summit Doppler LifeDop Display Hand-Held Doppler with Recharger & 3MHz Obstetrical Probe $629 Features of the Summit Doppler LifeDop Display Hand-Held Doppler with Recharger: The LifeDop 250R features a display, hand-held Doppler with superior sound quality, extended battery life, enhanced probe sensitivity, interchangeable probes and a one-year full warranty. The large, informative display shows battery life, signal quality and extended 50 to 220 bpm heart rate. It includes a battery recharging system where you don't have to worry about overcharging or draining the batteries. The 3 MHz obstetrical probe is optimized for early fetal heart detection and designed for use during the entire pregnancy. (It is the best general purpose obstetrical probe). |
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Summit Doppler LifeDop Non-Display Hand-Held Doppler with Recharger & 3MHz Obstetrical Probe $474.81 Features of the Summit Doppler LifeDop Non-Display Hand-Held Doppler with Recharger: The LifeDop 150R features a non-display, hand-held Doppler with superior sound quality, extended battery life, enhanced probe sensitivity, interchangeable probes and a one-year full warranty. It includes a battery recharging system where you don't have to worry about overcharging or draining the batteries. The 3 MHz obstetrical probe is optimized for early fetal heart detection and designed for use during the entire pregnancy. (It is the best general purpose obstetrical probe). |
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Grafco Ultrasound Pocket Doppler with 4 MHz Probe $449.99 Ultrasound Pocket Doppler The Grafco Ultrasound Pocket Doppler is intended for clinical use as an obstetrical or vascular monitoring tool. The unit includes a mini USB probe socket, probe detector, built-in speaker, adjustable volume, alkaline battery, and low battery detector. Available with one of three different interchangable probes: 2MHz, 4MHz or 8MHz. The 2MHz probe is used primarily for fetal heart detection. The 4MHz is utilized for vascular monitoring, and the 8MHz is used for superficial vascular monitoring. Features: Compact lightweight design. Accurate detection with clear audible sound produced. Low battery indicator and volume control. Interchangeable waterproof probe. Carrying Case Included. |
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Grafco Ultrasound Pocket Doppler with 8 MHz Probe $469 Ultrasound Pocket Doppler The Grafco Ultrasound Pocket Doppler is intended for clinical use as an obstetrical or vascular monitoring tool. The unit includes a mini USB probe socket, probe detector, built-in speaker, adjustable volume, alkaline battery, and low battery detector. Available with one of three different interchangable probes: 2MHz, 4MHz or 8MHz. The 2MHz probe is used primarily for fetal heart detection. The 4MHz is utilized for vascular monitoring, and the 8MHz is used for superficial vascular monitoring. Features: Compact lightweight design. Accurate detection with clear audible sound produced. Low battery indicator and volume control. Interchangeable waterproof probe. Carrying Case Included. |
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Grafco Ultrasound Pocket Doppler with 2 MHz Probe $319.2 Ultrasound Pocket Doppler The Grafco Ultrasound Pocket Doppler is intended for clinical use as an obstetrical or vascular monitoring tool. The unit includes a mini USB probe socket, probe detector, built-in speaker, adjustable volume, alkaline battery, and low battery detector. Available with one of three different interchangable probes: 2MHz, 4MHz or 8MHz. The 2MHz probe is used primarily for fetal heart detection. The 4MHz is utilized for vascular monitoring, and the 8MHz is used for superficial vascular monitoring. Features: Compact lightweight design. Accurate detection with clear audible sound produced. Low battery indicator and volume control. Interchangeable waterproof probe. Carrying Case Included. |
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Summit Doppler Non-Directional Probe, EchoHeart 5MHz Transvaginal Obstetrical Probe $343.91 Features of the Summit Doppler Non-Directional Probe: The EchoHeart 5 MHz transvaginal obstetrical probe is optimized for earlier fetal heart detection and perfect for retroverted and obese patients. It is used when transvaginal imaging is too costly or inconvenient. For use with SUD-L150, SUD-L150R, SUD-L150A, SUD-L250, SUD-L250R, SUD-L250AR & SUD-L350R. |
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Viasys Neurocare Nicolet Vascular Elite 100 Doppler with 5 MHz Probe $888.21 Features of the Viasys Neurocare Nicolet Vascular Elite 100 Doppler: The Elite from Nicolet Vascular offers everything that you need in a Doppler system. The Elite is a configurable, ultrasound Doppler used to detect the fetal heartbeat and to assist in monitoring peripheral arterial and venous blood flow. The Elite has a comfortable probe shape that makes finding a signal easier than ever before. Elite combines extreme sensitivity and incredibly clear, static-free sound into a compact, pocket-sized package. Plus, the various options can be configured to meet your specific needs. The Elite sets new standards for pocket Doppler performance! The comfortable shape of the Elite probe is easy to hold and features broad-beam technology, making it very easy to find and lock onto the signal of interest. Our probe technology has been tested in OB applications for years and is effective in detecting fetal heartbeats as early as 8 weeks in most pregnancies. Try something new! The pre-angled crystals, broad-beam technology and large probe face of our 5 MHz probe provide a unique method of quickly locating vascular signals. There is no need to angle the probe, simply align it along the vessel of interest. The most important output of any Doppler is the sound. Static Suppression Doppler (SSD) technology provides a crystal clear, static-free signal for the best possible diagnostic information. The large, built-in speaker or optional headset provides reliable sound that can be heard publicly or privately, depending upon the situation. |
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Summit Doppler Non-Directional Probe, 3MHz Obstetrical Probe - Early/General Use $156.78 Features of the Summit Doppler Non-Directional Probe: The 3 MHz obstetrical probe is optimized for early fetal heart detection and designed for use during the entire pregnancy. (It is the best general purpose obstetrical probe). For use with SUD-L150, SUD-L150R, SUD-L150A, SUD-L250, SUD-L250R, SUD-L250AR & SUD-L350R. |
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Summit LifeDop Non-Display Hand-Held Doppler with Audio Recorder & 3MHz Obstetrical Probe $514 Features of the Summit LifeDop Non-Display Hand-Held Doppler with Audio Recorder: The LifeDop 150A features a non-display, hand-held Doppler with superior sound quality, extended battery life, enhanced probe sensitivity, interchangeable probes and a one-year full warranty. It includes a built-in audio recorder - a first in the market. The 3 MHz obstetrical probe is optimized for early fetal heart detection and designed for use during the entire pregnancy. (It is the best general purpose obstetrical probe). |
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Summit Doppler Hand-held Doppler Carrying Case $26.34 Features of the Summit Doppler Hand-held Doppler Carrying Case:A convenient lightweight carrying case for all of Summit Doppler's hand-held Dopplers. |
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Summit Doppler Hand-held Doppler Universal Clamp $207.48 Features of the Summit Doppler Hand-held Doppler Universal Clamp:A heavy duty table or cart clamp for all of Summit Doppler's hand-held Dopplers. |
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Summit Doppler Rechargeable Battery for Rechargeable Doppler Systems, 3/pk $20.21 A package of 3 rechargeable batteries for all of Summit Doppler's rechargeable Doppler systems. |
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Summit LifeDop Display Hand-Held Doppler with Recharger, Audio Recorder & 3MHz Obstetrical Probe $708.81 Features of the Summit LifeDop Display Hand-Held Doppler with Recharger and Audio Recorder: The LifeDop 250AR has it all, a display unit with superior sound quality, extended battery life, enhanced probe sensitivity, interchangeable probes and a one-year full warranty. The large informative display shows battery life, signal quality and extended 50 to 220 bpm heart rate. It includes a battery recharging system where you don't have to worry about overcharging or draining the batteries, and includes a built-in audio recorder with download capability - a first in the market. The 3 MHz obstetrical probe is optimized for early fetal heart detection and designed for use during the entire pregnancy. (It is the best general purpose obstetrical probe). |
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Summit Doppler TableTop Doppler Stand with Storage Basket $262.61 Features of the Summit Doppler Stand:A sturdy 5 castor stand for all of Summit Doppler's table-top Dopplers with convenient storage basket. |
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Summit Doppler Alkaline Battery for Non-Rechargeable Doppler Systems, 3/pk $9.9 A package of 3 AA alkaline batteries for all of Summit Doppler's non-rechargeable Doppler systems. |
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Summit Doppler Hand-held Doppler Stand without Storage Basket $207.48 Features of the Summit Doppler Stand:Sturdy 5 Castor Stand for Summit Doppler's Handheld Dopplers. |
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Summit Doppler TableTop Doppler Stand without Storage Basket $207.48 Features of the Summit Doppler Stand:A sturdy 5 castor stand for Summit Doppler's Tabletop Dopplers. |
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Summit Doppler Stereo Headphones for Dopplers $17.11 Features of the Summit Doppler Stereo Headphones:Stereo headphones used with all of Summit Doppler's hand-held and table-top Dopplers. |
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Summit Doppler Hand-held Doppler Stand with Storage Basket $262.61 Features of the Summit Doppler Stand:A sturdy 5 castor stand for all of Summit Doppler's hand-held Dopplers with convenient storage basket. |
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Fluke Biomedical 17156 Mechanical Fetal Heart Cable $109.99 Fluke Biomedical 17156 Mechanical Fetal Heart Cable |
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Summit Doppler Ultrasound Gel, 60g $5.99 Features of the Summit Doppler Ultrasound Gel:A 60g bottle of Parker ultrasound gel for use with all Dopplers. |
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Summit Doppler EchoHeart Disinfectant Spray $17 Features of the Summit Doppler EchoHeart Disinfectant Spray: A disinfectant spray used specifically to clean the EchoHeart probe. |
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