PIH and HELLP • In addition to the changes in pregnancy A→ ↑ airway edema, difficult intubation→ difficult A/W cart in the room

B→ pul edema, more after delivery C→ CHF, ↑ BP, ↓ volume, ↓ oncotic pressure D→ Mg, other meds, could be on ASA M→ ↑ Mg, ↓ albumin Heme→ anemia, hemolysis, thrombocytopenia , ↓ fibrinogen CNS→ ↓ LOC, headache, blurred vision, seizure, bleeding , edema Renal→ ↓ GFR, oliguria, ARF GI/Hepatic → RUQ pain, liver rupture • Rx→ start Mg bolus 4g then infusion @ 1-3 g/h, consider other anti-HTN meds e.g. labetolol, SNP, NTG, hydralazine, (ACEI are C/I due to fetal effect) • Monitor Mg level avoid Mg toxicity, consider early epidural → help ↓ BP, improve UP blood flow (if PLT are OK) • Monitors: art line, fetal monitoring, CVP/PAC • Before giving any fluid bolus look for evidence of CHF • Lab: CBC-D, Lytes, BUN, Creat, Mg, PT, PTT, fibrinogen, LFT, BT

Mg level( 2.4mg/dl=2mEq/l= 1 mmol/L) in textbooks they use the first unit so have to convert, therapeutic 5-9 mg/dl, with loss of reflex 12mg/dl, resp arrest 15-20, Asystole 25, so convert, we use the last one so therapeutic 2-3.5, loss reflex 5, resp 6-8, arrest 10 • Mx of toxicity D/C Mg infusion, ABC, give CaCl 1g • Indication for immediate delivery: 1- severe persistent HTN 24-48h, ↑ thrombocytopenia, liver dysfunction, progressive renal dysfunction including oliguria, signs of eclampsia, evidence of fetal jeopardy • Other complications of PIH→ placenta abruption → DIC, fetal distress, IUGR • Consider ppost-op ICU for at least 24h, with continue Mg infusion Pre-eclampsia is classified as severe if it is associated with any of the following: 1. Systolic blood pressure of 160 mm Hg on bed rest, two occasion, 6hrs apart 2. Diastolic blood pressure of 110 mm Hg same 3. Proteinuria of 5 g·24 h, or > 3+ in 2 random urine samples 4hrs apart 4. Oliguria (400 ml·24 h–1) 5. Cerebral or visual disturbances 6. Pulmonary edema or cyanosis 7. Epigastric pain, or hepatic rupture 8. Intrauterine growth retardation

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