The document discusses hypertensive disorders of pregnancy including preeclampsia, eclampsia, and chronic hypertension. Some key points:
- Preeclampsia complicates 7-10% of pregnancies in the US and is a leading cause of maternal death. It is defined as new hypertension and proteinuria after 20 weeks.
- Eclampsia occurs in 1 in 10,000-150,000 pregnancies and is characterized by seizures that cannot be attributed to other causes in women with preeclampsia.
- Magnesium sulfate is the drug of choice for preventing and treating seizures from eclampsia, as it reduces the risk of recurrent seizures by over 50%. However,
Physiological changes in pregnancy include changes in the central nervous, respiratory, and cardiovascular systems. The minimum alveolar concentration of anesthetic gases decreases by up to 40% due to hormonal and endogenous changes. Oxygen consumption and minute ventilation increase while functional residual capacity decreases, increasing the risk of desaturation. Blood volume and plasma volume increase substantially, elevating cardiac output and stroke volume and decreasing systemic vascular resistance.
The document discusses two conditions that can cause bleeding in late pregnancy - abruptio placenta and placenta previa. Abruptio placenta involves the separation of the placenta from the uterus prior to delivery and common risk factors include hypertension and trauma. Placenta previa occurs when the placenta implants in the lower uterine segment over the cervical os. Management of both conditions involves monitoring for maternal and fetal stability and either emergency c-section or planned c-section depending on gestational age and severity of bleeding. Complications can include disseminated intravascular coagulation for abruptio placenta or placenta accreta if placenta previa occurs over a previous c-section
Anesthesia for non Obstetric Surgery in Pregnancyisakakinada
This document discusses anaesthesia considerations for non-obstetric surgery during pregnancy. It notes that while no anaesthetic agents have been proven to be teratogenic in humans, surgery can increase risks of preterm labour, abortion, or perturbations in uteroplacental blood flow that could impact the fetus. It emphasizes the importance of consulting an obstetrician prior to any invasive procedures or surgery during pregnancy due to their expertise in maternal-fetal physiology. Regional anaesthesia is generally preferred over general anaesthesia when possible.
This document discusses hypertensive disorders in pregnancy. It defines various types of hypertensive disorders including pregnancy-induced hypertension, pre-eclampsia, eclampsia, and chronic hypertension. It provides details on the pathophysiology, risk factors, clinical features, investigations, management, and complications of pre-eclampsia and eclampsia. Common antihypertensive drugs used for treatment are also mentioned.
This document defines hypertension in pregnancy as a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher on more than one occasion. Preeclampsia is a multifactorial condition affecting 3% of pregnancies that is characterized by poor placentation leading to endothelial dysfunction and clinical manifestations including hypertension and proteinuria after 20 weeks of gestation. Magnesium sulfate is the drug of choice for preventing seizures in women with moderate to severe preeclampsia, given either as a continuous intravenous infusion or intermittent intramuscular injections to control blood pressure and prevent complications.
This document discusses post-partum hemorrhage (PPH), including its definition, causes, risk factors, prevention, and management. It describes:
1) PPH is defined as blood loss over 500ml within 24 hours of delivery. The main cause is uterine atony but can also be due to retained placenta or trauma.
2) Risk factors include previous c-section, large babies, and medical conditions like placenta previa. Prevention focuses on identifying risks antenatally and using oxytocics to manage the third stage of labor.
3) Initial management of PPH involves resuscitation, oxytocics, and identifying the cause. Further steps may include balloon
This document discusses epidural analgesia for pain relief during labor and childbirth. It provides details on how epidurals are administered, possible complications, effects on labor and delivery outcomes, and the author's experience with over 250 cases at their hospital. Their results showed high mother satisfaction rates, few complications, and no serious issues. The author concludes that their technique for epidural administration was successful and safe based on their initial experience.
The document discusses obstetric emergencies including massive obstetric hemorrhage, antepartum hemorrhage from placenta previa or abruption, uterine rupture, and postpartum hemorrhage. It provides definitions, risk factors, diagnostic criteria, management guidelines, and anesthetic considerations for each of these conditions. Prevention and treatment involve careful monitoring, IV access, blood products, oxytocic medications, and timely delivery when indicated to stabilize both mother and fetus.
Physiological changes in pregnancy include changes in the central nervous, respiratory, and cardiovascular systems. The minimum alveolar concentration of anesthetic gases decreases by up to 40% due to hormonal and endogenous changes. Oxygen consumption and minute ventilation increase while functional residual capacity decreases, increasing the risk of desaturation. Blood volume and plasma volume increase substantially, elevating cardiac output and stroke volume and decreasing systemic vascular resistance.
The document discusses two conditions that can cause bleeding in late pregnancy - abruptio placenta and placenta previa. Abruptio placenta involves the separation of the placenta from the uterus prior to delivery and common risk factors include hypertension and trauma. Placenta previa occurs when the placenta implants in the lower uterine segment over the cervical os. Management of both conditions involves monitoring for maternal and fetal stability and either emergency c-section or planned c-section depending on gestational age and severity of bleeding. Complications can include disseminated intravascular coagulation for abruptio placenta or placenta accreta if placenta previa occurs over a previous c-section
Anesthesia for non Obstetric Surgery in Pregnancyisakakinada
This document discusses anaesthesia considerations for non-obstetric surgery during pregnancy. It notes that while no anaesthetic agents have been proven to be teratogenic in humans, surgery can increase risks of preterm labour, abortion, or perturbations in uteroplacental blood flow that could impact the fetus. It emphasizes the importance of consulting an obstetrician prior to any invasive procedures or surgery during pregnancy due to their expertise in maternal-fetal physiology. Regional anaesthesia is generally preferred over general anaesthesia when possible.
This document discusses hypertensive disorders in pregnancy. It defines various types of hypertensive disorders including pregnancy-induced hypertension, pre-eclampsia, eclampsia, and chronic hypertension. It provides details on the pathophysiology, risk factors, clinical features, investigations, management, and complications of pre-eclampsia and eclampsia. Common antihypertensive drugs used for treatment are also mentioned.
This document defines hypertension in pregnancy as a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher on more than one occasion. Preeclampsia is a multifactorial condition affecting 3% of pregnancies that is characterized by poor placentation leading to endothelial dysfunction and clinical manifestations including hypertension and proteinuria after 20 weeks of gestation. Magnesium sulfate is the drug of choice for preventing seizures in women with moderate to severe preeclampsia, given either as a continuous intravenous infusion or intermittent intramuscular injections to control blood pressure and prevent complications.
This document discusses post-partum hemorrhage (PPH), including its definition, causes, risk factors, prevention, and management. It describes:
1) PPH is defined as blood loss over 500ml within 24 hours of delivery. The main cause is uterine atony but can also be due to retained placenta or trauma.
2) Risk factors include previous c-section, large babies, and medical conditions like placenta previa. Prevention focuses on identifying risks antenatally and using oxytocics to manage the third stage of labor.
3) Initial management of PPH involves resuscitation, oxytocics, and identifying the cause. Further steps may include balloon
This document discusses epidural analgesia for pain relief during labor and childbirth. It provides details on how epidurals are administered, possible complications, effects on labor and delivery outcomes, and the author's experience with over 250 cases at their hospital. Their results showed high mother satisfaction rates, few complications, and no serious issues. The author concludes that their technique for epidural administration was successful and safe based on their initial experience.
The document discusses obstetric emergencies including massive obstetric hemorrhage, antepartum hemorrhage from placenta previa or abruption, uterine rupture, and postpartum hemorrhage. It provides definitions, risk factors, diagnostic criteria, management guidelines, and anesthetic considerations for each of these conditions. Prevention and treatment involve careful monitoring, IV access, blood products, oxytocic medications, and timely delivery when indicated to stabilize both mother and fetus.
1) The document discusses classifications of hypertension in pregnancy and definitions of preeclampsia. Preeclampsia is defined as hypertension and proteinuria or signs of multi-organ involvement without proteinuria.
2) Antihypertensive medications are prescribed during pregnancy to prevent maternal complications of severe hypertension like cardiovascular and cerebrovascular events, not to cure preeclampsia.
3) Common antihypertensives discussed for use in pregnancy include methyldopa, hydralazine, labetalol, and nifedipine. Their mechanisms of action, dosages, and potential side effects are reviewed.
This document outlines the treatment of magnesium sulfate for several medical conditions including eclampsia, pre-eclampsia, torsades de pointes, and refractory ventricular fibrillation. It recommends an initial IV dose of 4 grams of magnesium sulfate mixed with saline and dextrose given over 5-10 minutes, followed by additional 2 gram doses if needed to convert abnormal heart rhythms or address low magnesium levels. Ongoing maintenance infusion of 1 gram per 250 mL of dextrose solution is also described. Medical contact is advised for any questions.
Anaesthetic management of obstetric emergenciesVidhi Gajjar
This document discusses the anesthetic management of obstetric emergencies such as major obstetric hemorrhage and fetal compromise. It covers the challenges in managing obstetric hemorrhage including difficulty in estimating blood loss and early diagnosis of shock due to masking of signs by normal pregnancy physiology. The management approach "ORDER" is outlined which includes organization, resuscitation, defective coagulation, evaluation of response, and remedying the cause of bleeding. General anesthesia techniques for cesarean sections in hemorrhage emphasize rapid sequence induction, cricoid pressure, and hemodynamic support through fluid resuscitation and blood product transfusion to maintain coagulation.
The document discusses hypertensive disorders of pregnancy, which complicate 5-10% of pregnancies and are a major cause of maternal and infant morbidity and mortality. It defines gestational hypertension, preeclampsia, and eclampsia and describes their signs and symptoms. Risk factors for preeclampsia include young maternal age, obesity, family history, prior preeclampsia, and medical conditions. The document also summarizes current theories on the pathophysiology of preeclampsia relating to poor placentation, placental ischemia, and maternal endothelial dysfunction.
Pregnancy induced hypertension includes gestational hypertension, preeclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. Preeclampsia is a multisystem disorder caused by abnormal placentation leading to placental hypoxia and endothelial damage. Management involves maternal and fetal monitoring, antihypertensive treatment for severe hypertension, magnesium sulfate for seizure prophylaxis, and delivery once the fetus is mature. Anesthetic management is crucial and involves careful consideration of neuraxial versus general anesthesia depending on the severity of the preeclampsia and other maternal factors.
P R E G N A N C Y I N D U C E D H Y P E R T E N S I O NDr. Shaheer Haider
Pregnancy-induced hypertension (PIH) is defined as new hypertension developing after 20 weeks of gestation. It affects 5-8% of pregnancies and can range from mild to severe, including pre-eclampsia and eclampsia. The exact cause is unknown but may involve immunological and endothelial dysfunction factors. Treatment aims to prevent complications and involves bed rest, magnesium sulfate, antihypertensive drugs, and delivery if gestation reaches term or the mother/baby's condition deteriorates.
This document discusses pregnancy induced hypertension (PIH), also known as preeclampsia. PIH is a multisystem disorder characterized by high blood pressure and protein in the urine that develops during pregnancy. It can lead to serious complications for both the mother and baby if untreated. The document covers the definition, classification, signs and symptoms, risk factors, pathogenesis, diagnosis, and management of mild and severe cases of PIH.
The document discusses the effects of various anesthetic agents on uterine activity. It finds that inhalational agents like sevoflurane, desflurane, and isoflurane depress uterine activity in a dose-dependent manner. Epidural analgesia with dilute local anesthetics does not prolong labor. Intravenous fluids like normal saline can decrease uterine activity if given in large volumes. Vasopressors like phenylephrine can cause tetanic uterine contractions in large doses. Nitroglycerin relaxes the uterus through nitric oxide production. Oxytocin and prostaglandins stimulate uterine contractions while magnesium and beta-agonists inhibit contractions.
Pregnancy Induced Hypertension- PathophysiologyDr Anusha Rao P
This document discusses the pathophysiology of pregnancy induced hypertension. It begins by noting that hypertension is a leading cause of maternal and perinatal mortality, with an incidence of 5-10% that is increasing. It then describes the normal hemodynamic changes in pregnancy, including increased plasma volume and cardiac output. The document discusses etiologies such as poor placentation and immunological factors. It outlines the pathogenesis, including vasospasm, endothelial activation, and angiogenic/antiangiogenic factors. It details effects on organ systems like the brain, liver, kidneys and cardiovascular system. Finally, it provides classifications for HELLP syndrome and reviews its associated maternal morbidities.
This document provides information on preparing for and managing obstetric hemorrhage. Some key points:
- Severe bleeding is a leading cause of maternal death worldwide, with rapid blood loss occurring within 24 hours of delivery in many cases.
- Non-pharmacological measures for postpartum hemorrhage include uterine massage, uterine tamponade, compression sutures, and ligation of internal iliac or uterine arteries. Pharmacological options include oxytocin, ergometrine, carboprost, and tranexamic acid.
- For severe hemorrhage, measures such as hysterectomy, arterial embolization, factor VIIa, or cell salvage may be needed. Initial
Pregnancy induced hypertension introduction
Classification of pregnancy induced hypertension
Preeclampsia -
Definition
Criteria for diagnosis of preeclampsia,
Epidemiology of preeclampsia,
Risk factors of preeclampsia,
Pathogenesis of preeclampsia,
Pathophysiology of preeclampsia,
Course of preeclampsia,
Complications of preeclampsia,
What is HELLP ?
Management of preeclampsia at home, at hospital, during labour, during puerperium,
Management of acute fulminant preeclampsia
Anathesia in patients with preeclampsiaphoenix11090
This document discusses anesthesia considerations for cesarean delivery in patients with preeclampsia. It recommends neuraxial anesthesia over general anesthesia to avoid hypertension during induction and emergence. Neuraxial techniques like spinal or epidural are preferred but should be administered cautiously to prevent hypotension. Fluid administration should be conservative and vasopressors like phenylephrine given incrementally. While general anesthesia can be used, steps must minimize the hypertensive response to intubation. Magnesium sulfate therapy should continue during surgery.
This document summarizes postpartum hemorrhage, its risk factors, etiologies, pathophysiology, nursing interventions, and other potential postpartum complications including infection, emotional disorders, thrombophlebitis, and domestic violence. It discusses postpartum hemorrhage definitions and causes such as uterine atony, retained tissues, and genital tract trauma. It also outlines nursing assessments and treatments for various postpartum complications.
This document summarizes the physiological changes that occur during pregnancy and discusses their implications for anesthesia. Key points include:
- Blood volume, plasma volume, and cardiac output increase significantly during pregnancy to meet demands of the uterus, placenta, and fetus. Regional anesthesia can cause hypotension due to further decreases in peripheral resistance.
- Respiratory function changes include elevated diaphragm and decreased functional residual capacity, making pregnant women more susceptible to hypoxemia. Rapid sequence induction requires pre-oxygenation.
- Gastrointestinal changes like decreased lower esophageal sphincter tone increase risk of regurgitation and aspiration under general anesthesia. Regional techniques are preferred for labor and delivery.
This document discusses pain management techniques for labor and delivery. It begins by outlining the pain pathways involved in each stage of labor. It then discusses the effects of pain and stress on the mother and fetus. Various analgesic techniques are discussed, including systemic opioids, nitrous oxide, local anesthetics, and regional techniques like epidural and combined spinal-epidural blocks. Risks, benefits, and considerations for both maternal and fetal safety are provided for each technique. The document concludes by emphasizing individualizing the analgesic approach based on the patient's goals and labor stage while optimizing outcomes and safety.
Hypertensive disorders in pregnancy recent guidelines fogsi 2014Dr Meenakshi Sharma
This document discusses guidelines for hypertensive disorders in pregnancy from FOGSI 2014. Some key points:
1. Hypertension complicates 5-10% of pregnancies and is a leading cause of maternal mortality. Preeclampsia can develop in women with a history of the condition in 13-53% of future pregnancies.
2. Diagnosis of hypertensive disorders in pregnancy includes gestational hypertension (blood pressure over 140/90 without proteinuria after 20 weeks), preeclampsia (same with proteinuria), and chronic hypertension (high blood pressure before pregnancy).
3. Treatment for mild to moderate hypertension in pregnancy focuses on oral antihypertensives like labetalol and
This document discusses critical care for obstetric patients. It begins with an introduction and epidemiology section noting that while the proportion of obstetric patients in ICUs is low, the most common reasons for admission are postpartum hemorrhage and hypertensive disorders. It then covers obstetric critical care, basic principles for obstetric emergencies, transfer to critical care settings, the role of obstetricians, resuscitative hysterotomy, and supportive care. It provides recommendations including prioritizing maternal stabilization, consulting obstetricians, and not withholding necessary treatments due to fetal concerns. The document aims to guide management of critically ill obstetric patients.
This document provides an overview of pregnancy induced hypertension (PIH), including its definition, risk factors, pathophysiology, clinical features, investigations, complications, and treatment. Some key points:
- PIH complicates 5-10% of pregnancies and is a leading cause of maternal and neonatal morbidity and mortality.
- It is defined as new onset hypertension (blood pressure over 140/90 mmHg) and proteinuria developing after 20 weeks of gestation.
- The pathophysiology involves vasoconstriction due to an imbalance in vasodilators and vasoconstrictors, which can lead to complications like IUGR, preterm birth, and eclampsia.
This document provides an overview of obstetric emergencies that may require intensive care admission. It defines obstetric emergencies as multi-disciplinary problems directly related to pregnancy. It discusses the physiological changes in pregnancy that increase risks and describes several types of emergencies including hemorrhagic (placenta previa, abruption, atony), hypertensive disorders, and thromboembolic complications. The document outlines assessment, management considerations, and treatment approaches for these time-critical maternal conditions in the ICU.
Pregnancy Induced Hypertension - Pre eclampsiaomar143
This document provides information about a 33-year-old pregnant woman admitted to the hospital with mild preeclampsia at 36 weeks of gestation. It includes her medical history, symptoms, physical exam findings, lab results, diagnosis, and notes on preeclampsia and its management. The key details are that she presented with swelling in her lower limbs and a history of amenorrhea for 8 months, and was found to have elevated blood pressure and mild preeclampsia at 36 weeks of pregnancy.
This document provides information about the pons including its gross appearance, internal structure, nuclei of cranial nerves V and VII, and lesions that can occur. It contains diagrams of the pons showing fiber tracts and nuclei. Statements are provided to test knowledge about the pons' anatomy and relationships.
1) The document discusses classifications of hypertension in pregnancy and definitions of preeclampsia. Preeclampsia is defined as hypertension and proteinuria or signs of multi-organ involvement without proteinuria.
2) Antihypertensive medications are prescribed during pregnancy to prevent maternal complications of severe hypertension like cardiovascular and cerebrovascular events, not to cure preeclampsia.
3) Common antihypertensives discussed for use in pregnancy include methyldopa, hydralazine, labetalol, and nifedipine. Their mechanisms of action, dosages, and potential side effects are reviewed.
This document outlines the treatment of magnesium sulfate for several medical conditions including eclampsia, pre-eclampsia, torsades de pointes, and refractory ventricular fibrillation. It recommends an initial IV dose of 4 grams of magnesium sulfate mixed with saline and dextrose given over 5-10 minutes, followed by additional 2 gram doses if needed to convert abnormal heart rhythms or address low magnesium levels. Ongoing maintenance infusion of 1 gram per 250 mL of dextrose solution is also described. Medical contact is advised for any questions.
Anaesthetic management of obstetric emergenciesVidhi Gajjar
This document discusses the anesthetic management of obstetric emergencies such as major obstetric hemorrhage and fetal compromise. It covers the challenges in managing obstetric hemorrhage including difficulty in estimating blood loss and early diagnosis of shock due to masking of signs by normal pregnancy physiology. The management approach "ORDER" is outlined which includes organization, resuscitation, defective coagulation, evaluation of response, and remedying the cause of bleeding. General anesthesia techniques for cesarean sections in hemorrhage emphasize rapid sequence induction, cricoid pressure, and hemodynamic support through fluid resuscitation and blood product transfusion to maintain coagulation.
The document discusses hypertensive disorders of pregnancy, which complicate 5-10% of pregnancies and are a major cause of maternal and infant morbidity and mortality. It defines gestational hypertension, preeclampsia, and eclampsia and describes their signs and symptoms. Risk factors for preeclampsia include young maternal age, obesity, family history, prior preeclampsia, and medical conditions. The document also summarizes current theories on the pathophysiology of preeclampsia relating to poor placentation, placental ischemia, and maternal endothelial dysfunction.
Pregnancy induced hypertension includes gestational hypertension, preeclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. Preeclampsia is a multisystem disorder caused by abnormal placentation leading to placental hypoxia and endothelial damage. Management involves maternal and fetal monitoring, antihypertensive treatment for severe hypertension, magnesium sulfate for seizure prophylaxis, and delivery once the fetus is mature. Anesthetic management is crucial and involves careful consideration of neuraxial versus general anesthesia depending on the severity of the preeclampsia and other maternal factors.
P R E G N A N C Y I N D U C E D H Y P E R T E N S I O NDr. Shaheer Haider
Pregnancy-induced hypertension (PIH) is defined as new hypertension developing after 20 weeks of gestation. It affects 5-8% of pregnancies and can range from mild to severe, including pre-eclampsia and eclampsia. The exact cause is unknown but may involve immunological and endothelial dysfunction factors. Treatment aims to prevent complications and involves bed rest, magnesium sulfate, antihypertensive drugs, and delivery if gestation reaches term or the mother/baby's condition deteriorates.
This document discusses pregnancy induced hypertension (PIH), also known as preeclampsia. PIH is a multisystem disorder characterized by high blood pressure and protein in the urine that develops during pregnancy. It can lead to serious complications for both the mother and baby if untreated. The document covers the definition, classification, signs and symptoms, risk factors, pathogenesis, diagnosis, and management of mild and severe cases of PIH.
The document discusses the effects of various anesthetic agents on uterine activity. It finds that inhalational agents like sevoflurane, desflurane, and isoflurane depress uterine activity in a dose-dependent manner. Epidural analgesia with dilute local anesthetics does not prolong labor. Intravenous fluids like normal saline can decrease uterine activity if given in large volumes. Vasopressors like phenylephrine can cause tetanic uterine contractions in large doses. Nitroglycerin relaxes the uterus through nitric oxide production. Oxytocin and prostaglandins stimulate uterine contractions while magnesium and beta-agonists inhibit contractions.
Pregnancy Induced Hypertension- PathophysiologyDr Anusha Rao P
This document discusses the pathophysiology of pregnancy induced hypertension. It begins by noting that hypertension is a leading cause of maternal and perinatal mortality, with an incidence of 5-10% that is increasing. It then describes the normal hemodynamic changes in pregnancy, including increased plasma volume and cardiac output. The document discusses etiologies such as poor placentation and immunological factors. It outlines the pathogenesis, including vasospasm, endothelial activation, and angiogenic/antiangiogenic factors. It details effects on organ systems like the brain, liver, kidneys and cardiovascular system. Finally, it provides classifications for HELLP syndrome and reviews its associated maternal morbidities.
This document provides information on preparing for and managing obstetric hemorrhage. Some key points:
- Severe bleeding is a leading cause of maternal death worldwide, with rapid blood loss occurring within 24 hours of delivery in many cases.
- Non-pharmacological measures for postpartum hemorrhage include uterine massage, uterine tamponade, compression sutures, and ligation of internal iliac or uterine arteries. Pharmacological options include oxytocin, ergometrine, carboprost, and tranexamic acid.
- For severe hemorrhage, measures such as hysterectomy, arterial embolization, factor VIIa, or cell salvage may be needed. Initial
Pregnancy induced hypertension introduction
Classification of pregnancy induced hypertension
Preeclampsia -
Definition
Criteria for diagnosis of preeclampsia,
Epidemiology of preeclampsia,
Risk factors of preeclampsia,
Pathogenesis of preeclampsia,
Pathophysiology of preeclampsia,
Course of preeclampsia,
Complications of preeclampsia,
What is HELLP ?
Management of preeclampsia at home, at hospital, during labour, during puerperium,
Management of acute fulminant preeclampsia
Anathesia in patients with preeclampsiaphoenix11090
This document discusses anesthesia considerations for cesarean delivery in patients with preeclampsia. It recommends neuraxial anesthesia over general anesthesia to avoid hypertension during induction and emergence. Neuraxial techniques like spinal or epidural are preferred but should be administered cautiously to prevent hypotension. Fluid administration should be conservative and vasopressors like phenylephrine given incrementally. While general anesthesia can be used, steps must minimize the hypertensive response to intubation. Magnesium sulfate therapy should continue during surgery.
This document summarizes postpartum hemorrhage, its risk factors, etiologies, pathophysiology, nursing interventions, and other potential postpartum complications including infection, emotional disorders, thrombophlebitis, and domestic violence. It discusses postpartum hemorrhage definitions and causes such as uterine atony, retained tissues, and genital tract trauma. It also outlines nursing assessments and treatments for various postpartum complications.
This document summarizes the physiological changes that occur during pregnancy and discusses their implications for anesthesia. Key points include:
- Blood volume, plasma volume, and cardiac output increase significantly during pregnancy to meet demands of the uterus, placenta, and fetus. Regional anesthesia can cause hypotension due to further decreases in peripheral resistance.
- Respiratory function changes include elevated diaphragm and decreased functional residual capacity, making pregnant women more susceptible to hypoxemia. Rapid sequence induction requires pre-oxygenation.
- Gastrointestinal changes like decreased lower esophageal sphincter tone increase risk of regurgitation and aspiration under general anesthesia. Regional techniques are preferred for labor and delivery.
This document discusses pain management techniques for labor and delivery. It begins by outlining the pain pathways involved in each stage of labor. It then discusses the effects of pain and stress on the mother and fetus. Various analgesic techniques are discussed, including systemic opioids, nitrous oxide, local anesthetics, and regional techniques like epidural and combined spinal-epidural blocks. Risks, benefits, and considerations for both maternal and fetal safety are provided for each technique. The document concludes by emphasizing individualizing the analgesic approach based on the patient's goals and labor stage while optimizing outcomes and safety.
Hypertensive disorders in pregnancy recent guidelines fogsi 2014Dr Meenakshi Sharma
This document discusses guidelines for hypertensive disorders in pregnancy from FOGSI 2014. Some key points:
1. Hypertension complicates 5-10% of pregnancies and is a leading cause of maternal mortality. Preeclampsia can develop in women with a history of the condition in 13-53% of future pregnancies.
2. Diagnosis of hypertensive disorders in pregnancy includes gestational hypertension (blood pressure over 140/90 without proteinuria after 20 weeks), preeclampsia (same with proteinuria), and chronic hypertension (high blood pressure before pregnancy).
3. Treatment for mild to moderate hypertension in pregnancy focuses on oral antihypertensives like labetalol and
This document discusses critical care for obstetric patients. It begins with an introduction and epidemiology section noting that while the proportion of obstetric patients in ICUs is low, the most common reasons for admission are postpartum hemorrhage and hypertensive disorders. It then covers obstetric critical care, basic principles for obstetric emergencies, transfer to critical care settings, the role of obstetricians, resuscitative hysterotomy, and supportive care. It provides recommendations including prioritizing maternal stabilization, consulting obstetricians, and not withholding necessary treatments due to fetal concerns. The document aims to guide management of critically ill obstetric patients.
This document provides an overview of pregnancy induced hypertension (PIH), including its definition, risk factors, pathophysiology, clinical features, investigations, complications, and treatment. Some key points:
- PIH complicates 5-10% of pregnancies and is a leading cause of maternal and neonatal morbidity and mortality.
- It is defined as new onset hypertension (blood pressure over 140/90 mmHg) and proteinuria developing after 20 weeks of gestation.
- The pathophysiology involves vasoconstriction due to an imbalance in vasodilators and vasoconstrictors, which can lead to complications like IUGR, preterm birth, and eclampsia.
This document provides an overview of obstetric emergencies that may require intensive care admission. It defines obstetric emergencies as multi-disciplinary problems directly related to pregnancy. It discusses the physiological changes in pregnancy that increase risks and describes several types of emergencies including hemorrhagic (placenta previa, abruption, atony), hypertensive disorders, and thromboembolic complications. The document outlines assessment, management considerations, and treatment approaches for these time-critical maternal conditions in the ICU.
Pregnancy Induced Hypertension - Pre eclampsiaomar143
This document provides information about a 33-year-old pregnant woman admitted to the hospital with mild preeclampsia at 36 weeks of gestation. It includes her medical history, symptoms, physical exam findings, lab results, diagnosis, and notes on preeclampsia and its management. The key details are that she presented with swelling in her lower limbs and a history of amenorrhea for 8 months, and was found to have elevated blood pressure and mild preeclampsia at 36 weeks of pregnancy.
This document provides information about the pons including its gross appearance, internal structure, nuclei of cranial nerves V and VII, and lesions that can occur. It contains diagrams of the pons showing fiber tracts and nuclei. Statements are provided to test knowledge about the pons' anatomy and relationships.
The document discusses pregnancy-induced hypertension (PIH), including risk factors, symptoms, medical and nursing management, and interventions. PIH is a condition characterized by vasospasm and hypertension during pregnancy. Primary treatment goals are delivery of the fetus, reducing vasospasm and preventing seizures. Nursing focuses on monitoring the patient, administering medications to control blood pressure and prevent eclampsia, and delivering the baby via induction or c-section if needed to stabilize the mother's condition.
This document discusses hypertension in pregnancy and preeclampsia. It begins with definitions and classifications of hypertension in pregnancy. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. Risk factors for preeclampsia are discussed. The pathogenesis involves placental ischemia leading to endothelial dysfunction. Clinical manifestations in the mother can include issues in cardiovascular, respiratory, neurological, renal and hepatic systems. Management involves controlling blood pressure, preventing seizures with magnesium sulfate, and timely delivery of the baby.
The brainstem consists of three parts: the midbrain, pons, and medulla oblongata. It serves several broad functions including transmitting ascending and descending nerve pathways, containing important reflex centers that control cardiovascular and other bodily functions, and housing the nuclei of cranial nerves III through XII. The midbrain is involved in visual and auditory processing as well as voluntary motor control. The pons acts as a relay station between the cerebellum and medulla and helps control subconscious movements. The medulla regulates vital functions like respiration, circulation, and digestion.
Hold oxygen mask
Monitor vital signs
IV fluids if needed
45 8/31/2012 Dr. Nitika Jain
46 Dr. nitika jain 31 August 2012
Local anesthetic and analgesic
administration during pregnancy
Local anesthetics are safe to use during pregnancy.
Lignocaine is the local anesthetic of choice during
pregnancy.
Use the minimum effective dose.
Avoid repeated administration of local anesthetics.
Use aspirin or acetaminophen for analgesia during
pregnancy.
Avoid NSAIDs during pregnancy
This document discusses pregnancy induced hypertension, which includes chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension. It defines each condition and describes their causes, risk factors, management during pregnancy, and criteria for delivery. Chronic hypertension is high blood pressure before or early in pregnancy, while gestational hypertension develops after 20 weeks without other complications. Preeclampsia involves hypertension and proteinuria. Management depends on severity and gestational age, ranging from observation to medical treatment and delivery.
This document discusses hypertensive disorders of pregnancy, including classifications, signs and symptoms, risk factors, pathophysiology, investigations, management, and complications. The key points are: Preeclampsia is classified based on severity of symptoms and can occur with or without proteinuria. It involves abnormal placentation leading to maternal endothelial dysfunction and multi-system maternal and fetal effects. Management includes anti-hypertensive treatment if needed, magnesium sulfate for severe preeclampsia, corticosteroids under 34 weeks, and delivery once condition is stabilized or threatens mother/baby's health. Risks of long-term complications for mother include chronic hypertension, heart and kidney disease.
Pregnancy-induced hypertension (PIH) is a condition characterized by new onset hypertension after 20 weeks of gestation without prior chronic hypertension. It can range from mild to severe preeclampsia and eclampsia. Severe PIH is associated with multiple organ involvement and risks to both mother and baby. Care involves careful monitoring, controlling blood pressure, delivering the baby when term, and preventing and treating seizures with magnesium sulfate. Anesthetic management focuses on regional techniques like epidural anesthesia to control blood pressure, while preparing for potential difficulties like airway edema during general anesthesia if needed.
Hypertensive crisis in pregnancy can occur at any stage and is a leading cause of maternal and fetal morbidity and mortality worldwide. It is defined as severe hypertension (systolic BP >160 or diastolic BP >110) accompanied by acute end organ damage. It requires immediate treatment to prevent further complications. Common end organ effects include pulmonary edema, acute kidney injury, liver dysfunction, cerebral hemorrhage or infarction. Immediate treatment involves careful blood pressure control, monitoring for organ dysfunction, and delivery of the fetus and placenta when stable to ultimately resolve the condition.
The document discusses physiological changes during pregnancy that affect the kidneys. There is an increase in glomerular filtration rate and renal plasma flow by 50-60% due to rising plasma volume. Intraglomerular blood pressure remains unchanged despite these changes. Common renal complications in pregnancy include urinary tract infections, preeclampsia, acute renal failure, and renal calculi. Pregnancy poses risks but can be managed for women with pre-existing kidney disease through monitoring and adjusting treatment as needed.
Hypertension in pregnancy can take several forms including gestational hypertension, preeclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. Risk factors for preeclampsia include chronic hypertension, obesity, diabetes, and a family history. Screening and treatment with low dose aspirin and calcium supplementation can help prevent preeclampsia in high risk women. Severe preeclampsia requires close monitoring in hospital and timely delivery if signs worsen. Magnesium sulfate is the treatment of choice to prevent eclampsia. Postpartum follow up is also important to monitor for ongoing high blood pressure
1) Hypertension in pregnancy is defined as blood pressure of 140/90 mmHg or higher on two occasions after 20 weeks of gestation.
2) The main hypertensive disorders of pregnancy include gestational hypertension, preeclampsia, preeclampsia with severe features, chronic hypertension, and preeclampsia superimposed on chronic hypertension.
3) Management involves antihypertensive treatment, seizure prophylaxis with magnesium sulfate in preeclampsia, and delivery depending on gestational age and severity of symptoms.
This document discusses the etiopathogenesis and management of preeclampsia. It begins by outlining recommendations for blood pressure measurement in pregnancy. It then covers the classification of hypertension in pregnancy and risk factors for preeclampsia. The document discusses the etiology of preeclampsia involving poor placentation leading to placental oxidative stress and endothelial dysfunction. Predictors of preeclampsia and the role of ultrasound are described. Management involves termination of pregnancy, with timing based on gestational age and severity of symptoms. Antihypertensive therapy aims to control blood pressure without dropping it too low.
Preeclampsia in pregnancy etiopathogenesis and management Deepti Daswani
This document discusses the etiopathogenesis and management of preeclampsia. It begins by outlining recommendations for blood pressure measurement in pregnancy. It then covers the classification of hypertension in pregnancy and risk factors for preeclampsia. The document discusses the etiology of preeclampsia involving poor placentation leading to placental oxidative stress and endothelial dysfunction. Predictors of preeclampsia and the role of ultrasound are described. Management involves termination of pregnancy, with timing based on gestational age and severity of symptoms. Antihypertensive therapy aims to control blood pressure without dropping it too low.
Hypertensive disorders in pregnancy refer to a group of conditions characterized by high blood pressure during pregnancy, which can include gestational hypertension (high blood pressure that develops after 20 weeks of pregnancy) and preeclampsia (a more severe form of hypertension that can also cause protein in the urine and changes in liver function). These conditions can be serious for both the mother and the baby and may require close monitoring and management. Treatment options may include medications to lower blood pressure, as well as close monitoring of the mother and baby to ensure their health and well-being.
A 38 slide power-point presentation for medical students years 4 or 5. The idea to familiarize with classification, clinical features, diagnosis and management.
This document discusses hypertensive disorders in pregnancy. It begins by defining hypertensive disorders and noting their high rates of morbidity and mortality. It then discusses the various types of hypertensive disorders seen in pregnancy (gestational hypertension, preeclampsia, eclampsia, chronic hypertension, etc.) and their signs and symptoms. Risk factors are identified. The pathophysiology and assessment/management of hypertensive disorders are explained in detail over multiple pages. Management includes antihypertensive treatment, seizure prophylaxis, monitoring, delivery indications, and postpartum care. Hypertensive disorders are identified as one of the most significant complications seen in up to 10% of pregnancies.
Pregnant patients are admitted in ICU with a number of pregnancy related problems. Some of them are really life threatening. Identification and prompt action is the key to save lives.
This document discusses various topics related to renal physiology and disease in pregnancy. It begins with an overview of the normal adaptations the kidneys undergo during pregnancy, including increases in kidney size, glomerular filtration rate (GFR), and decreased creatinine and blood urea nitrogen levels. It then covers specific topics like urinary tract infections (UTIs), hypertensive disorders of pregnancy, acute kidney injury, and chronic kidney disease in the context of pregnancy. For each topic, it provides details on pathogenesis, screening, treatment approaches, and management considerations for caring for pregnant patients with renal conditions.
Preeclampsia is a multi-system disorder of pregnancy characterized by new onset hypertension and organ dysfunction. It is caused by poor placentation leading to placental ischemia and maternal endothelial dysfunction. It can range from mild to severe preeclampsia. Risk factors include primiparity, obesity, diabetes and family history. Treatment involves controlling blood pressure, preventing seizures, corticosteroids for fetal lung maturity and delivery between 34-37 weeks. Complications for both mother and baby include preterm birth, growth restriction and death.
This document discusses pregnancy induced hypertension (PIH), including definitions, classifications, risk factors, pathophysiology, diagnosis, and management. PIH is a multisystem disorder characterized by new onset hypertension after 20 weeks of gestation. It includes gestational hypertension, preeclampsia, and eclampsia. Management involves monitoring for signs of worsening disease and delivering after 37 weeks if mild or earlier if severe to prevent maternal and fetal morbidity and mortality. Treatment includes antihypertensives, magnesium sulfate to prevent seizures, and delivery.
This document discusses hypertensive disorders of pregnancy, which are a leading cause of maternal mortality worldwide. It defines the different types of hypertensive disorders like gestational hypertension, preeclampsia, and chronic hypertension. Preeclampsia is characterized by new onset hypertension and proteinuria after 20 weeks of gestation. The document outlines risk factors, pathogenesis, clinical manifestations, investigations, management including delivery timing, and complications like eclampsia and HELLP syndrome for different hypertensive disorders of pregnancy. Magnesium sulfate is the primary treatment for seizures of eclampsia. Delivery is usually required to resolve preeclampsia symptoms.
This document summarizes renal disorders that can occur in pregnancy. It discusses the normal physiologic changes in pregnancy that affect the kidneys as well as specific disorders like preeclampsia, hypertension, AKI, lupus nephritis, diabetic nephropathy, and nephrotic syndrome. It provides diagnostic criteria and recommendations for management and treatment for many of these conditions to help support healthy pregnancies and outcomes.
This document provides information on convulsions during pregnancy. It discusses the different causes of convulsions including eclampsia, epilepsy, infections, tumors, and electrolyte imbalances. Eclampsia is defined as new-onset seizures in a woman with preeclampsia after 20 weeks of gestation. The incidence of eclampsia is higher in developing countries. Magnesium sulfate is the primary treatment for preventing seizures in eclampsia. Management of eclampsia involves controlling blood pressure, delivering the fetus, and preventing further seizures and complications. Epilepsy during pregnancy can increase risks for the fetus but does not necessarily contraindicate breastfeeding with proper monitoring and treatment.
The document summarizes the management of hypertensive disorders in pregnancy. It defines hypertension and the different types of hypertensive disorders that can occur during pregnancy including gestational hypertension, preeclampsia, eclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension. It discusses the risk factors, pathogenesis, clinical manifestations, diagnostic criteria, and management approaches for non-severe and severe preeclampsia, including antihypertensive treatment and seizure prophylaxis.
This document discusses pregnancy induced hypertension (PIH), also known as preeclampsia. PIH is a multisystem disorder of unknown etiology that can lead to increased maternal and fetal morbidity and mortality if left untreated. It is characterized by new onset hypertension and proteinuria after 20 weeks of gestation. The document covers the classification, signs, symptoms, risk factors, pathophysiology, diagnosis and management of the different types of PIH, including chronic hypertension, gestational hypertension, preeclampsia, and eclampsia. Treatment involves blood pressure control with antihypertensives, magnesium sulfate to prevent seizures, and timely delivery once the fetus is mature.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. Hypertensive disease is the 4th
leading cause of
maternal death
Preeclampsia complicates about upto 8% of
pregnancies
In U.S preeclampsia complicates approx 7-10%
of pregnancies
Eclampsia 1 in 10000-150000 pregnancies
Severe PIH contributes to 20-40% of maternal
deaths & 20% of perinatal deaths
4. Defined as a systolic BP >140 mm Hg or
diastolic BP >90 mm Hg
OR
a constant increase in systolic or diastolic BP
by 30 mmHg & 15 mm Hg respectively above
patient’s baseline
5. Classic Triad of Preeclampsia - Hypertension
Proteinuria, Edema
Defined as hypertension occuring after 20
wks gestation or in early postpartum period
& returned to normal within 3 months after
delivery
OR
Onset after 20wks gestation & atleast one of
the following
6. Proteinuria >300 mg/24 hr
Oliguria /serum plasma creatinine ratio >0.09mmol/L
Headaches with hyperreflexia,eclampsia,clonus,or visual
disturbances
Increased liver enzymes , plasma glutathione S-transferase –
alpha 1-1, or serum alanine aminotransferase or right
quadrant pain
Thrombocytopenia,increased LDH, haemolysis, DIC
Intrauterine growth retardation
7. SBP > 160 mm Hg
DBP > 110 mm Hg
Proteinuria > 5 g/24° or
3-4+ on dipstick
Oliguria < 500 cc/24°
↑ serum creatinine
Pulmonary edema or
cyanosis
CNS symptoms (HA,
vision changes)
Abdominal (RUQ) pain
Any feature of HELLP
hemolysis
↑ liver enzymes
thrombocytopenia
IUGR or oligohydramnios
8.
9. Nulliparity(Elderly & young primigravida)
Chronic renal disease(Nephritis)
Angiotensin gene T235
Chronic hypertension
Antiphospholipid antibody syndrome
Multiple gestation
Family or personal history of preeclampsia
Age > 40 years
African-American race
Diabetes mellitus
10. DISEASE OF THEORIES
Etiology is unknown.
Many theories:
Abnormal Placentation
Endothelial cell dysfunction
Imbalance b/w TXA2 & PGI2
dietary deficiency (calcium, magnesium, zinc)
▪ supplementation has not proven effective
11. A major underlying defect is a relative deficiency
of prostacyclin vs. thromboxane
Normally (non-preeclamptic) there is an 8-10 fold
↑ in prostacyclin with a smaller ↑ in thromboxane
prostacyclin salutatory effects dominate
▪ vasodilation, ↓ platelet aggregation, ↓ uterine tone
In preeclampsia, thromboxane’s effects dominate
↑ thromboxane (from platelets, placenta)
↓ prostacyclin (from endothelium, placenta)
12. Aspirin has been extensively studied as a targeted
therapy to ↓ thromboxane production
CLASP study, 1994, multicenter, randomized
CLASP Collaborative Group, Lancet 1994;343:619-29
9364 women, risk factors for PIH or IUGR or who had PIH
or IUGR
60 mg ASA daily vs. placebo
Small reduction (12%) in occurrence of PIH
Small reduction in preterm deliveries: 20 vs 22%
No difference in neonatal outcome
13. NIH study of high-risk patients, randomized, 60 mg
aspirin daily vs. placebo
Caritis, et al., N Engl J Med 1998;338:701-5
pre-gestational DM (471 patients)
chronic hypertension (774 patients)
multifetal gestations (688 patients)
prior history of preeclampsia (606 patients)
No reduction in development of preeclampsia in any
subgroup or groups in aggregate
No difference in perinatal death, preterm delivery,
IUGR, maternal or fetal hemorrhagic complications
14. At this time the most widely accepted proposed
mechanism for preeclampsia is:
▪ global endothelial cell dysfunction
Redman: endothelial cell dysfunction is just one
manifestation of a broader intravascular
inflammatory response
Redman, et al., Am J Obstet Gynecol 1999;180:499-506
present in normal pregnancy
excessive in preeclampsia
Proposed source of inflammatory stimulus: placenta
15. In severe preeclampsia, typically hyperdynamic
with normal-high CO, normal-mod. high SVR,
and normal PCWP and CVP.
Despite normal filling pressures, intravascular
fluid volume is reduced (30-40% in severe PIH)
Variations in presentation depending on prior
treatment and severity and duration of disease
Total body water is increased (generalized
edema)
16. Preeclamptic patients are prone to develop
pulmonary edema due to reduced colloid oncotic
pressure (COP), which falls further postpartum:
Colloid oncotic pressure:
Antepartum
Postpartum
Normal pregnancy: 22 mm Hg 17 mm Hg
Preeclampsia: 18 mm Hg 14 mm Hg
17. Respiratory:
Airway is edematous; use smaller ET tube (6.5)
↑ risk of pulmonary edema; 70% postpartum
Renal:
Renal blood flow & GFR are decreased
Renal failure due to ↓ plasma volume or renal artery
vasospasm
Proteinuria due to glomerulopathy
▪ glomerular capillary endothelial swelling w/subendothelial
protein deposits
Renal function recovers quickly postpartum
18. RUQ pain is a serious complaint
warrants imaging, especially when accompanied
by ↑ liver enzymes
caused by liver swelling, periportal hemorrhage,
subcapsular hematoma, hepatic rupture (30%
mortality)
HELLP syndrome occurs in ~ 20% of severe
preeclamptics.
19. Coagulation:
Generally hypercoagulable with evidence of platelet
activation and increased fibrinolysis
Thrombocytopenia is common, but fewer than 10%
have platelet count < 100,000
DIC may occur, esp. with placental abruption
Neurologic:
Symptoms: headache, visual changes, seizures
Hyperreflexia is usually present
Eclamptic seizures may occur even w/out ↑↑BP
▪ Possible causes: hypertensive encephalopathy, cerebral
edema, thrombosis, hemorrhage, vasospasm
20. Hemolysis – abnormal peripheral smear
Increased bilirubin level
Elevated liver enzymes- SGOT>70U/L
LDH>600U/L
Low platelet count<100000/mm3
Clinical features –Malaise(90%) , Epigastric pain(90%),
Nausea & vomitting(50%), Flu like syndrome
Usually before 36 weeks
70% antepartum & 30% postpartum
Rapidly progress to DIC
Associated with high maternal & fetal mortality
21. LIKE A FLASH OF LIGHTENING
Preeclampsia complicated by convulsion /coma
Most common in primi & multiple pregnancy
Cause of convulsion
Hypertensive encephalopathy
Vasospasm- ischemia
Infarction
Haemorrhage
Oedema
23. Differential Diagnosis
Epilepsy,ICSOL,Meningitis,Hysteria
Management
MgSO4 is the DOC for seizure control & prevention of recurrent
eclamptic seizures
Reduces seizures by >50%
4g MgSO4 iv over 10 min followed by a maintanence infusion of 1g/hr
Mg also causes vasodilataion & increase in CO by reducing SVR
Narrow Therapeutic Index ,with serum Mg level b/w 2 & 3.5 mmol/L .
Therapeutic level 4-6 mEq/L
If toxicity present 10 ml 10 % Ca gluconate given slow iv
27. Classically “stabilize and deliver”
Medical management while awaiting delivery:
use of steroids X 48 hours if fetus < 34 wks
antihypertensives to maintain DBP < 105-110
magnesium sulfate for seizure prophylaxis
monitor fluid balance, I/O, daily weights, symptoms, reflexes,
HCT, plts, LFT’s, proteinuria
Indications for expedited delivery:
fetal distress
↑ BP despite aggressive Rx
worsening end-organ function
development or worsening of HELLP syndrome
development of eclampsia
28. Most commonly, for acute control:
1.)Hydralazine
Arterial dilator, dose 5-10mg iv ,slow onset 20-30mtsDOA: 2-3 hrs
2) Labetolol
10-20mg iv, Improves placental blood flow ,Rapid onset of action 1-2mts
DOA-2-3hrs
CI- Bronchial asthma,CCF
Most common for chronic control:
Alpha methyl dopa.
Central alpha 2 agonist
Dose – 250 mg bd
DOC for chronic treatment
29. Nifedipine may be used, but unexpected hypotension may
occur when given with MgSO4
For refractory hypertension: nitroglycerin or nitroprusside may
be used
Nitroprusside dose and duration should be limited to avoid
fetal cyanide toxicity
Usually require invasive arterial pressure monitoring
Angiotensin-converting enzyme (ACE) inhibitors
contraindicated due to severe adverse fetal effects
30. Evidence is strong that magnesium sulfate is
indicated for
seizure treatment in eclamptics
seizure prophylaxis in severe preeclamptics
Role of magnesium prophylaxis in mild
preeclamptics is less clear
awaits large, prospective, randomized, placebo-
controlled trial
31. Magnesium sulfate has many effects; its
mechanism in seizure control is not clear.
NMDA (N-methyl-D-aspartate) antagonist
vasodilator
▪ Brain parenchymal vasodilation demonstrated in
preeclamptics by Doppler ultrasonography
increases release of prostacyclin
Potential adverse effects:
toxicity from overdose (respiratory, cardiac)
↑ bleeding
↑ hypotension with hemorrhage
↓ uterine contractility
32. Renally excreted
Preeclamptics prone to renal failure
Magnesium levels must be monitored frequently
either clinically (patellar reflexes) or by checking
serum levels q 6-8 hours
▪ Therapeutic level: 4-7 meq/L
▪ Patellar reflexes lost: 8-10 meq/L
▪ Respiratory depression: 10-15 meq/L
▪ Respiratory paralysis: 12-15 meq/L
▪ Cardiac arrest: 25-30 meq/L
Treatment of magnesium toxicity:
stop MgSO4, IV calcium, manage airway
33. Seizures are usually short-lived.
If necessary, small doses of barbiturate or
benzodiazepine (STP, 50 mg, or midazolam, 1-2
mg) and supplemental oxygen by mask.
If seizure persists or patient is not breathing, rapid
sequence induction with cricoid pressure and
intubation should be performed.
Patient may be extubated once she is completely
awake, recovered from neuromuscular blockade,
and magnesium sulfate has been administered.
35. To establish & maintain hemodynamic
stability (control hypertension & avoid
hypotension)
To provide excellent labor analgesia
To prevent complications of preeclampsia
To be able to rapidly provide anesthesia for
C/S
To avoid drug induced depression
36. Newer studies shows that degree of hypotension in spinal & epidural
block is same in PIH pt
So we can use either spinal / epidural
Graded epidural in a preeclampsia patient
5ml (0.5% bupivacaine)loading dose to attain T10 level
Then 5 ml increment at 5 mt interval to attain T4 level
Fentanyl(50-100mcg) can be added to increase speed of onset , duration
quality
Advantages of epidural
Gradual onset of sympathetic blockade
Cardiovascular stability
Avoids neonatal depression
37. Hood, et al., Anesthesiology 1999;90:1276-82
Retrospective study
Lowest intraoperative blood pressures not different
Total ephedrine use was small & not different
Spinal group received 400 cc more IV fluid
No pulmonary edema attributable to intraop fluid
Maternal & infant outcomes were similar
38. Prior to placing regional block in a preeclamptic it
is recommended to check the platelet count.
No concrete evidence at to the lowest safe platelet
count for regional anesthesia in preeclampsia
Any clinical evidence of DIC would contraindicate
regional
In the absence of such signs, most
anesthesiologists would proceed at plt count
>100000, many would proceed at 80000-100000,
<80000 some would proceed (esp. spinal)
39. When placing a regional block in a patient with a
platelet count < 100000, the most important thing
is to monitor resolution of block closely
Bleeding time has been discredited as an indicator
of epidural bleeding risk and is not indicated.
Channing-Rogers, Semin Thromb Hemost 1990;16:;1-30
Low-dose aspirin is not a contraindication to
regional anesthesia in preeclampsia
CLASP study: 1422 women on aspirin received epidurals
without any bleeding complications
40. Epidural anesthesia would probably be preferred
by many anesthesiologists in a severely
preeclamptic pt in a non-urgent setting
For urgent cases it is reassuring to know that
spinal is also safe
This allows us to avoid general anesthesia with
the potential for encountering a swollen, difficult
airway and/or labile hypertension
41. General anesthesia is a well-known hazard in
obstetric anesthesia:
16X more likely to result in anesthetic-related
maternal mortality
Mostly due to airway/respiratory complications,
which would only be exaggerated in preeclampsia
Hawkins, Anesthesiology 1997;86:273
42. Airway edema is common
Mandatory to reexamine the airway soon before
induction
Edema may appear or worsen at any time during the
course of disease
▪ tongue & facial, as well as laryngeal
Laryngoscopy and intubation may → severe ↑BP
Labetolol & NTG are commonly used acutely
Fentanyl (2.5 mcg/kg), alfentanil (10 mcg/kg), lidocaine
may be given to blunt response
43. Magnesium sulfate potentiates depolarizing
& non-depolarizing muscle relaxants
Pre-curarization is not indicated.
Initial dose of succinylcholine is not reduced.
Neuromuscular blockade should be monitored &
reversal confirmed.
44. Usually reserved for patients with
complications
oliguria unresponsive to modest fluid challenge (500
cc LR X 2)
pulmonary edema
refractory hypertension
▪ may have increased CO or increased SVR
Poor correlation between CVP and PCWP in PIH
However, at most centers anesthesiologists would
begin with CVP & follow trend
▪ not arbitrarily hydrate to a certain number
45. Preeclampsia is a serious multi-organ system
disorder of pregnancy that continues to defy our
complete understanding.
It is characterized by global endothelial cell
dysfunction.
The cause remains unknown.
There is no effective prophylaxis.
46. Delivery is the only effective cure.
Magnesium sulfate is now proven as the best
medication to prevent and treat eclampsia.
Epidural analgesia for labor pain
management & regional anesthesia for C/S
have many beneficial effects & are preferred.