preeclampsia and Eclampsia

1. Preeclampsia
Eclampsia

2. Definition
Pre eclampsia : sustained BP
elevation in pregnancy after
20 weeks’ gestation in the
absence of preexisting
hypertension
Systolic BP>160 or diastolic >110 on two
occasions at least 6 hour apart
Proteinuria ≥ 5 g/24 H
Oliguria < 500 cc /24 H
Cerebral or visual symptoms
Epigastric or Rt upper quadrant pain
Pulmonary edema
IUGR
Eclampsia :is the presence of new-
onset grand mal seizures in a
woman with preeclampsia that
cannot be attributed to other causes

3. Mechanisms behind preeclampsia
• The mechanisms by which preeclampsia occurs is not certain. The factors currently
considered to be the most important include the following:
• Inadequate uteroplacental perfusion leading to placental ischemia, or hypoxia,
appears to be central to the development of the disease
• Maternal immunologic intolerance
• Abnormal placental implantation
• Genetic, nutritional, and environmental factors
• Cardiovascular and inflammatory changes

4. Risk factor • Primigravidae
• Previous pre-eclampsia
• Family history
• Race black > white
• Maternal age >35
• Placenta abnormalities
• Pre existing vascular
disease
• Chronic renal disease
• Chronic hyprtension
• antiphospholipid
syndrome
• Thrombophilias
• DM
• Obesity
• multiple gestation

5. Symptom of
pre-
eclampsia
Asymptomatic
Flashing lights
Photophobia
Headache
Visual field loss
Epigastric pain
Vomiting

6. Diagnostic
Criteria

7. COMPLICATIONS
• Maternal complication
• During pregnancy
• Eclampsia
• Oliguria and anuria
• Preterm labour
• HELLP syndrome
• Dimness of vision and
even blindness
• Cerebral hemorrhage
• Acute respiratory distress
syndrome (ARDS)
• During labour
• Eclampsia
• Postpartum
hemorrhage
• Shock
• Sepsis
• HELLP syndrome
• Haemolysis
• Elevated Liver
enzymes
• Low Platelets

8. Cont….
Fetal complications
Intrauterine death
Asphyxia
Prematurity
IUGR
Residual hypertension
Recurrent pre-eclampsia
Chronic renal disease
Placental abruption

9. Investigations
CBC
platelet count , LDH if abnormal, order D-dimers,
coagulation panel, and smear .
Clotting profile , electrolytes
Renal studies: serum BUN creatinine and uric acid,
urinalysis, 24-hr urine for protein and creatinine, or
protein/creatinine ratio
Liver function tests: AST, ALT, and bilirubin

10. Management
• Delivery is the only definitive cure for preeclampsia.
• Individualized
• stabilization of the patient with magnesium sulfate for seizure prophylaxis, along with medical control
of severe hypertension and corticosteroids will allow delivery to be delayed in the hopes of advancing
gestational age
• complete medical history, physical examination, and laboratory evaluation.
• A careful fetal evaluation is also indicated
• Chronic antihypertensive therapy or diuretic therapy does not prevent the progression to severe
disease and is not recommended.
• Termination of pregnancy with the least possible complication to the mother & fetus
• No rule for c/s except if there is one of the indication for C/S
• the blood pressure should not be lowered too rapidly or too much <130/80 mm Hg , may result in a
decreased uteroplacental blood flow

11. Anti hypertensive treatment
• Methyldopa 500 mg P.O. loading
followed by 250- 750 mg not
used in acute need 8H to start
action
• the safest, most efficacious drugs
for the acute control of severe
hypertension complicating
preeclampsia are labetalol and
hydralazine
• Nifedipine should be used
cautiously to avoid hypotension,
particularly when used in
conjunction with magnesium
sulfate
• Antihypertensive medications
that should be avoided Diuretics
• Atenolol
• Angiotensin converting enzyme
inhibitors (ACE)
• Angiotensin receptor-blocking
drugs (ARB)

12. SEIZURE PROPHYLAXIS
• magnesium sulfate
• IV + IM , IM is very painful not recommended
• Therapeutic levels are generally accepted to
be in the range of 4.8 to 9.6 mg/dL, but to
avoid toxicity, levels should not be allowed to
rise above 7 to 8 mg/dL
• Carful monitoring of urine output monitoring
patellar reflexes , respiratory rate
• Magnesium toxicity is treated by stopping
the infusion and, when severe, administering
IV calcium gluconate, 10 mL of a 10%
solution
• D/C 24 after delivery

13. FLUID MANAGEMENT
• Total fluids should be limited to 30 to 50 ml/ hour should be
monitored closely to avoid excessive administration.
• For how are at risk of pulmonary edema and significant third-spacing
maintenance infusion of a balanced salt or isotonic saline solution at
approximately 80 mL/hour is often adequate for a patient who has
no ongoing abnormal fluid losses .
• Fluid restriction should be maintained until postpartum diuresis
ensures

14. • Call for help
• Vital signs
• 2 large IV canula
• Send blood sample
• cross match 4-6 unit of
blood
• Foley's catheter
• Control fluid intake
• Control blood presser
• Full examination
• Fetal assessment (CTG)
• Deliver

15. Reference
• Up to data
• Medscape
• hacker and moore's essentials of
obstetrics
• Kaplan USMLE Step 2 CK
Obstetrics and Gynecology. Edition
2017