Preeclampsia & eclampsia


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Preeclampsia & eclampsia

  2. 2. ObjectiveObjective:-:-  A unique diseaseA unique disease ((syndromesyndrome)) of pregnantof pregnant woman in the second half of pregnancy.woman in the second half of pregnancy.  Carries significant maternal & fetal morbidityCarries significant maternal & fetal morbidity and mortality.and mortality.  Two criteria for diagnosing preeclampsiaTwo criteria for diagnosing preeclampsia hypertension & proteinuria, in eclampsiahypertension & proteinuria, in eclampsia tonic and clonic convulsions.tonic and clonic convulsions.  The definite cure of preeclamsia &The definite cure of preeclamsia & eclampsia is delivery.eclampsia is delivery.
  3. 3. Defenition of preeclampsiaDefenition of preeclampsia:-:- The presence of hypertension of at leastThe presence of hypertension of at least 140140//9090 mm Hg recorded on two separatemm Hg recorded on two separate occasions at leastoccasions at least 44 hours apart and in thehours apart and in the presence of at leastpresence of at least 300300 mg protein in amg protein in a 2424 hours collection of urine arrising de novohours collection of urine arrising de novo after theafter the 2020thth week gestation in a previouslyweek gestation in a previously normotensive women and resolvingnormotensive women and resolving completetly by the sixth postpartum weekcompletetly by the sixth postpartum week..
  4. 4. Classification ofClassification of hypertensivehypertensive disorders of pregnancydisorders of pregnancy  PreeclampsiaPreeclampsia // eclampsiaeclampsia  Chronic hypertensionChronic hypertension  Chronic hypertension withChronic hypertension with superimposedsuperimposed preeclampsiapreeclampsia  Gestational or transient hypertensionGestational or transient hypertension
  5. 5. Aetiology ofAetiology of preeclampsiapreeclampsia:-:- ((Genetic predispositionGenetic predisposition)) ((Abnormal immunological responseAbnormal immunological response)) ((Deficient trophoplast invasionDeficient trophoplast invasion)) ((Hypoperfused placentaHypoperfused placenta)) ((Circulating factorsCirculating factors)) ((Vascular endothelial cell activationVascular endothelial cell activation)) ((Clinical manifestations of the diseaseClinical manifestations of the disease))
  6. 6.  IncidenceIncidence 3%3% of pregnancies.of pregnancies. EpidemiologyEpidemiology  More common in primigravidMore common in primigravid  There isThere is 3-43-4 fold increase in first degreefold increase in first degree relatives of affected women.relatives of affected women.
  7. 7. Risk Factors for preeclampsiaRisk Factors for preeclampsia  Condition in which the placenta isCondition in which the placenta is enlargedenlarged ((DM,MP,hydropsDM,MP,hydrops))  Pre-existing hyertension or renal diseasesPre-existing hyertension or renal diseases..  Pre-existing vascular diseasePre-existing vascular disease ((diabetesdiabetes,,autoimmune vasculitisautoimmune vasculitis))
  8. 8. PathophisiologyPathophisiology:-:- Defective trophoplast invasion hypoperfusedDefective trophoplast invasion hypoperfused placenta release factorsplacenta release factors ((growth factors,growth factors, CytokinesCytokines)) vascular endothelial cellvascular endothelial cell activation.activation.  VasospasmVasospasm hypertensionhypertension  Endothelial cell damage oedema,Endothelial cell damage oedema, hemoconcentrationhemoconcentration  Kidneys,glomeruloendotheliosisKidneys,glomeruloendotheliosis proteinuria,reduced uric excretion and oligouria.proteinuria,reduced uric excretion and oligouria.
  9. 9.  Liver,subendothelial fibrin depositionLiver,subendothelial fibrin deposition elevated liver,hemorrhage,infarction,liverelevated liver,hemorrhage,infarction,liver rupture and epigastric pain.rupture and epigastric pain.  BloodBlood thrombocytopenia,DIC,HELLPthrombocytopenia,DIC,HELLP syndrome.syndrome.  Placental vasospasm placentalPlacental vasospasm placental infarction,placental abruptio&infarction,placental abruptio& uteroplacental perfusion IUGR.uteroplacental perfusion IUGR.  CNS vasospasm&oedemaCNS vasospasm&oedema headache,headache, visual symptonsvisual symptons((blurred vision,spots,blurred vision,spots, scotomascotoma)) hyperreflexia and convulsionshyperreflexia and convulsions.
  10. 10. Symptoms of preeclampsiaSymptoms of preeclampsia 1.1. HeadacheHeadache 2.2. May be symptomlessMay be symptomless 3.3. Visual symptomsVisual symptoms 4.4. Epigastric and right abdominal painEpigastric and right abdominal pain Signs of preeclampsiaSigns of preeclampsia 1.1. HypertensionHypertension 2.2. Non dependent oedemaNon dependent oedema 3.3. Brisk reflexesBrisk reflexes 4.4. Ankle clonusAnkle clonus((more thanmore than 33 beatsbeats)) 5.5. Fundal heightFundal height
  11. 11. InvestigationsInvestigations MaternalMaternal  Urinalysis by dipstickUrinalysis by dipstick  2424hours urine collectionhours urine collection  Full blood countFull blood count((platelets&haematocritplatelets&haematocrit))  Renal functionRenal function((uric acid,s.creatinine,ureauric acid,s.creatinine,urea))  Liver function testsLiver function tests  Coagulation profileCoagulation profile
  12. 12. FetalFetal 1.1. Uss(growth parameters,fetal size,AF)Uss(growth parameters,fetal size,AF) 2.2. CTGCTG 3.3. BPPBPP 4.4. DopplerDoppler Management of preeclampsiaManagement of preeclampsia PrinciplesPrinciples  Early recognition of the syndromeEarly recognition of the syndrome  Awarness of the serious nature of the conditionAwarness of the serious nature of the condition  Adherence to agreed guidelines(protocol)Adherence to agreed guidelines(protocol)  Well timed deliveryWell timed delivery  Postnatal follow up and counselling for futurePostnatal follow up and counselling for future pregnancypregnancy  REMEMBER: Delivery is the only cure forREMEMBER: Delivery is the only cure for preeclampsiapreeclampsia
  13. 13. A Mild preeclampsiaA Mild preeclampsia Diastolic blood pressure 90-95mmhgDiastolic blood pressure 90-95mmhg minimal proteinurea,normal heamatologicalminimal proteinurea,normal heamatological and biochemical parameters,no fetaland biochemical parameters,no fetal compromise.Deliver at termcompromise.Deliver at term.. B severe preeclampsia (BP>160/110MMHGB severe preeclampsia (BP>160/110MMHG,, urine protein 5grams 3urine protein 5grams 3+ )+ ) Abnormal haematological and biochemicalAbnormal haematological and biochemical parameters,abnormal fetal findingsparameters,abnormal fetal findings 11..Control blood pressure(aim to keepControl blood pressure(aim to keep BP 90-95mmghBP 90-95mmgh))
  14. 14. DrugsDrugs:-:- agentagent actionaction dosedose Side effectSide effect commentcomment MethylMethyl dopadopa centralcentral 500-4000500-4000 mgmg dpressiondpression Late onsetLate onset 24hours24hours hydralazinehydralazine DirectDirect vasodilatorvasodilator 5mg…10mg5mg…10mg HeadacheHeadache,, FlushingFlushing palpitationpalpitation Drug ofDrug of emergencyemergency labetalollabetalol Beta&alphaBeta&alpha blockerblocker 20mg…20mg… 40mg every40mg every 10m10m NauseaNausea VomitingVomiting h.blockh.block Avoid inAvoid in h.Failureh.Failure b.asthmab.asthma nifedipinenifedipine blockerblocker 5mg sub5mg sub.. SevereSevere headacheheadache ForFor emergencyemergency
  15. 15. DeliveryDelivery:-:- Transfer patient to tertiary center if herTransfer patient to tertiary center if her Condition permitsCondition permits.. If fetus is preterm give motherIf fetus is preterm give mother 12mg12mg Dexamethasone im twiceDexamethasone im twice 12hs12hs apart toapart to enhance lung maturityenhance lung maturity.. Deliver cDeliver c//s or vaginals or vaginal.. Avoid ergometrine inAvoid ergometrine in 33rdrd stagestage.. Give anticoagulantGive anticoagulant..
  16. 16. Complications of preeclampsiaComplications of preeclampsia:-:-  ECLAMPSIAECLAMPSIA MaternalMaternal  CVACVA  HEELP syndromeHEELP syndrome  Pulmonary oedemaPulmonary oedema  Adult RDSAdult RDS  Renal failureRenal failure FetalFetal  IUGRIUGR  IUFDIUFD  Abruptio placentaAbruptio placenta Prophylaxis(aspirin,antioxidant)Prophylaxis(aspirin,antioxidant)
  17. 17. EclampsiaEclampsia:-:- Is a life threatening complications ofIs a life threatening complications of preeclampsia,defined as tonic,clonicpreeclampsia,defined as tonic,clonic convulsions in a pregnant woman in theconvulsions in a pregnant woman in the absence of any other neurological orabsence of any other neurological or metabolic causes.It is an obstetricmetabolic causes.It is an obstetric emergency.emergency. It occurs antenatal,intrapartum,postpartumIt occurs antenatal,intrapartum,postpartum ((after deliveryafter delivery 24-48hs24-48hs))
  18. 18. ManagementManagement((carried out by a teamcarried out by a team)) 1.1.Turn the patient on her sideTurn the patient on her side 2.2.Ensure clear airwayEnsure clear airway((suction,mouth gagsuction,mouth gag)) 3.3.Maintain iv accessMaintain iv access 4.4.Stop fitsStop fits((mag.sul,diazepammag.sul,diazepam)) 5.5.Control BPControl BP((hydralazine,labetalolhydralazine,labetalol)) 6.6.Intake & output chartIntake & output chart 7.7.InvestigationsInvestigations((urine,urine,FBCFBC,,RFTRFT,,LFTLFT,, clotting profile,cross matchclotting profile,cross match)) 8.8.Monitor patient and her fetusMonitor patient and her fetus 9.9.After stabilizationAfter stabilization((BPcontrolled,noBPcontrolled,no convulsions,hypoxia controlledconvulsions,hypoxia controlled)) deliverdeliver
  19. 19. Mag.sulphate:-Mag.sulphate:-  Drug of choice in ecclampsiaDrug of choice in ecclampsia  Given iv,imGiven iv,im((4-6gr4-6gr bolus dose,bolus dose,1-2gr1-2gr maintenancemaintenance))  Acts as cerebral vasodilator andActs as cerebral vasodilator and menbrane stabilizermenbrane stabilizer  Over dose lead to respiratory depressionOver dose lead to respiratory depression and cardiac arrestand cardiac arrest  Monitor patientMonitor patient((reflexes,reflexes,RRRR,urine output,urine output))  Antidote cal.gluconateAntidote cal.gluconate 10ml 10%.10ml 10%.