Eclampsia

- Eclampsia is the final and most severe phase of preeclampsia and occurs when preeclampsia is left
untreated. In addition to the previously mentioned symptoms, women with eclampsia often have seizures.
Eclampsia can cause coma and even death of the mother and baby and can occur before, during or after
childbirth.
- an acute and life-threatening complication of pregnancy, is characterized by the appearance
of tonic-clonic seizures, usually in a patient who had developed pre-eclampsia.

Preeclampsia

o Also referred to as toxemia, preeclampsia is a condition that pregnant women can get. It is marked
by high blood pressure accompanied with a high level of protein in the urine. Women with
preeclampsia will often also have swelling in the feet, legs and hands. Preeclampsia, when present,
usually appears during the second half of pregnancy, generally in the latter part of the second or in
the third trimesters, although it can occur earlier.
o is a medical condition in which hypertension arises in pregnancy (pregnancy-induced
hypertension) in association with significant amounts of protein in the urine. Pre-
eclampsia refers to a set of symptoms rather than any causative factor, and there are
many different causes for the condition.

Edema, Seizures, and Proteinuria

The normal increase in blood plasma volume and decrease in peripheral vascular
resistance that occur during an uncomplicated pregnancy are absent. The patient's blood vessels
allow fluid to leak from the vessels into the surrounding tissue, which results in edema. The
seizures that characterize eclampsia result from edema of the brain. The patient's kidneys are
under stress because of diminished blood flow through the kidneys and decreased filtration. This
process allows protein molecules to spill over into the urine. Damage to the kidneys lowers
urine output and increases the levels of sodium in body tissues. Higher concentrations of sodium
result in increased fluid retention. Protein lost through the urine also affects the movement of fluid
into the tissues, further increasing fluid retention.

Signs and symptoms

- The hallmark of eclampsia is seizures. The most common symptom and hallmark of preeclampsia
is high blood pressure. This may be the first or only symptom. Blood pressure may be only
minimally elevated initially or can be dangerously high; symptoms may or may not be present.
- With the advancement of the pathophysiological process, other organ symptoms may be present
including abdominal pain, liver failure, signs of the HELLP syndrome, pulmonary edema,
and oliguria.

o HELLP Syndrome
H  - Hemolysis (break down of Reb blood cells)
EL - Elevated Liver enzymes
LP - Low platelets

Hemolysis -The hemolysis in HELLP syndrome is microangiopathic hemolytic anemia. The narrowing or
obstruction of small blood vessels results in distortion and fragmentation of erythrocytes, hemolysis, and
anemia. The red blood cells become odd shaped, known as traumatic hemolytic anemia. These red blood cells are
seen in the peripheral blood when they are exposed to a large amount of turbulence.

Liver enzymes - increase in Bilirubin and lactic dehydrogenase levels (typical range is 105 - 333 IU/L).
Measurement Significance Reference range (Normal Values)
Albumin -  is a protein made specifically by the liver. It is the main constituent of
total protein. Albumin is not considered to be an especially useful marker of liver 3.9 to 5.0 g/dL
synthetic function; coagulation factors (see below) are much more sensitive
Alanine transaminase (ALT) - also called Serum Glutamic 9 to 60 IU/L
Pyruvate Transaminase (SGPT) or Alanine aminotransferase (ALAT) . When a cell is
damaged, it leaks this enzyme into the blood, where it is measured. ALT rises
dramatically in acute liver damage.
22.0| Aspartate transaminase (AST) - also called Serum Glutamic Oxaloacetic
Transaminase (SGOT) or aspartate aminotransferase (ASAT). It is raised in acute
liver damage, but is also present in red blood cells, and cardiac and skeletal muscle
10 to 40 IU/L
and is therefore not specific to the liver. The ratio of AST to ALTis sometimes useful
in differentiating between causes of liver damage. Elevated AST levels are not
specific for liver damage, and AST has also been used as a cardiac marker.
113.2| Alkaline phosphatase (ALP) - is an enzyme in the cells lining the biliary
30 to 120 IU/L
ducts of the liver. ALP is also present in bone and placental tissue.
0.3| Bilirubin is a breakdown product of heme (a part of haemoglobin in red blood
cells). The liver is responsible for clearing the blood of bilirubin. It does this by the
following mechanism: bilirubin is taken up into hepatocytes, conjugated (modified 0.2–1.2 mg/dL
to make it water-soluble), and secreted into the bile, which is excreted into the
intestine.
Gamma glutamyl transpeptidase (GGT) - Although reasonably specific to the liver
and a more sensitive marker for cholestatic damage than ALP, Gamma glutamyl
transpeptidase (GGT) may be elevated with even minor, sub-clinical levels of liver 0 to 51 IU/L
dysfunction. It can also be helpful in identifying the cause of an isolated elevation
in ALP. (GGT is raised in chronic alcohol toxicity).

Low Platelets - HELLP appears to be the last indicator of some attack that leads to microvascular endothelial
impairment and “intravascular platelet activation. With the activation of the platelets, serotonin and thromboxane A
are released, thus resulting in platelet agglutination and aggregation and then continued damage of the epithelium.
With marked endothelial disruption, enough platelets will be consumed resulting to thrombocytopenia.

MEDICATIONS:

Magnesium sulfate is the treatment of choice once eclampsia develops. This treatment decreases the
chances of having recurrent seizures. Magnesium treatment is continued for a total of 24-48 hours after
your last seizure.

Phenytoin – Dilantin, is an anticonvulsant, a drug that acts to prevent seizures.

Diazepam - is a benzodiazepine. It is used to treat anxiety and nervousness. It also can help treat alcohol
withdrawal, relax muscles, and treat certain types of seizures.

Hydralazine - is a type of vasodilator. It relaxes blood vessels, increasing the blood and oxygen supply to
your heart. This medicine is used to treat high blood pressure.
- Peripheral vasodilator.Maintains or increases renal and cerebral blood flow.

Calcium channel blockers  - block the entry of calcium into muscle cells in artery walls.
Nifedipine and Amlodipine - is a calcium-channel blocker. It affects the amount of calcium found in your
heart and muscle cells. This relaxes your blood vessels, which can reduce the amount of work the heart
has to do.

***Calcium controls the contraction of the heart as it is pumping blood through the body.
Magnesium controls the relaxing of the heart, when no blood is being pumped out
Carvedilol -  is both a beta blocker (β1, β2) and alpha blocker (α1). It the workload on the heart and help it
to beat more regularly. This medicine is used to treat high blood pressure.
 - Norepinephrine stimulates the nerves that control the muscles of the heart by binding to the β 1-
and β2-adrenergic receptors. Carvedilol blocks the binding to those receptors, which both slows
the heart rhythm and reduces the force of the heart's pumping. This lowers blood pressure and
reduces heart failure.
- Norepinephrine also binds to the α1-adrenergic receptors on blood vessels, causing them to
constrict and raise blood pressure. Carvedilol blocks this binding to the α 1-adrenergic receptors
too, which also lowers blood pressure.

captopril - ACE inhibitors inhibit the activity of Angiotensin-converting enzyme (ACE), an enzyme

responsible for the conversion of angiotensin I into angiotensin II, a potent vasoconstrictor.

losartan and telmisartan - Angiotensin II receptor antagonists. They block the activation of angiotensin
II receptors. Blockade of AT1 receptors directly causes vasodilation, reduces secretion of vasopressin,
reduces production and secretion of aldosterone, amongst other actions – the combined effect of which is
reduction of blood pressure.

Methyldopa (Aldomet) -  is a psychoactive drug used as a sympatholytic or antihypertensive. Its use is

now deprecated following introduction of alternative safer classes of agents. However, it continues to
have a role in otherwise difficult to treat hypertension and gestational hypertension (also known
as pregnancy-induced hypertension (PIH)
- It is a competitive inhibitor of the enzyme DOPA decarboxylase, also known as aromatic L-amino
acid decarboxylase, which converts L-DOPA into dopamine. Dopamine is a precursor
for norepinephrine (noradrenaline) and subsequently epinephrine (adrenaline). This inhibition
results in reduced dopaminergic and adrenergicneurotransmission in the peripheral nervous
system. This effect may lower blood pressure and cause central nervous system effects such
as depression, anxiety,apathy, anhedonia, and parkinsonism.
- It is converted to α-methylnorepinephrine by dopamine beta-hydroxylase (DBH). α-
methylnorepinephrine is an agonist of presynaptic central nervous system α2-
adrenergic receptors. Activation of these receptors in the brainstem appears to
inhibit sympathetic nervous system output and lower blood pressure.

Furosemide (Lasix)- to stimulate urine output. Furosemide inhibits primarily the reabsorption of sodium
and chloride not only in the proximal and distal tubules but also in the loop of Henle.
- Pulmonary Edema 
o Fluid restriction is advisable in patients with preeclampsia to reduce the risk of fluid
overload in the intrapartum and postpartum periods. In usual circumstances, total fluids
should be limited to 80 ml/hour or 1 ml/kg/hour

Duvadilan - A beta-adrenergic agonist that causes direct relaxation of uterine and vascular smooth
muscle. Its vasodilating actions are greater on the arteries supplying skeletal muscle than on those
supplying skin. It is used in the treatment of peripheral vascular disease and in premature labor.

Dexamethasone - The antenatal administration of dexamethasone (Decadron) in a high dosage of 10 mg

intravenously every 12 hours has been shown to markedly improve the laboratory abnormalities
associated with HELLP syndrome
- Steroids given antenatally do not prevent the typical worsening of laboratory abnormalities after
delivery. However, laboratory abnormalities resolve more quickly in patients who continue to
receive steroids postpartum.

Oxytocin - induce labor or increase the strength or duration of contractions for the health of mother or
baby.
Metronidazole - is an antianaerobic drug. It inhibits Bacteroides fragilis, Clostridium, Anaerobic,
Fusobacterium and Eubacterium. It is mainly used in the treatment of septicemia, bacteremia,
peritonitis, phlegmon, braia abscess, pelvic abscess and postoperation infections.

Cefuroxime - For the treatment of many different types of bacterial infections such as bronchitis,
sinusitis, tonsillitis, ear infections, skin infections, gonorrhea, and urinary tract infections.

Bisacodyl - is a stimulant laxative drug

Fibrosine  - Dietary fiber from corn starch

Prenatal MV - Multivitamin - Formulated to meet the nutrient needs of active women before or during
pregnancy.