Pre-eclamptic toxaemia (PET) is also called Toxemia of pregnancy or pregnancy induced hypertension. This is a syndrome that develops after the 20th week of pregnancy. It is characterized by:
- Persistent high blood pressure at or above 140/90mmHg.
- Edema or swelling of the feet and ankles.
- Proteinuria or presence of protein in the urine.
Edema is usually the first sign to occur followed by high blood pressure and then by proteinuria.
Cause of PET : The exact cause is unknown but it is believed to be associated with a defect of the immunological mechanism involved in normal fetomaternal host response.
Signs and Symptoms of PET:
Tests in PET
- Blood : Haemoglobin level and serum Uric Acid levels.
- Urine : The total quantity of urine; presence of protein in the urine.
- Eyes : The fundus of the eye has to be checked for any changes caused by hypertension.
Complications of PET:
- Eclampsia: The most important complication is eclampsia which is PET complicated with convulsions or fits. Cerebral hypoxia (lack of oxygen in the brain) and cerebral edema due to high blood pressure are the main causes.
- Placental Abruption: Placental Abruption i.e. bleeding into the base of the placenta leading to fetal death is another important complication.
- Chronic Hypertension: Some patients may develop chronic hypertension after delivery.
Management / Treatment of Pre-eclamptic Toxaemia (PET)
Mild PET :
- Bed rest: Bed rest should be taken for at least 8 hours at night and 2 hours during the day. She should also lie down in bed on her left side during the other hours as much as possible. Rest causes decrease in hypertension, decrease in oedema, increases the placental blood flow.
- Diet and Salt Restriction: Pregnancy Diet should be nutritious with adequate fluid intake. Salt is restricted to 5 mg per day instead of 10 mg per day as advised in normal pregnancy.
- Medicines: Anti-hypertensive and sedative drugs are prescribed.
- Regular monitoring: Regular monitoring of blood pressure, fluid intake and output chart; urine for protein; weight increase; check up of eyes; blood tests.
- Regular fetal monitoring The rate and rhythm of the fetal heart sound and number of fetal movements per day is monitored.
- Delivery of the baby: Pregnancy is terminated at 37 weeks after checking for fetal maturity by USG. If cervix is soft and inducible, then labor is induced. If fetus is deemed to be at risk and cervix firmly closed , elective caesarian section should be done.
Severe PET :
- Total Bed rest: The patient is advised total bed rest, rising from bed only to go to the bathroom. Sometimes in very severe cases, she may even have to use the bed pan.
- Immediate hospital admission: She is admitted in the hospital immediately as soon as she is diagnosed as a a severe case of pre-eclamptic toxaemia. This ensures constant monitoring of the vital parameters.
- Medicines: Drugs to control convulsions, hypertension and maintain urine output are prescribed.
- Regular monitoring: of blood pressure, fluid intake and output chart; urine for protein; weight increase; check up of eyes; blood tests.
- Regular fetal monitoring The rate and rhythm of the foetal heart sound and number of foetal movements per day is monitored.
- Delivery of the baby: Pregnancy is terminated at 37 weeks after checking for foetal maturity by USG. If cervix is soft and inducible, then labor is induced. If fetus is deemed to be at risk and cervix is firmly closed, elective cesarian section should be done.
- Cesarian Section: Caesarian section has to be done if blood pressure cannot be controlled or there is risk of developing complications like eclampsia or eye changes.
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