www doctor sd www doctor sd Pre eclampsia

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www. doctor. sd Pre- eclampsia Impending Eclampsia It is a disease of pregnancy characterized by • BP 140/ 90 or more. • After 20 week gestational age. • In previous normotensive pt. • Reading taken twice at interval 6 hours. • Exclude other causes of 2. ry hypertension (ACDEPR)

www. doctor. sd A C D E P R alchol coarctation of aorta drugs Endocrine disease PIH renal disease

www. doctor. sd But diagnosis can be by: DBP 110 or more Increase in SBP by 30 mm. Hg Increase in DBP by 15 mm. Hg 2 read of MABP 105 or more OR increase by 20 This condition is associated with significant protienuria

www. doctor. sd Aetiology: � ? ? ? � Not related to the fetus or uterus � Failure of placentation � Abnormal lipid metabolism � Decrease Ca++ in diet All pathogenesis due to vasospasm & endothelial dysfunction

www. doctor. sd Risk facctors: Primigravida age Past history Change the husband Condition in which placenta enlarge Pre-existing disease Low socioeconomic Risk factor decrease : Smokers Prolong exposure to paternal antigen

www. doctor. sd SYSTEMIC EFFECTS 1. 2. 3. 4. 5. CVS Blood Renal system Liver CNS

www. doctor. sd INCIDENCE & EPIDEMIOLOGY � � � Occur in 5 -10% pregnancy Death about 2% in UK Death increase in Eclampsia which occur in intrapartum &post partum due to: -Relax of observation during these period -Increase in release of pathogenic factor

www. doctor. sd PRE-ECLAMPSIA Symptoms: may be Asymptomatic Headache Visual disturbance Epigastric pain oedema Sign: may be High BP Fluid retension Brisk reflexs Fundel level less than date

www. doctor. sd IMPENDING ECLAMPSIA TRANSITIONAL CONDITION CHARACTERIZE BY INCREASE IN Symptoms: Headache Visual disturbance Epigastric pain Nausea Restlessness Swelling Poor urine output signs: Agitation Hyperreflexia Facial &peripheral oedema Rt upper quadrant tendernes

www. doctor. sd Eclampsia

www. doctor. sd CLINICAL FEATURE it is grand mal convulsion which pass through stages of: 1. Tonic contraction 2. Clonic 3. Coma Usually take about 60 -90 seconds.

www. doctor. sd EDEN’S CRITERIA OF SEVERITY � Coma take 6 hours or more � SBP reach 200 mm. Hg � Tm 39 or more � Pulse rate 120/min � RR 40/min � 2 fits or more All this can end in maternal brain death

www. doctor. sd DIFFERENTIAL DIAGNOSIS 1. 2. 3. 4. Epilepsy CVA SOL Drugs reaction

www. doctor. sd MANAGMENTS � Aim of it : 1 -maintain patent airways 2 -prevents the fits 3 -terminate the pregnancy

www. doctor. sd 1. 2. 3. Usually unnecessary to try to stop the initial convulsion which usually last about 60 -90 seconds IV Diazepam slowly 5 mg over 1 min 3. Roll the patient on his left side to avoid maternal injury

www. doctor. sd 4. Apply Suction to the secretion from her mouth 5. Adequate Oxygen should be maintained by face mask & airways to prevent swallowing of tongue 6. Prevent further convulsions by Mg. SO 4 by IV bolus of 4 – 6 g over 15 min. If convulsion recur further bolus of 2 g. 7. Acidosis should be corrected if necessary by IV Na. HCO 3 8. SBP 170 mm. Hg or more, DBP 110 mm. Hg is risk factor for CVA so should be lowered by either Nifedipine 10 – 20 mg SL. Or Hydrallazine 5 mg followed by infusion.

www. doctor. sd 1. Insert canula size 10 2. Send blood to Lab for Hb, blood group, Platelet count, RFT, LFT, Uric acid concentration, coagulation study, RBS 3. Urine catheter (to urine output & protein)

www. doctor. sd 1. Assessment of state of fetus (U/S, Doppler CTG) 2. either : - Deliver the baby regardless of the gestational age intense monitoring maternal health in hope of improvement fetal outcome by increase gestational age.

www. doctor. sd It is attention to fluid balance , BP , Renal & Hepatic function & CNS 1. More aggressive control of BP 2. Mg. SO 4 maintained for 48 hrs at 1 g/hr iv 3. Subcutaneous heparin prophylaxis

www. doctor. sd 1. During the fit tounge bitting head trauma bone # Aspiration 2. permanent CNS damage 3. Intracranial haemorrhage 4. Renal failure 5. Death

www. doctor. sd 1. Prematurity 2. placenta infarction 3. IUGR 4. Abruptio placentae 5. Fetal hypoxia

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