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How to manage pre-eclampsia (high blood pressure during pregnancy)?

Q: I am 28 year old and I am expecting, (sixth month in progress) and according to my sonographic report, I have bicornuate uterus. Presently my health condition is alright. This is my second pregnancy. Last time I conceived during Danozen treatment due to cyst problem, I knew about my pregnancy four month later. After seven month suddenly I suffered from pre-eclampsia (BP 220/110). I was hospitalised and after three four days doctors decided to terminate the child I delivered a PT alive male child, normally, child weight 1.12 kg. Baby did not cry immediately, resuscitation done, baby shifted to ventilator support but could not be saved due to extreme prematurity. Eight years back I was operated for chocolate ovarian cyst left side & appendicitis. As per as my gynaecologist's advice I am taking four Maintinee & four Pubergen 5000 injections. In this month, ASA 50, HB rich 300, Oleven, low salt & high protein diet. Sometime I have a problem in left abdomen & my doctor advised for duwadin retard. Kindly suggest me what type of care as well as treatment I should take. Is there any possibilities of premature delivery due to bicornuate uterus? Is there any possibility of pre-eclampsia repetition again? What kind of facility in a hospital may be required where, I can deliver the child safely? I am very fearful about my delivery.

A:It seems that you suffer from some degree of Endometriosis. This however is irrelevant since you are already pregnant. In fact the pregnancy may be good for your endometriosis in the long run. You had severe pre-eclampsia in the last pregnancy and that puts you at a higher risk of developing Pre-eclampsia this time. There is nothing else that you can do to prevent pre-eclampsia. Salt restriction and keeping a track of weight gain is of no consequence and is not prescribed currently. Indeed both these can be harmful to pregnancy. You should take normal quantities of salt. I am also perplexed by the number of medicines that have been prescribed to you. Maintain (a progesterone) and injections of Pubergen (injection HCG) are useless, expensive and potentially harmful. Both these are potent hormones and should be avoided. In the current state of knowledge it is best to avoid these hormones during pregnancy. Duvadilan Retard (Isoxsuprine) was prescribed earlier when it was believed that discomfort in the abdomen is because of premature uterine contractions. This is a very potent drug with serious side effects like breathlessness and palpitations. Death due to pulmonary oedema has been reported with this drug and has since been banned for use during pregnancy by FDA in USA. For some strange reason it is still being marketed in India. I can assure you that taking this drug has nothing to do with the pain or discomfort that you are getting in your abdomen. Please stop taking this drug. To answer your questions categorically: The bicornuate uterus does make you a little prone to premature delivery. Since you came in the last pregnancy up to more than seven months, and that too was terminated because of pre-eclampsia, it is possible that you will continue this time also to a gestation which is safe for the fetus. There is nothing you can do to improve your chances of having a full term delivery. In other words you cannot take any precautions or medicines to prevent pre-maturity. Please continue your normal life and do not exert yourself unduly. Absolute bed rest, often prescribed, is not required and in fact that this may cause more harm than good. Just continue to do normal work at home but avoid exertion. You should also keep a check on urinary infection and in case of any evidence of infection, in form of vaginal discharge or fever, take a course of antibiotics promptly to avoid prematurity. I must assure you that even if you have a bicornuate uterus (and ultrasound diagnosis is not 100% correct) in all likelihood you will have a full term pregnancy. Most women with bicornuate uterus had normal pregnancies and the condition is discovered accidentally, like it was in your case during a routine ultrasound examination or during a caesarean section. If you have a bicornuate uterus you are more likely to have abnormal presentation like breech and transverse lie, both of these may require a caesarean section, but otherwise is unlikely to affect the pregnancy significantly. You are taking low dose aspirin. There is nothing else you can do to prevent pre-eclampsia from occurring. Remaining active throughout the pregnancy may help. Otherwise only precaution you need to take is to check the blood pressure frequently (possibly every week) and the urine examined weekly for the presence of proteins. If either one appears you need close monitoring. Even if either develops there is no need to panic and the timing of the delivery. Development of pre-eclampsia will still depend on your developing either hypertension or protein in the urine. So in effect please get a BP and Urine protein check every week and serum uric acid and a platelet count every two to three weeks or so until reported abnormal after which these tests also need to be done every week. Please have food with normal salt and eat a normal healthy balanced diet as any pregnant woman or indeed any adult should have. Coming to where you should deliver, this is something which is difficult for me to answer and you will have to decide for yourself. But speaking medically you should be in a place which can take care of premature babies and is used to handling medical emergencies like hypertension and has intensive care backup with a good blood bank. Any hospital which has a level II Nursery and emergency services with intensive care and a blood bank, and is capable of performing caesarean sections urgently if required should be chosen. The obstetrician should be used to handling severe pre-eclampsia cases and should follow evidence based internationally accepted protocols for this disease including those guidelines which help us decide when to deliver.

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