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MANAGEMENT OF ECLAMPSIA

Dr Susanta Kumar Behera Senior Resident Department of Obstetrics & Gynecology MKCG Medical College Brahmapur,ODISHA,INDIA
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Eclampsia is pre eclampsia convulsion and or coma


Or

with

Development of Convulsions and/or unexplained coma during pregnancy or postpartum in patients with signs and symptoms of preeclampsia
What is the most common EPILEPSY causePRE ofEXISTING seizure during Pregnancy ?
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Incidence : o 1:500 to 1: 30 & Common in Primigravida (75%) than multigravida (25%) o In 80% cases it is proceeded by severe preeclampsia o Commonly occurs between 36th week to term Types a) Antepartum -50% b) Intrapartum-30% c) Postpartum-20%(Early & Late) d) Intercurrent-Rare
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ABNORMAL TROPHOBLASTIC INVASION

CAUSES OF CONVULSION Cerebral anoxia : spasm of cerebral vessel due to hypertension-increase cerebrovascular resistancedecrease oxygen consumption-convulsion Cerebral edema irritation Cerebral dysarhythmia : increases following edema & anoxia Stages of convulsion a) Premonitory : 30 Sec twitching of muscle rolling of eye ball & fixing.
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b) Tonic (30 sec) :


Tonic spasm of body

c) Clonic (1-4 min) :

Alternate contraction & relaxation of muscle Ceasing of respiration Congested face & Cyanosed Protruding of tongue Conjunctival Congestion Twitching starting from face Fixing of Eye ball & spreading tongue biting Cyanosis Stertourous breathing with froths Involuntary passage of stool & urine

d) Coma :
-Persits for variable period & at times patient confused -Deep coma may occurs (cerebral hemorrhage). 7 -Labor usually starts shortly after the fit.

SYMPTOMS
Headache Oedema Visual disturbance Focal neurology, fits, anxiety, amnesia Abdominal Pain Decreased urine output None

SIGNS
Hypertension Tachycardia and tachypnoea Creps or wheeze Neurological deficit Hyperreflexia Petechiae, ICH Generalised oedema Small uterus for dates
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D/D
WITH CONVULSIONS WITH COMA

Epilepsy.

Hypoglycemic . Hyperglycemic coma Uremic coma.

Hysteria.
Meningitis and Encephalitis. Tetanus. Strychnine poisoning.

Hepatic coma.
Alcoholic coma. Cerebral coma.

Brain tumors.
Uremic convulsions
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INVESTIGATION
Hb% DC, TLC, TPC, BT/CT Urinalysis R & M Urinary Protein LFT RFT Serum Uric acid FBS Ophthalmoscopy BPP Obstetric Scan CT Brain & Abdomen CTG Coagulation Profile USG of Abdomen & Pelvis Color Doppler MRI Electrolytes ECG
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MANAGEMENT General 1) Maintenance of airway 2) Oxygen administration 3) Fluid Management 4) Organization of investigation Control of Convulsions Control of BP Obstetric Management Complication Management Postpartum Care Prevention
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THE OBSTETRIC ICU PATIENT


INTENSIVE CARE UNIT

DELIVERY ROOM

HDCU

POST ANESTHESIA OPERATING ROOM CARE UNIT

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GENERAL
Transfer of patient to hospital

Place the patient in a railed cot in isolated room.


Detailed history taking

Vital stabilizing(Control of BP)


Continuous drainage facility Monitoring vitals & Urine Output Antibiotics & H2 blockers
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Patent airway with tracheal and bronchial suction. Nasogastric tube may be inserted . IV glucose 25% as a Liver support, increases UO & improves hemoconcentration. Nursing Care a) Mouth gag in between teeth b) Clearing of air passage c) Raising foot end of bed
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HDCU

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FLUID THERAPY
IATROGENIC FLUID OVERLOAD IS THE MAIN CAUSE OF MATERNAL DEATH IN ECLAMPSIA

Depends upon a careful balance between restriction with possible exacerbation of end organ hypoperfusion and renal dysfunction and volume overload with pulmonary edema

PRINCIPLES :
Accurate Recording of Fluid Balance a) Delivery & Postpartum Loss b) Input/Output Deficit
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Maintenance Crystalloid infusion :


1) 2) 3) 4) Crystalloids is the choice of fluid-RL Total daily infusion=UO+1000 ml Fluid load : 80ml/hr or UO in Preceding hr+30 ml No excess use of Crystalloids/Dextrose

Selective Colloid expansion No unnecessary fluid overload before regional anesthesia - Severe refractory HTN - Pulmonary Edema - Oliguria unresponsive to fluid therapy
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Diuretics: Only in presence of PE/CCF Pulse Oximetry Selective monitoring of CVP if blood loss is excessive Intraarterial pressure monitoring indicated
- Unstable eclamptic women - BP is very high - Obese women when noninvasive measurement are unreliable - Hemorrhage > 1000ml - Severe Cardiac Disease
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POSTPARTUM Urine output recorded hrly & each four hr block summated Each FOUR hr block should be > 80 ml If two consecutive four hour block fails to achieve 80 ml
Total Input > 750 ml in excess of U/O in last 24 hr 20 mg IV Frusemide Colloid if diuresis > 200 ml in next hr Total Input < 750 ml in excess of U/O in last 24 hr 250 ml Colloid over 20 min U/O < 200 ml 20 mg IV Frusemide U/O >200 ml Baseline Fluid + 250 ml Gelofusine 19

ANTICONVULSANTS
Magnesium Sulphate(1924) Continuous IV 1) Continuous IV Regimen Regimen 2) Pitchard Regimen 4-6 gm loading dose 3) Sibai Regimen of Mg So4 in 100 ml of 4) Zuspan Regimen fluid IV slowly over Diazepam 15-20 min Phenytoin Lytic Cocktail Regimen 1-2gm/hr in 100 ml of a) Chlorpromazine IV maintenance b) Promethazine infusion c) Pethidine
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PITCHARD REGIMEN Route : IM 4gm of 25% MgSO4 IV slowly over 5-10 min followed by 5 gm 50% MgSO4 IM into each buttock. 5 gm 50% MgSO4 IM 4hrly to alternate buttock.
MOA 1) motor end plate sensitivity to Ach & reduces neuromuscular irritability 2) Blocking neuronal uptake of Calcium 3) Inhibits platelet aggregation. 4) Increase PGI2 synthesis.
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SIBAI REGIMEN(1990) 6 gm MgSo4 over 20 min followed by 2 gm MgSO4 IV infusion ZUSPAN REGIMEN(1978) 4 gm MgSo4 over 5-10 min followed by 1gm/hr MgSO4 IV infusion DIAZEPAM
10-40 mg IV slowly followed by 40 mg in 500 ml of 5%D at the rate of 30 drops/min
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MAGNESIUM SULFATE
Lazard in 1924,intern in California started mgso4. Given IV 20-25% (most commonly) or IM (50%) or SC(15%) 6 gram load followed by 2 grams per hour Total dose should not >24 gm/24hr Supra therapeutic levels lead to CNS depression, cardiac arrhythmias,

Monitoring :
Patellar reflex. RR >16/min. U/O >100ml/4hrs. Serum Mg++ level.
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MAGNESIUM TOXICITY
Clinical Manifestation Serum Level Physiologic 1.3-2.1 mEq/L Peripheral Vasodilatation/Flushing 3-5 mEq/L /Sense of warmth/Vomiting Therapeutic 4-7 mEq/L Depression of deep reflex 7-8 mEq/L Antidote 10 ml of 10%Reflex Calcium Arrest of Deep 8-10 mEq/L Gluconate slow IV 10-12 mEq/L Respiratory Depression Respiratory Arrest 12-15 mEq/L Arrhythmia/Heart Block/Bradycardia 15-20 mEq/L Cardiac Arrest 2424242424 24

LYTIC COCKTAIL REGIMEN

Menon in India has started this regimen-1961 25 mg Chlorpromazine & 100 mg Pethidine in 20 ml of 5%D IV + 50 mg Chlorpromazine & 25 mg Promethazine IM 50 mg Chlorpromazine & 25 mg Promethazine IM alternatively 4 hrly X 24 hr IV drip 10%D with 100 mg Pethidine at rate of 20-30 drop/min X 24 hr following last fit.
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PHENYTOIN 10 mg/kg slow IV followed by 5 mg/kg after 2 hr


200 mg given orally after 12 hrs X 48 hrs following delivery Side effects : hypotension/cardiac arrhythmia /phlebitis ECG monitoring required
MOD. STROGANOFF METHOD

MgSO4 6gm IV initially then 4 gm/4hours IM + 20mg Morphine IM.


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STATUS ECLAMPTICUS Consult anaesthetist Nasophayngeal Suction Intubation , IPPV & Muscle relaxation Medications a) Inj Thiopentone Sodium 0.5 mg in 20 ml of 5D IV slowly b) Inj Diazepam 10 mg Slowly IV followed by 10 mg in 5D as IV drip General Anesthesia(PPV + Muscle Relaxants) Evaluation of Intracranial Abnormalities

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Investigations : CT/EEG/Cerebral Doppler Velocimetry/MRI/Cerebral Angiography

Cerebral imaging indicated in


1) Patients with Focal Deficits/Prolonged Coma

2) Atypical presentations of Eclampsia


- Onset before 20 weeks - > 48 hrs following delivery - Refractory to Magnesium Sulphate therapy
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ANTIHYPERTENSIVES
Indicated if BP > 160/110 mm of Hg in spite of Anticonvulsants & Sedatives Common drugs 1) IV Labetalol 2) Oral Nifedipine

3) IV Hydralazine
4) Diuretics in Edema/CCF presence of Pulmonary

If C/I of MgSO4 : Phenytoin: 15 mg/kg at 40 mg/min with monitoring of Cardiac function and BP x 5 min Therapeutic Range : 10-20 g/ml. 29

COMMON AGENTS
Agent Labetalol Nifedipine M-Dopa Hydralazi ne Sod. Nitr. MOA -Blocker CCB Direct PAV Direct PAV Direct PAV Side Effects Fatigue, Bradycardia, Swelling of Feet, Depression Headache, Hypotension, Palpitation, Constipation Flushing, Hypotension Headache, Dry Mouth Flushing, Headache, Diarrhea, Constipation Metabolite (Cyanide) 30

Agent Hydralazine

Dose Oral : 25 mg 8 hrly IV : 5-10 mg & repeat after every 10-20 min Oral : 100 mg 12 hrly IV : 20 mg & repeat 4080 mg every 10 min Oral :10 mg 6-8 hrly Oral : 250 mg 8 hrly IV : 5 mcg/kg/min

Max Dose

Oral : 300 mg IV : 20 mg Oral : 2400 mg IV : 300 mg


120 mg 2 gm 10 mcg/kg/min
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Labetalol Nifedipine Methyldopa Sodium Nitr.

Eclampsia
Anticonvulsants/Antihypertensives+/-Diuretics

Not in Labor Fits controlled Fits not controlled

Labor

ARM

LSCS

Ventouse Forcep

Obstetric Indication

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FITS NOT CONTROLLED

6-8 hrs

Termination
ASSESS INDUCTION SCORE

Favourable ARM OXYTOCIN MISOPROSTOL


INDUCTION

Unfavourable

LSCS
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FITS CONTROLLED BABY

ALIVE

DEAD

TERMINATION

SPONTANEOUS EXPULION

INDUCTION

LSCS
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PGE2 GEL/ARM/OXYTOCIN/MISOPROSTOL

INDICATION OF LSCS

Uncontrolled fits in Spite of therapy Unconscious patient and prospect of vaginal delivery Obstetric indication a) Preterm (< 34 Week) b) IUGR c) Non reassuring FHR d) Oligohydramnios e) Malpresentations f) Suspected AP
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CARE DURING DELIVERY


Care full monitoring of maternal & fetal status

Delivery : Well Planned, done on the best Day, performed in the best Place, by best Route and with best Support team H2 antagonists & Antibiotics
Vaginal delivery Preferred if not indicated otherwise Local infiltration of anesthesia for all VD
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No prophylactic MethylEgrometrine/Symtometrine Cut Short of Second stage of labour Prophylactic Rectal Misoprostol Managing 3rd Stage : 5-10 units of IV Syntocinon / Inj Prostaglandin Vigilant about PPH & Prompt Management Prophylaxis against thromboembolism
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POSTPARTUM CARE
Continuing MgSo4 following 24 hr of delivery/last Seizure. Regular Monitoring of BP 4 hrly MONITORING OF VITAL X 48 HRS Antihypertensive till BP < 150/100 mm of Hg Discharged on 4th Puerperal day Regular intake of Iron & Calcium
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CHOICE OF ANESTHESIA
Local Anesthesia Pudendal Block Regional Anesthesia : Spinal Or Epidural
a) Preferred for LSCS/Labor b) Decreased Maternal Morbidity & Mortality c) Epidural preferred over spinal due to provocation of excessive hypotension

-Superior pain relief


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-Epidural Promotes Utero-Placental Blood Flow -Extended to Provide Regional Anesthesia for ID/CS

General Anesthesia Indicated a) Coagulopathy / Pulmonary Edema / Impaired Consciousness b) Failed Spinal /Epidural block c) Inadequate time to perform/extend a block Difficulty intubation due to laryngeal edema
Risk of ICH & Aspiration Pneumonia
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COMPLICATIONS

Maternal :
CVS(4%) : Cardiac failure, Hypertension Renal (4%): Oliguria/ARF/ ATN/ Cortical Necrosis Respiratory(5%) : ARDS(7%), Pulmonary Edema Hepatic : HELLP Syndrome(20%) & Subcapsular Hematoma/DIC Cerebral(7%): Encephalopathy, Infarction, Hemorrhage, Edema Eye (10%): Cortical Blindness, Retinal Detachment, Edema, Reproductive : AP(10%) or PPH

Fetal :
IUGR/Premature delivery/Fetal distress/Fetal Demise
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FETAL MONITORING
Done by a) DFMC b) USG-GA/AFI/FW c) BPP/CTG

d) Color Doppler of MCA/Ut A/UA/DV


Maternal hypoxemia & hypercarbia : FHR & Uterine Changes a) FETAL : Bradycardia/Transient Late deceleration/decreased beat to beat variability & Compensatory tachycardia
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b) MATERNAL : frequency & tone of Ut. contractions FHR changes resolves in 3-10 min spontaneously If not resolved in 15 min : Suspect AP/NR-FHR

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RENAL FAILURE

Etiology : Renal or Prerenal Diagnosis : S Cr X 3.0, or UO < 300 mL/ for 24 hours
Commonly complicated by volume overload/ hyponatremia/hyperkalemia/hypocalcemia/metabolic acidosis. Commonly presented with thirst/hypotension/ tachycardia/reduced JVP/dry mucus membrane/ reduced axillary sweating Sp.Inv. : Serum Urea, Creatinine, Urinary Na+,/urine Osmolality/ Urinay Cast
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IP/OP charting daily Input = Output/24hrs + 500ml(non febrile)+ 200 ml/ deg C of inc. in Temp No hypotonic fluid Isotonic fluid to be fluid of choice FCT :1000 ml of isotonic fluid over 1 hr

No UO increases, further infusion will be guarded by CVP/PWP

UO increases, maintain at 100 ml/hr

Protein intake of 0.6 g per kg per day


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Hyperkalemia, should be treated by

1) Decreasing intake 2) Controlling intracellular Shifts Dialysis


a) Hemodialysis : Hemodynamically Stable patients & following abdominal Surgery(LSCS) b) Peritoneal Dialysis : Hemodynamically Unstable patients Acidosis- 5% Sod. Bicarbonate if S. HCO-3 > 15 mmol/L or arterial PH < 7.2
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Indication of Dialysis. -Clinical evidence of Uremia -Intractable intravascular overload -Hyperkalemia resistant to conservative tr. -Serum Creatinine > 8 mg/dl Coagulopathy : FFP for a prolonged aPTT, Cryoprecipitate : Fibrinogen < 100 mg/dL, Platelets Transfusion : TPC < 20,000/mm3 Continuous AV hemodiafiltration(CAVH) Continous Venoveno hemodiafiltration(CVVH)
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HELLP SYNDROME
LOUIS WEINSTEIN (1982)

0.3% of all Pregnancies


20% of Severe Preeclampsia & Eclampsia

Delivery is the only cure


More common in white women.

2/3rd : Antepartum & 1/3rd : Postpartum(48hr)

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a) Biomarkers to follow disease progression : Platelet Count & Serum LDH, HCG,Maternal AFP,Serum Haptoglobin Rate of recurrence in subsequent pregnancy : 2-19% Manifested by nausea, vomiting, epigastric pain, and biochemical and hematological changes.

Two Clinical Types :


1) Full HELLP syndrome : Considered for delivery within 48 hours 2) Partial HELLP Syndrome : Candidates for more conservative management
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TYPES & DIAGNOSIS


Class 1 TPC <50 000/mm3. Class 2 TPC: 50 000 100 000/mm3. Class 3 TPC :100 000-150 000/mm3.
Hemolysis

1) Abnormal Peripherical Smear


2) Serum Bilirubin >1.2 mg/dl Elevated Liver Enzymes a) SGOT/SGPT >72 UI / L b) LDH >600 UI / L Low Platelets Platelet Count < 150 103 /mm3
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HELLP Syndrome Microangiopathic hemolytic anemia, consumptive thrombocytopenia, liver dysfunction Secondary to placental abruption, sepsis or fetal death Complications : Eclampsia(6%), ARF(5%), ARDS,Pulmonary edema(10%), hemorrhage, placental abruption(10%), liver hematoma with rupture(1.6%) Maternal Mortality : upto 50%. Perinatal Mortality : 25%
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TTP/HUS DIC/ACUTE FATTY LIVER/SEPSIS SEVERA HEMORRHAGE ABRUPTIO CONNECTIVO TISSUE DISORDERS-SLE PRIMARY RENAL DISEASE-AGN DM

D/D

Similar to Pre-eclampsia with


RUQ/epigastric pain Jaundice Microangiopathic anaemia Deranged LFTs
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MANAGEMENT
Bed rest Fluid : Crystalloid /Albumin-5 to 25% Magnesium Sulphate Antihypertensive Volume Expansion & Electrolyte Balance Corticosteroids: Dex/Pred/Beta(10/10/5/5) Surveillance a) Maternal : BP/Lab Invest./Hemodynamic Monitoring b) Fetal : FHR & BPP Transferring patient to ICU where safe delivery can be done
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Indication for termination


a) b) c) d) e) GA 32-34 weeks Bleeding/DIC Abruptio Placentae Eclampsia Abnormal FHR pattern

Antithrombotics : Low dose Aspirin & Heparin Steroid : HELLP syndrome with TPC < 100,000 per mm3
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ADMINSTRATION OF CORTICOSTEROIDS
Improves Maternal Outcome

1) Improves thrombocyte count


2) Improves Urine Output
Improves Perinatal Outcome

a) Improves Pulmonary Maturity

b) Decreases IVH
c) Decreasing Necrotising Enterocolitis
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Continue till Liver function abnormalities are resolving


and TPC > 100,000 per mm3

HELLP Syndrome : Prophylactically with magnesium


sulfate to prevent seizures

Absence of improvement of the thrombocytopenia


within 72-96 hrs Postpartum : MOF. Patients with DIC should be given fresh frozen plasma and packed red blood cells.
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MANAGEMENT OF LABOR

If transabdominal delivery is required, prefer :


a) Vertical Skin Incision. b) Corporeal incision of the uterus . c) SD of Placenta to avoid hemorrhage Admisin in Obstetric ICU until: (1) Sustained of TPC and a in LDH. (2) Diuresis : UO <100ml/h X 2 hours . (3) Control BP with SBP 150 mm Hg & DBP < 100 mm Hg.
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MANAGEMENT OF LSCS
GA : Platelet count < 75000/cmm Transfuse 6 Packs of platelet if < 40000/cmm Insert Subfascial drain Secondary Skin Closure or leave Observe for bleeding from Upper abdomen before closure
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INTRACRANIAL HEMORRHAGE
5% presented with focal neurological deficits. Gross hemorrhage is due to ruptured arteries caused by severe hypertension.

Eclampsia : Loss of Cerebral auto-regulation ,


hyper-perfusion similar to hypertensive

encephalopathy
Cerebral edema in 95-100% cases of Eclampsia
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Widespread edema, ischemia,thrombosis . CT : Hypodense area in Cortex , corresponds to

Petechial hemorrhage and infarctions


Remarkable changes in area of distribution of

Posterior Cerebral A.
MRI : Hyperperfusion due to Vasogenic Edema

Eclampsia : 25% were area of infarction


Intracranial bleeding is leading cause of mortality
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Autopsy Specimen from a 40-Year-Old Woman with Eclampsia and Subarachnoid Hemorrhage

Greene M. N Engl J Med 2003;348:275-276

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Conservative 1) Low Dose Aspirin : 30-100 mg/day 2) Anticoagulant :Conventional Heparin/LMW Heparin 3) Thrombolytics : Heparin/ Stretokinase/ Alteplase/ Urokinase 4) Antihypertensives 5) Mannitol(20%) :1 g /kg 20% solution IV 8 hrly 6) Glycerol : 30 ml 6hrly orally 7) Dexamethasone : 10 mg IV followed by 4 mg 6hrly

Surgical
1) Bore-Hole Aspiration 2) Decompression
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DIC MANAGEMENT 7-10 % of patients with eclampsia DIC is defined as presence of thrombocytopenia, low fibrinogen(<300 mg/dl) & FDP >40 mg/dl Two forms : Acute & Chronic or Overt & Nonovert Two Stages : Hyper & hypocoagulable Central pathology : Progressive generation of thrombin in blood due to TF in underlying pathology Common specific investigations : PT /aPT /TPC /Fibrinogen/D-Dimer or FSP/Antithrombin/ PS/ thrombelastography
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Cardinal rule in treatment of DIC is to identify & treat underlying cause. Nonspecific
Airway management Restoration of blood volume - Fresh Plasma/Fresh Frozen Plasma - Platelet Concentration - Cryopreciptate Adequate oxygen delivery CPV monitoring Ionotropes Correction of Electrolyte imbalance
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PLATELET TRANSFUSION Dose : 1 U / every 10 kg Weight. Spontaneous Bleeding : TPC < 50.000/mm3. In PP Period, maintain the Count a) >50.000/mm3 LSCS b) >20.000/ mm3 VD Each pack is 4050 ml raises Dexamethasone : HELLP & count by 7500Sev. thrombocytopenia . 10000/cmm Alternatives : Plasmaphersis & Immunoglobulins

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FOZEN PLASMA/FFP
Each bag=1Unit containing 100600 ml Contains all procoagulant factors including labile factor 1U FFP=2U of Frozen Plasma

Dose : 10-15ml/kg(both)
Infuse over 2-3 hr Infuse < 4 hrs of issue Each bag raises factors by 25%
FFP
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Specific :
1) Heparin : Conventional/LMW
2) Fibrinogen Conc. 3) Antifibrinolytics 4) Thrombodulin 5) Activated Factor VII

6) Antithrombin Conc.
7) Activated Protein C(APC) 8) Recomb. TF pathway inhibitor : Tifacogin

9) Gabexate Mesylate : Syntheic inhibitor of serine proteases such as thrombin & anticoagulant activity in absence of antithrombin
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PULMONARY EDEMA
Attributed due to 1) Increased Capillary Permeability 2) Low colloidal Osmotic Pressure 3) Pulmonary Endothelial Damage Clinically characterized by -Tachypnoea -Respiratory Distress -Crepitations -Bronchospasm -Pink frothing -Desaturation
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Titrate Insp. Oxygen Conc. against SpO2 Head tilt/Sit up Position 100%-Oxygen Inhalation Restricted Fluid intake Intubate if necessary Mechanical Ventilation with CPAP Evaluate for underlying etiology Drug therapy : 1) Inj Frusemide 40 mg IV 20 mg Mannitol 2) IV Aminophylline (if bronchospasm)
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MORTALITY & MORBIDITY

Maternal : 8-36% most frequently related to

seizure activity Fetal : 13-30% most frequently related to iatrogenic prematurity


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FOLLOW UP Postnatal follow up for 6 weeks Persistence of HTN > 12 weeks : Medical evaluation Recurrence risk 1) Onset at term : 30% 2) Onset at 30-37 weeks : 40% 3) Onset at < 30 weeks : 70% Permanent Neural Damage Increased risk of Essential Hypertension Contraception :
a) POP or Low dose Pill b) No Puerperal tubal ligation
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PREVENTION
Primary : Prevention of development of preeclampsia Folic Acid & Calcium Supplentatation Fish oil capsules : Modify abnormal PG balance Periodic Monitoring BP & Weight gain Antioxidants Reduced endothelial cell activation , reduction in preeclampsia
a) Vit-C 1000 mg/day b) Vit-E 400 mg/day

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Periodic Screening : a) Serum Uric Acid > 6.0 mg/dl b) Doppler :Uterine Artery & Umibilical Vein in 2nd trimester. c) Biophysical Testing d) Ultrasonography 4 Weekly e) Roll Over Test at 28-32 Weeks f) Platelet Count(High Platelet Volume) g) Urinary Calcium < 12 mg/dl h) Serum Fibronectin i) Urinary Protein j) Serum Antithrombin-III k) Fetal DNA in maternal Serum

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EnSuRing good exercise during pregnncy

To prevent one case of Eclampsia - 71 women with Preeclampsia need to be treated - 36 women with imminent eclamspia need to be treated - 129 women without symptoms(Gest.Hypertension)
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Secondary : Pharmacological agents to prevent convulsion in preeclampsia 1) Salt restriction 2) Inappropriate diuretic therapy 3) Low dose aspirin (60mg)/Baby Aspirin 4) Magnesium Sulphate 5) Antihypertensives Tertiary : Preventing subsequent convulsion in established eclampsia.
With optimum Mode of management we can prevent 70% of eclampsia
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THANK Q

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