KNOWLEDGE REGARDING THE PRE-ECLAMPSIA & ECLAMPSIA

1. PREECLAMPSIA &PREECLAMPSIA &
ECLAMPSIAECLAMPSIA

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. 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. 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. 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))

7.  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.

8. 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))

9. 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.

10.  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.

12. 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

13. 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

14. 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

15. 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))

17. 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 Ca.channelCa.channel
blockerblocker
5mg sub5mg sub.. SevereSevere
headacheheadache
ForFor
emergencyemergency

18. 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..

19. 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)

21. 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))

22. 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

23. 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%.