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Pre- eclampsiaPre- eclampsia ImpendingImpending EclampsiaEclampsia

It is a disease of pregnancy characterized It is a disease of pregnancy characterized byby

• BP 140/ 90 or more.BP 140/ 90 or more.

• After 20 week gestational age.After 20 week gestational age.

• In previous normotensive pt.In previous normotensive pt.

• Reading taken twice at interval 6 hours.Reading taken twice at interval 6 hours.

•Exclude other causes of 2.ry hypertension Exclude other causes of 2.ry hypertension (ACDEPR)(ACDEPR)

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renal diseaserenal disease

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AA

CC

DD

EE

PP

RR

alchoalchollcoarctation of coarctation of aortaaortadrugsdrugs

Endocrine Endocrine diseasediseasePIHPIH

DBP110 or moreDBP110 or more

Increase in SBP by 30 mmHgIncrease in SBP by 30 mmHg

Increase in DBP by 15mmHg Increase in DBP by 15mmHg

2 read of MABP 105 or more OR increase by 202 read of MABP 105 or more OR increase by 20

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But diagnosis can be But diagnosis can be by:by:

This condition is associated with significant This condition is associated with significant protienuriaprotienuria

?????? Not related to the fetus or uterusNot related to the fetus or uterus Failure of placentationFailure of placentation Abnormal lipid metabolism Abnormal lipid metabolism Decrease CaDecrease Ca++++ in diet in dietAll pathogenesis due to vasospasm & endothelial

dysfunction

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Aetiology:Aetiology:

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

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SYSTEMIC EFFECTSSYSTEMIC EFFECTS

1.1. CVSCVS

2.2. BloodBlood

3.3. Renal systemRenal system

4.4. LiverLiver

5.5. CNSCNS

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INCIDENCE & EPIDEMIOLOGYINCIDENCE & EPIDEMIOLOGY

Occur in 5-10% pregnancy Occur in 5-10% pregnancy Death about 2% in UKDeath about 2% in UK Death increase in Eclampsia which Death increase in Eclampsia which

occur in intrapartum &post partum occur in intrapartum &post partum due to:due to:

-Relax of observation during these period-Relax of observation during these period

-Increase in release of pathogenic factor-Increase in release of pathogenic factor

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PRE-ECLAMPSIAPRE-ECLAMPSIA

Symptoms: Symptoms: may be may be AsymptomaticAsymptomatic HeadacheHeadache Visual disturbanceVisual disturbance Epigastric painEpigastric pain oedemaoedema

Sign: Sign: may bemay be High BPHigh BP Fluid retensionFluid retension Brisk reflexsBrisk reflexs Fundel level less Fundel level less

than datethan date

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Symptoms:Symptoms: HeadacheHeadache Visual disturbanceVisual disturbance Epigastric painEpigastric pain NauseaNausea RestlessnessRestlessness SwellingSwelling Poor urine outputPoor urine output

signs:signs: AgitationAgitation HyperreflexiaHyperreflexia Facial &peripheral Facial &peripheral

oedemaoedema Rt upper quadrant Rt upper quadrant

tendernestendernes

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EclampsiaEclampsia

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CLINICAL FEATURECLINICAL FEATURE

it is grand mal convulsion which pass it is grand mal convulsion which pass through stages of:through stages of:

1.1. Tonic contractionTonic contraction

2.2. ClonicClonic

3.3. ComaComa

Usually take about 60-90 seconds.Usually take about 60-90 seconds.

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EDEN’S CRITERIA OF SEVERITYEDEN’S CRITERIA OF SEVERITY

Coma take 6 hours or moreComa take 6 hours or more SBP reach 200 mmHgSBP reach 200 mmHg Tm 39 or moreTm 39 or more Pulse rate 120/minPulse rate 120/min RR 40/minRR 40/min 2 fits or more2 fits or more

All this can end in maternal brain All this can end in maternal brain deathdeath

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DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS

1.1. EpilepsyEpilepsy

2.2. CVACVA

3.3. SOLSOL

4.4. Drugs reactionDrugs reaction

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MANAGMENTS MANAGMENTS

Aim of it :Aim of it :

1-maintain patent airways1-maintain patent airways

2-prevents the fits2-prevents the fits

3-terminate the pregnancy3-terminate the pregnancy

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1.1. Usually unnecessary to try to stop the Usually unnecessary to try to stop the initial convulsion which usually last initial convulsion which usually last about 60-90 secondsabout 60-90 seconds

2.2. IV Diazepam slowly 5mg over 1 minIV Diazepam slowly 5mg over 1 min

3.3. 3. Roll the patient on his left side to 3. Roll the patient on his left side to avoid maternal injuryavoid maternal injury

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4. Apply Suction to the secretion from her mouth4. Apply Suction to the secretion from her mouth5. Adequate Oxygen should be maintained by face 5. Adequate Oxygen should be maintained by face mask & airways to prevent swallowing of tonguemask & airways to prevent swallowing of tongue6. Prevent further convulsions by MgSO6. Prevent further convulsions by MgSO44 by IV by IV

bolus of 4 – 6 g over 15 min. If convulsion recur bolus of 4 – 6 g over 15 min. If convulsion recur further bolus of 2g.further bolus of 2g.7. Acidosis should be corrected if necessary by IV 7. Acidosis should be corrected if necessary by IV NaHCONaHCO33

8. SBP 170 mmHg or more, DBP 110 mmHg is risk 8. SBP 170 mmHg or more, DBP 110 mmHg is risk factor for CVA so should be lowered by either factor for CVA so should be lowered by either Nifedipine 10 – 20 mg SL. Or Hydrallazine 5mg Nifedipine 10 – 20 mg SL. Or Hydrallazine 5mg followed by infusion.followed by infusion.

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1.Insert canula size 101.Insert canula size 102.Send blood to Lab for Hb, blood 2.Send blood to Lab for Hb, blood

group, Platelet count, RFT, LFT, Uric group, Platelet count, RFT, LFT, Uric acid concentration, coagulation acid concentration, coagulation study, RBSstudy, RBS

3.Urine catheter (to urine output & 3.Urine catheter (to urine output & protein)protein)

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1.Assessment of state of fetus (U/S, 1.Assessment of state of fetus (U/S, Doppler CTG)Doppler CTG)

2.either : - Deliver the baby regardless 2.either : - Deliver the baby regardless of the gestational ageof the gestational ageintense monitoring maternal health in intense monitoring maternal health in

hope of improvement fetal outcome hope of improvement fetal outcome by increase gestational age.by increase gestational age.

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It is attention to fluid balance , BP , Renal It is attention to fluid balance , BP , Renal & Hepatic function & CNS& Hepatic function & CNS

1.More aggressive control of BP1.More aggressive control of BP2.MgSO2.MgSO44 maintained for 48 hrs at 1g/hr iv maintained for 48 hrs at 1g/hr iv

3.Subcutaneous heparin prophylaxis3.Subcutaneous heparin prophylaxis

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2.permanent CNS damage2.permanent CNS damage3.Intracranial haemorrhage3.Intracranial haemorrhage4.Renal failure4.Renal failure5.Death5.Death

1.During the fit1.During the fittounge bittingtounge bitting

head traumahead trauma

bone #bone #

AspirationAspiration

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1.Prematurity1.Prematurity2.placenta infarction2.placenta infarction3.IUGR3.IUGR4.Abruptio placentae4.Abruptio placentae5.Fetal hypoxia 5.Fetal hypoxia

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