Severe Preclampsia management with risk stratification and prophylactic magnesium sulphate a better approach

Severe preclampsia is the commonest medical disorder of pregnancy that we encounter in our tertiary care center with an incidence of 21 % seen over the past 5 years. We define severe preclampsia as proteinuric hypertension after 20  weeks of gestation associated with BP  ≥150 mmHg systolic and/or ≥100 mmHg diastolic (on 2 occasions at least 6 hours apart, while the patient is on bed rest), proteinuria of ≥5 g/24 hrs or ≥3+ (on 2 random urine samples, collected at least 4 hrs apart), oliguria <500 ml/24 hrs, cerebral or visual disturbances, pulmonary oedema or cyanosis, epigastric or right upper quadrant pain, impaired liver function and  thrombocytopenia. Immediate hospitalization, laboratory investigations, imaging, fetal monitoring, risk assessment for maternal as well as fetal condition are swiftly done and treatment planned. We use 4 grams intravenous magnesium sulphate in all women with severe preclampsia and nifedepine orally in titrating or slow release dose schedule. Injectablelabetolol is used if no response to nifedepine seen within half an hour. All mothers less than 34 weeks are administered steroids. Some women needed repetition of the magnesium sulphate and effective temporization could be achieved. Neonatal outcomes were satisfactory. All the women presenting had inadequate or no antenatal care. Poor nutrition especially proteins and anemia was found to be a prevalent risk factor. HELLP syndrome was found in about 35 % of the mothers. We conclude that risk stratification, prophylactic magnesium sulfate and appropriate antihypertensives is associated with better perinatal outcome.

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