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PET ECLAMPSIA.ppt
- 1. Division of ReproductiveHealth PRE-ECLAMPSIA/ECLAMPSIA PRESENTER:- Mr. MUSINDI TOPIC:- pet/eclampsia DATE:- 29th september 2010 WELCOME
- 2. Division of ReproductiveHealth LEARNING OBJECTIVES At the end of the session, health care provider will: • Define pre-eclampsia and eclampsia • Identify risk factors for pre-eclampsia and eclampsia • Diagnose and classify pre-eclampsia • Diagnose eclampsia • Manage a woman with pre-eclampsia and eclampsia • Referral
- 3. Division of ReproductiveHealth Epidemiology • This is the third most common cause of maternal mortality worldwide and in Kenya as well. • Eclampsia is estimated to occur in about 1 in 100 -1700 deliveries • In Kenyatta National Hospital the incidence of eclampsia among 14,730 deliveries over a two-year period (Jan 1999 - Dec 2000) was 147, approximately 10 per 1000 deliveries
- 4. Division of ReproductiveHealth Statistics from Webuye district hospital as from January 2010-september 2010; Month 2010 Admissions Delivered P.E.T Eclampsia M/Deaths Jan 341 253 4 2 0 Feb 282 213 6 0 0 Mar 422 286 4 3 0 Apr 345 245 6 6 1 May 381 318 7 3 1 Jun 340 274 4 3 1 July 381 323 5 1 1 Aug 406 311 4 1 0 Sept 7 1 1 TOTAL 2898 2223 47 20 5
- 5. Division of ReproductiveHealth Risk Factors for Pre-eclampsia • Nulliparas • Maternal age >40 • Twin gestation • Family history of pre-eclampsia or eclampsia • Chronic hypertension • Chronic renal disease • Diabetes mellitus • Angiotensin gene T235
- 6. Division of ReproductiveHealth Pre-Eclampsia • WHO defines pre-eclampsia as "A condition specific to pregnancy, arising after 20th week of gestation, characterised by hypertension (BP >140/90) and Proteinuria. Oedema may also be present“ • Hypertension and Proteinuria must be present on two occasions >6 hr apart
- 7. Division of ReproductiveHealth Eclampsia • Eclampsia is a condition peculiar to pregnant or newly delivered women. • It is characterized by convulsions (fits) in the absence of other medical conditions predisposing to convulsions. • The woman usually has pre-eclampsia (hypertension and Proteinuria). • The fits may occur in the ante-partum, intra-partum or post-partum periods.
- 8. Division of ReproductiveHealth Clinical picture of Pre-eclampsia and Eclampsia ײ Present Absent Diminished foetal Movement ײ Present Absent Oliguria ײ Present Absent Upper abdominal pain ײ Present Absent Visual disturbance ײ Present Absent Headache ײ 2+ or greater Persistently present Trace or 1+ Absent Proteinuria Generalised oedema: including face and hands. As in severe pre- eclampsia plus fits Rises >20 mmHg or absolute level is >100 Rises 15-20 mmHg or absolute level is > 90 but <100 Diastolic blood pressure Eclampsia Severe Pre-eclampsia Mild Pre-eclampsia Finding
- 9. Division of ReproductiveHealth ECLAMPTIC MOTHER IN COMA
- 10. Division of ReproductiveHealth Laboratory investigations Routine tests include • Full haemogram • Platelet count • Urinalysis for Proteinuria • Urea and electrolytes • Liver function tests • Serum Creatinine levels • Uric acid • 24hr urine for protein • Coagulation screen • Tests to rule out other causes of convulsions e.g. malaria, epilepsy, meningitis • Obstetric Ultrasound scan
- 11. Division of ReproductiveHealth Management of mild PET • Establish if the mother can rest at home • Advise patient and relatives on importance of bed rest • Give oral anti-hypertensive (Aldomet 250mg three times daily) Maintain diastolic BP at 90-100 mmHg • Monitor maternal and foetal condition weekly • Admit if coming too far away from hospital advise on worsening signs of the conditions and should report if any be present • If no improvement refer to hospital if at a health centre • Deliver at 37 completed weeks
- 12. Division of ReproductiveHealth 33-34 weeks Delivery Delivery Decisions - Severe Preeclampsia Maternal deterioration? Severe IUGR? Fetal compromise? In labor? >34 weeks gestation? 28-32weeks •Corticosteroids •Antihypertensive drugs •Daily evaluation of maternal and fetal conditions until 33-34 weeks Yes Delivery within 24 hours Amniocentesi s Immature fluid •Corticosteroids •Deliver 48 hours later Mature fluid No Adapted from University of Tennessee, Memphis, management plan for patients with severe preeclampsia, Sibai, BM, in Obstetrics: Normal and Problem Pregnancies, 3rd Edition, Gabbe, SG, Niebyl, JR, Simpson, JL.
- 13. Division of ReproductiveHealth Magnesium sulphate schedules for severe pre-eclampsia and eclampsia 1 • Loading Dose • Magnesium sulphate 20% Solution, 4g IV for 10-15 minutes • Follow promptly with 10g of 50% magnesium sulphate solution, 5g in each buttock as deep IM injection with 1mL of 2% Lignocaine in the same syringe • Ensure that aseptic technique is practised when giving magnesium sulphated deep IM injection. Warn the woman that a feeling of warmth will be felt when magnesium sulphate is given. • If convulsions occur after 15 minutes, give 2g magnesium sulphate (50% solution) IV over 5 minutes
- 14. Division of ReproductiveHealth Magnesium sulphate schedules for severe pre-eclampsia and eclampsia 2 Maintenance Dose • 5g magnesium sulphate (50% solution) + 1 mL lignocaine 2% IM every 4 hours into alternate buttocks. Continue treatment with magnesium sulphate for 24 hours after delivery or at the last convulsion, whichever occurs last. Before repeat administration, ensure that: • Respiratory rate is at least 16 per minute • Patellar reflexes are present • Urinary output is at least 30 mL per hour over preceding four hours
- 15. Division of ReproductiveHealth Magnesium sulphate schedules for severe pre-eclampsia and eclampsia 3 WITHHOLD OR DELAY DRUG IF: • Respiratory rate falls below 16 per minute • Patellar reflexes are absent • Urinary output falls below 30mL per hour over the preceding 4 hours KEEP ANTIDOTE READY: • In case of respiratory arrest: • Assist ventilation (mask and bag, anaesthesia apparatus, intubation) • Give Calcium Gluconate 1g (10mL of 10% solution) IV slowly until respiration begins to antagonise the effects of magnesium sulphate.
- 16. Division of ReproductiveHealth Management of fitting patient: • Patient should be put in semi prone position so that mucous and saliva can drain out • Tight fitting dresses around the neck should be loosened or removed • Clean mouth and nostrils gently and remove secretions (Dentures should be removed if possible) • No attempt should be made to insert any instrument into the mouth
- 17. Division of ReproductiveHealth Management cont.. • Give Oxygen (if available) continuously during fit and for 5 minutes after each fit • Fitting should be allowed to complete its course without physically attempting to hold the patient down. • Privacy and dignity of patient must be observed - pull screens around her. • Administer diazepam or magnesium sulphate as per regime to control fits
- 18. Division of ReproductiveHealth Prevention and control ( no proven benefits) • Correct nutritional deficiencies – Magnesium –Zinc –Omega 3 fatty acids • Change prostacyclin / thromboxane balance: –Aspirin (only beneficial in low risk groups)
- 19. Division of ReproductiveHealth Nursing care; • Admit patient if severe PET • Bed rest- Nurse patient in Semi prone position (helps secretions to drain easily) • Ensure a clear airway • Administer antihypertensive as indicated • Take & Monitor vital signs ½ to 1 hourly
- 20. Division of ReproductiveHealth CARE CONT; • Watch for impending eclampsia signs i.e. (continuous rising Bp, increasing oedema of the face and hands, heavy Proteinuria, Oliguria, headache and visual disturbances, vomiting, epigastric pains, reduced fetal movements) • Take samples for lab. Investigation- urinalysis, full haemogram
- 21. Division of ReproductiveHealth CARE CONT; • Monitor urinary output • Fluid balance chart daily. 85mls total / hr input: fluid overload leads to oedema and sometimes ARDS( Adult respiratory distress syndrome). • Avoid:- undue noise, bright light, painful procedure, discomfort, full bladder, strained position in bed. • Prepare patient for C/S if indicated • Document findings & procedures done
- 22. Division of ReproductiveHealth THE END; QUOTE OF THE WEEK:- KINDNESS IS AN INTEGRAL VIRTUE FOR A REAL MEDICAL PRACTITIONER ‘’MERCI’’ THANKS FOR LISTENING!!