Proeklampsia- Eklampsia
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Transcript of Proeklampsia- Eklampsia
7/23/2019 Proeklampsia- Eklampsia
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!"#$%&'µ()'- *%&'µ()'
!"#$%&&" '()*+#%
,-./)#"0 12!"$(3/$.40 56$&$.40 7"&(8$9/:µ;)3 1<:&=&
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+!*,-./01*/ 20.-.,.3*/
1+4/4/
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ΥΠΕΡΤΑΣΙΚΕΣ
ΔΙΑΤΑΡΑΧΕΣ
ΚΥΗΣΗΣ
ΟΡΙΣΜΟΙ
>#?&$" 38-#/"9: – .!5. >140mmHg 6 .!7.>90mmHg 6 #8#)' 79':9:;<5%$='9 8"9; =6; %>656 ? 8"9; =6; 20$@7. %>656A %'9 $89µB;$9 µ$=C =#; =#%$=D.
7"#)*$.4 38-#/"9: – E8B"='56 %'=C =6 79C"%$9' =6A %>656A FG")A C&&' 5Eµ8=<µ'=' =6A 8"#$%&'µ()'A.
7#)(.6"µ@;" – #")H$='9 GA 6 'EI6µB;6 .! µ$=C =6; 20 $@7. %>656A (µ$ $I')"$56 =6; ="#J#@&'5=9%? ;D5# %'9 =9A 8#&>7Eµ$A %E?5$9A) %'9 F'"'%=6")H$='9 '8D:
• +8B"='56 (>140/90mmHg)
• K$E%Gµ'=#E")' (>1g ? >0.3g/24h)
•
L$;9%$EµB;# #)76µ' (+/-)4 &$E%Gµ'=#E")' %'9 6 E8B"='56 ;' $);'9 8'"#>5$A 5$ 2 79'7#F9%BA
$I$=C5$9A µ$ µ$5#79C5=6µ' >6 <"$A.
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• 4 +8$"='59%? MD5#A $µJ';)H$='9 5=# 12-20% =G; %E?5$G; %'9 $);'9 E8$>NE;6 :9' 8$")8#E 18% =G; µ6="9%<; N';C=G;.
•
4 8"#$%&'µ()' $µJ';)H$='9 5=# 3-7% =G; 8"G=#=D%G; %'9 1-3% =G;
8#&E=D%G;
• *);'9 56µ';=9%DA '9=9#&#:9%DA 8'"C:#;='A 8$"9:$;;6=9%?A ;#56"D=6='A %'9
N;659µD=6='A, =D5# '8D =9A Cµ$5$A 5E;B8$9$A =6A E8$"='59%?A ;D5#E 5=# Bµ@"E# (E8#&$98Dµ$;6 $;7#µ?="9' ';C8=EI6, #&9:Cµ;9#, $;7#µ?="9#A NC;'=#A, %C), D5# %'9 '8D =#; 9'="#:$;? 8"DG"# =#%$=D, $I ’'9=)'A
$898&#%<; 8#E 8"#%'&$) 5=6 µ6=B"' ? 5=# Bµ@"E#.
• .; %'9 95=#"9%D 8"#O8C"F#E5'A E8B"='56A (F"D;9' E8B"='56) 8"#79'NB=$9 :9' ';C8=EI6 E8$"='59%?A ;D5#E %'9/? 5F$=9%<; µ$ 'E=? 79'='"'F<; 5=6;
%>656, 6 8'N#JE59#&#:)' %'9 6 ';=9µ$=<8956 $);'9 79'J#"$=9%BA %'9 :9’
'E=D $I$=CH#;='9 I$FG"95=C.
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7#)(.6"µ@;"
• !#&E5E5=6µ'=9%? 79'='"'F? C:;G5=6A '9=9#&#:)'A, 8#E
F'"'%=6")H$='9 '8D E8B"='56, 79'='"':µB;6 ;$J"9%? &$9=#E":)'
8#E #76:$) 5$ 8"G=$P;#E")'.
• QA 8"G=$P;#E")' F'"'%=6")H$='9 6 8'"#E5)' &$E%<µ'=#A > 300mg
5$ 5E&&#:? #>"G; 24<"#E. *;'&&'%=9%C 79'8)5=G56 >8'"I6A &$E%<µ'=#A 8$"955D=$"# '8D B;' 5='E"D (+) 5$ 5=9% #>"G;.
•
4 8"#$%&'µ()' $µJ';)H$='9 µ$=C =6; 206 5Eµ8&6"GµB;6 $@7#µC7'
%E?5$GA 5$ :E;')%' µ$ JE59#&#:9%? .! 8"#6:#EµB;GA %'9 FG")A
8"#O8C"F#E5' ;$J"9%? @&C@6. .J#"C '8#%&$95=9%C =6;
';N"<89;6 %>656. /E;?NGA 8"<=' 5Eµ@');$9 6 E8B"='56 %'9 '%#&#EN$) 6 8"G=$P;#E")', '; %'9 5=# 10% =G; 8$"98=<5$G;
5Eµ@');$9 =# ';=)N$=#.
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• R89' 8"#$%&'µ()': 5Eµµ$=#F? =G; ;$J"<; µ$ 8"G=$P;#E")'
• /#@'"? 8"#$%&'µ()': .!>160/110 µ$ 5#@'"? 8"G=$P;#E")' ? 56µ$)' 5#@'"?A @&C@6A #":C;G; (8"G=$P;#E")' >5gr 5$ 24 <"$A,
#&9:#E")' < 500ml 5$ 24 <"$A, 8;$Eµ#;9%D #)76µ',
µ9%"#'::$9#8'N6=9%? '9µD&E56, N"#µ@#8$;)', 68'=#%E=='"9%? @&C@6, $89:'5="9%D C&:#A, $:%$J'&9%BA ? #8=9%BA 79'='"'FBA,
$;7#µ?="9' E8#&$98Dµ$;6 ';C8=EI6 ? #&9:Cµ;9#) 5$ :E;')%$A µ$
8"#$%&'µ()'.
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ΡΙ ΠΡΟΕΚΛ ΜΨΙ
ΟΡΙΣΜΟΣ
•
.!5. >140mmHg 6 .!7.>110mmHg 8'"#>5$A 5$ 279'7#F9%BA $I$=C5$9A µ$ µ$5#79C5=6µ' >6 <"$A.
• K$E%Gµ'=#E")' >5g /24G"#.
•
S&9:#E")' - <400mL /24<"$A ? %"$'=9;);6 #"#> >1.2 mg/dL
•
29'='"'FBA D"'56A ? 5E;$)7656A (5%#=<µ'=',%$J'&'&:)').
•
!;$Eµ#;9%D #)76µ' ? %EC;G56.
•
*89:C5="9' C&:6
•
T%8=G56 68'=9%?A &$9=#E":)'A (FG")A 5E;68C"F#E5' '9=)')
•
U"#µ@#%E=#8$;)' - <100,000/mm3
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A.6"µ@;"
/Eµµ$=#F? =#E %$;="9%#> ;$E"9%#>
5E5=?µ'=#A µ$ '8#=B&$5µ' 58'5µ#>A 5$ '5N$;? µ$ 8"#$%&'µ()' 5=6; %>656, %'9
'8#E5)' C&&6A '9=)'A 58'5µ<;. 4 @&C@6 8#E 5Eµ@');$9 'J#"C 58'5µD =G;
$:%$J'&9%<; '::$)G;, 79C58'56 =#E
'9µ'=#$:%$J'&9%#> J"':µ#> %'9 $:%$J'&9%D #)76µ'
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!,S*1K.VW0.
!.,.LSM*/ 10M2+MS+ •
!"<=6 %>656
•
4&9%)' µ6=B"'A (>40 ? <16 B=6)
• !#&>7Eµ6 %>656
•
S9%#:$;$9'%D 95=#"9%D
•
3"D;9' E8B"='56 (8"#E8C"F#E5')
• 3"D;9' ;$J"9%? ;D5#A
•
/'%F'"<76A 79'@?=6A
• .;=9JG5J#&98979%D 5>;7"#µ#
•
L#;)79# '::$9#='5);6A -235
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•
BC&*#)µ) HELLP: />;7"#µ# 8#E F'"'%=6")H$='9 '8D '9µD&E56,
'EI6µB;$A 68'=9%BA 7#%9µ'5)$A %'9 F'µ6&C '9µ#8$=C&9'. /8C;9'
'&&C N';'=6JD"' 8'"'&&':? =6A 8"#$%&'µ()'A %'9 =6A $%&'µ()'A.
/E;';=C='9 5E;?NGA 5$ 8#&E=D%#EA %'9 5$ 6&9%)$A %>656A %C=G =G;
36 @7#µC7G;. /Eµ@');$9 5=# 20% =G; '5N$;<; µ$ 5#@'"?
8"#$%&'µ()'. -# 50% =G; '5N$;<; µ$ 5>;7"#µ# HELLP $µJ';)H$9 5#@'"? 8"#$%&'µ()', %'9 30% $µJ';)H$9 ?89' 8"#$%&'µ()'.
+8B"='56 7$; 5E;#7$>$9 =# 5>;7"#µ# 5=# 20% =G; '5N$;<;.
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A7D7,E5AB – 5,DFD5G 7EHAD1
I1HAD1B 7HEA5,1!JD1B
•
EK'1,!ED – #)76µ' #8=9%?A N6&?A, '9µ#""':)' 'µJ9@&65="#$97#>A
• 1F17FALBMD5E – 8;$Eµ#;9%D #)76µ', 5>;7"#µ# ';'8;$E5=9%?A 7E5FB"9'A (ARDS)
•
G71H – E8#%C(9# '9µC=Gµ', "?I6 ?8'=#A.•
1D!E7EDGMD5E – 2*!, 5>;7"#µ# HELPP
•
5FB – 58'5µ#) , .**, $;7#%"';9'%? '9µ#""':)', $:%$J'CN$9'
•
51HND1 – 1'"79'%? ';$8C"%$9' ('EI6µB;# µ$='J#"=)#)
•
71O5HA1B – 95F'9µ9%? 8':%"$'=)=97'
•
FAKHED – SI$)' ;$J"9%? ';$8C"%$9', 5G&6;'"9'%? ;B%"G56 •
!GMHE7,15ELFMD15G 5L5,EKEHD1 – IUGR, '8#%D&&656 8&'%#>;=', $µ@"EP%? 7E5FB"9', $µ@"EP%DA NC;'=#A.
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ΡΕΙ ΠΡΟΕΚΛ ΜΨΙ
ΝΤΙΜΕΤΩΠΙΣΗ
•
*95':G:? 5=# ;#5#%#µ$)# – 8'"'%#&#>N656
•
-'%=9%? µB="656 .!, 5JE:µ<;, N$"µ#%"'5)'A %'9 95#H>:9# E:"<;.
• !&?"6A '9µ'=#&#:9%DA - @9#F6µ9%DA B&$:F#A %'9 B&$:F#A
86%=9%D=6='A.•
T&$:F#A #>"G; (&$E%Gµ'=#E")') – 5E&&#:? #>"G; 24<"#E.
•
*%=) µ656 =#E $µ@">#E – NST, U/S %'9 Doppler,
@9#JE59%D 8"#J)&.•
3#"?:656 ';=9-E8$"='59%<; '; F"$9CH$='9.
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X.,*0. !,S*1K.VW0.
.M-0V*-Q!0/4
Y.,V.1*+-014 .LQL4 •
MgSO4 iv. ('; .!> 140/90mmHg)
.; .! 2 >110mmHg:• Hydralazine (NepresolR) 5-10mg iv %CN$
15’-30’.
•
Nifedipine (Adalat R) 10mg iv %CN$ 20’.
• Labetalol 20mg iv %CN$ 10’-20’.
•
L9' =# Bµ@"E#, F#"?:656: betamethasone 12mg/12h im.
*8958$>5=$ =#; =#%$=D.
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X'"9C !"#$%&'µ()' & -#%$=DA
•
*897$);G56 $:%>#E;
• /#@'"D IUGR;
• Eµ@"E)%? 7E5FB"9';
•
-#%$=DA 5$ $IB&9I6;•
4&9%)' %>656A
>34$@7;
Επιλογή
μεθόδου
τοκετού
NAI
OXI • .; 6 :E;')%' $F$9 5='N$"#8#96N$) %'9
6 6&9%)' %>656A $);'9 <34$@7
• 1'N6µ$"9;? $%=) µ656 =6A $:%>#E
•
.8DJ'56 :9' F"?56 ';=9-E8$"='59%<;
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X'"9C !"#$%&'µ()' & -#%$=DA
1'95'"9%? =#µ? D=';:•
*8$95D79' 58'5µ<; ? C&&# $8$):#;
• *µ@"EP%? 7E5FB"9'
•
.;<"9µ#A ="CF6&#A • /#@'"? 8"#G"D=6='
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X.,*0. !,S*1K.VW0.
.M-0V*-Q!0/4
V*-. -SM -S1*-S
• /E;?NGA ='F$)' @$&=)G56 µ$=C =#; =#%$=D.
•
S %);7E;#A 58'5µ<; $);'9 µ$:'&>=$"#A =# 1#
24G"#.
• 3#"?:656 MgSO4 iv :9' 24<"$A
• !'"'%#&#>N656 $898B7G; MgSO4, .! %'9
'8#@#&?A #>"G;.
• T:%'9"6 ';':;<"956 89N';?A E8$"JD"=G56A
E:"<;.
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*1K.VW0.
• *µJC;956 58'5µ<; 5=6; '5N$;?
(5E;?NGA $8) $7CJ#EA 8"#$%&'µ()'A).
• 1/2000 %E?5$9A (';$8=E:µB;$A F<"$A).
•
Z:;G5=6 '9=9#&#:)'.
•
4 .! $);'9 E(6&? (5=# 20% JE59#&#:9%?).
•
V8#"$) ;' 5Eµ@$) 8"9; (71%), %'=C =6 79C"%$9' ? µ$=C =#; =#%$=D.
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*1K.VW0.
.M-0V*-Q!0/4
• 29'=?"656 '$"':G:#> (ABC).
• .;'""DJ656 $%%")5$G; (';'95N659#&.)
• !"D&6(6 ="'Eµ'=95µ#> =6A $:%>#E.
•
3#"?:656 MgSO4 iv
• .8#JE:? F#"?:656A 79'H$8Cµ6A ! ';'8;#?
• !"#:"'µµ'=95µDA =#%$=#> µD&9A 5='N$"#8#96N$)
6 %'=C5='56.! !"#5#F? 5=# 5>;7"#µ# HELPP (Hemolysis,
Elevated Liver enzymes, Low Platelets)
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• *8'J? µ$ 8$"9@C&&#;, $89%#9;G;)'
• SIE:D;# µ$ µC5%'
•
Y&$@9%? :"'µµ?, $8$):#; 8&?"6A $":'5=6"9'%DA B&$:F#A
• NST F'µ6&? µ$='@&6=D=6=', DF9
$89='F>;5$9A, DF9 $89@"'7>;5$9A •
.! 200/120
• SE"#%'N$=?"'A, stick #>"G; +++
8"G=$);6
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• /E;;$;D656 µ$ ';'95N659#&D:# %'9
F$9"#E":$)#
• .µ$56 µ$='J#"C :9' %'95'"9%? =#µ?
• Ht 29, WBC 8000, PLT 214000
• SGOT, SGPT<50 SE"9%D #I> 6.3
•
2 amp Nepresol/250ml iv, 30 mg Labetaloliv
• 3 amp MgSO4/250ml iv 5=C:76;
•
Fentanyl, Stedon iv
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• L$;9%? ';'95N65)', 79'5G&?;G56
• *8$):#E5' %'95'"9%? =#µ?
•
.""$; 2200 :"µ, Apgar 9• Oxytocin, 1$J':#");6 iv
• EBL 300 ml
•
1'&? 79#>"656
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• .8#5G&?;G56 '5N$;#>A
• *;'"I6 $% ;B#E =#;9%#%&G;9%<; 58'5µ<;
•
*8$):#E5' $8';'79'5G&?;G56 • MgSO4 iv 4 g bolus, 1g/h 5=C:76;
• Nepresol 12.5 mg bolus, 50mg/250ml iv
•
V$='J#"C 5=6 V.Y .! 120/70, HR 106,SpO2 100
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• V.Y 79'5G&6;GµB;6, µ6"9')' '"=6"9'%?
:"'µµ?, 5J':)=97'
• Nepresol, bolus Lasix,
• Flagyl, Voncon,
• LMWH, Human Albumin
•
K$>%Gµ' #>"G; 24/h 8,9 g• USS %'"79CA %J
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• V$='J#"C 5=6; .;C;6(6 D3
• Sµ'&? µ$=$:F$9"6=9%? 8#"$)'
•
Norvasc 5mg x 2, LMWH, 1$J':#");6 • *I9=?"9# D7 µ$ =# µG"D
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*%&'µ()'
•
*;' ? 8'"'8C;G $8$95D79' 58'5µ<; 5$
5E5FB=956 µ$ 8"#$%&'µ()'
• 44% &#F$)', 18% 5=6 79C"%$9' =#%$=#>
• 5-20% $8';'&'µ@C;#;='9 8'"C =6
N$"'8$)'
•
2.6/10000 $:%Eµ#5>;$A (UK)•
M$E"#&#:9%BA $898&#%BA (1.2%) %<µ',
$5=9'%BA %9;6=9%BA @&C@$A, $:%$J'&9%D
'::$9'%D $8$95D79#, =>J&G56
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•
-#;9%#%&G;9%#) 58'5µ#) C%"G; %'9
%$J'&?A
• 1EC;G56, 7C:%Gµ' :&<55'A, '%"C=$9'
#>"G;
• !&$9#(6J)' 5='µ'=#>; 5$ 1 [ &$8=D
•
*µ8$9")' 8#&> ="#µ'%=9%? :9' =6; B:%E#,=#EA 5E::$;$)A, =# 8"#5G89%D
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.M-0V*-Q!0/4
XS4U*0.
+!S/-4,0\4 ABC
.$"':G:DA ."95=$"? 8&':)' NB56
SIE:D;# 5$
E(6&? "#?
IV :"'µµ? Screen PET
*K*L3S/ /!./VQM
2D56 $JD7#E MgSO4 4g IV5$ 20 &$8=C
/E;=?"656
MgSO4 1g/hr:9' 24 <"$A
+8#="#8? MgSO4 2g iv5$ 5 &$8=C
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•
Collaborative Eclampsia Trial: ';G=$"D=6=' MgSO4B;';=9 79'H$8Cµ6A % J'9;E=#);6A 5=6; E8#="#8?
58'5µ<;
•
MAGPIE Trial: MgSO4 µ8#"$) ;' 8"#&C@$9 =6; $%&'µ()'
5$ 5#@'"? 8"#$%&'µ()'
• *% ;B#E E8#="#8? 58'5µ<;, 79'H$8Cµ6- J'9;E=#9;6,
N$9#8$;=D;6 ? 8"#8#JD&6 '8D ';'95N659#&D:#
• CT, MRI %"';)#E (89N';D '9µ#""':9%D $8$95D79#)
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-#I9%D=6=' MgSO4
•
MgSO4 '8#@C&&$='9 '8#%&$95=9%C '8D =' ;$J"C
• /$ #&9:#E")', µB="656 $898B7G; % µ$)G56 7D56A
•
.8<&$9' $; =G @CN$9 ';=';'%&'5=9%<;, ';'8;$E5=9%? %'='5=#&?, ';'8;$E5=9%? ';'%#8?, ';'%#8? %'"79CA
• 1 g :&E%#;9%D '5@B5=9# iv (10 ml 79'&>µ'=#A 10%) $;=DA
10 &$8=<;
• Integrated review of side effects to the use of MgSO4 forPreeclampsia ans Eclampsia management
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.;=9E8$"='59%? ':G:? 5$ 5#@'"?
8"#$%&'µ()'
•
.;$8'"%?A ';=9µ$=<8956 5E5=#&9%?A
E8B"='56A %>"9' µ$)HG; '9=)'
$;7#%"';9'%?A '9µ#""':)'A %'9 N';C=#E
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+7"'&'H);6 IV (1mg/ml)
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K'@6='&D&6 IV (5mg/ml)
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*8';C&6(6 %CN$ 5&$8=C (max 4
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2D56 5E;=?"656A B:FE56 4 ml/hr
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