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AND ECLAMPSIA
Preeclampsia is a multisystem disorder of
unknown aetiology and unique to pregnant
women after 20 weeks gestation.
It is a progressive disease with a very
variable mode of presentation and rate of
progression.
It is pregnancy specific with reduced organ
perfusion secondary to vasospasm and
endothelial classification.
Preeclampsia is said to complicate 5% of all
deliveries.
It is said to affect 5.8% of primigravidas and
0.4% of secundagravidas.
The incidence is influenced by parity, race,
multiple gestations, environmental
factors,maternal age, maternal size and history
of chronic hypertension
Classification of hypertensive
disorders of pregnancy
1. Gestational hypertension
(formerly pregnancy-induced
hypertension or transient
hypertension).
2. Preeclampsia
3. Eclampsia
4. Preeclampsia superimposed on
chronic hypertension
5. Chronic hypertension
Definition and Diagnosis
Preeclampsia can not be accurately
defined until its cause is known. It is
described as a syndrome comprising of
hypertension, oedema and proteinuria
occurring after 20 weeks gestation.
Hypertension -140/90 mm of Hg or
more on at least two occasions four
hours or more apart after the 20th week
of pregnancy in a woman known to be
normotensive and in whom blood
pressure has returned to normal by the
sixth postpartum week.
Proteinuria is defined as the excretion of
0.3 g protein or more within 24 Hr or a
measurement of 1+ or more using
Classification
This is classified as mild or
severe forms as the latter
is associated with
increased maternal and
fetal morbidity.
Genetic
Immunologic or
Inflammatory
Factors
Reduced Uteroplacental
Perfusion
Endothelial
Activation
Capillary Leak
Vasospasm Activation of
Coagulation
Edema Proteinuria
Hemo- Thrombo
concentration cytopenia
Seizures Abruption
Pathophysiology
The summary is that as a result of
the damage of the endothelial
cells, it
looses its functions and in addition
also produces proagulants,
vasoconstrictions and mitogens.
The increased pressor sensitivity of
the maternal vessels leads to
profound vasospasm and reduced
organ perfusion which are
arious Changes
aternal
necrosis)
Cardiovascular - ↓ Plasma Volume, ↓ CVP, AP ↑ & SVR
Contractility usually unchanged.
Liver Altered LFT, Periportal hepatic necrosis, Subcapsulaar haemorrhage, FDP, HELLP.
ARDS
Prolonged therapy-methyldopa
nifedipine, atenolol
Antihypertensive
- Follow by Delivery
Conservative management in
severe cases – Need to be
cautious.
Think of maternal safety.
MANAGEMENT IN HOSPITAL
1.Detailed examination followed by daily scrutiny
for clinical findings such as headache, visual
disturbances, epigastric pain, and rapid weight
gain.
2. 2.Weight on admittance and every day
thereafter
3 3.Analysis for proteinuria on admittance and at
least every 2 days thereafter
4.4Blood pressure readings in sitting position
with an appropriate-size cuff every 4 hours,
except between midnight and morning.
5.Measurement of plasma or serum
creatinine,uric acid, hematocrit, platelets, and
serum liver enzymes, the frequency to be
ECLAMPSIA
Eclampsia is defined as the new onset of
convulsions, before or during pregnancy
or post partum, unrelated to other
cerebral pathologic conditions in a woman
with preeclampsia. Incidence Reported
rate 1:2000 to 1:3000 deliveries. The
incidence is signficiantly higher in non
industrialized nations. Estimates in
developing countries varies from 1 in 100
to 1 in 1700.
Worldwide of estimated 500,000,
maternal deaths every year – 10 – 15% are
associated with HDP.
Reported maternal mortality rates varies
Management Aim
1. Stop Convulsions and prevent
recurrence
2. Control the blood pressure
3. Avoidance of diuretics and
limitation of fluid administration
4. Correct fluid and electrolyte
imbalance
5. Deliver the patient
Anticonvulsants
- Valium
- Phenytoin
- Chlomethiazole
- Magnesium sulphate
The anticonvulsant therapy
should protect the woman and
her fetus from deleterious
effects of convulsion but
should not expose either to
additional risks from the
therapy.
Supportive Management
- Airways
- Nasogatric tube
- Oxygen
- Catheterization / Urinary output
monitoring
- Tepid sponge / Expose to fan
- Management of an unconscious
patients.
Complications
- Pulmonary Oedema
- Renal and hepatic failiure
- Hemiplegia
- Altered Consciousnes/Coma
- Some degree by Blindness
- Psychoses