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PREECLAMPSIA & ECLAMPSIA

Objective: A unique disease (syndrome) of pregnant woman in the second half of pregnancy.  Carries significant maternal & fetal morbidity and mortality.  Two criteria for diagnosing preeclampsia hypertension & proteinuria, in eclampsia tonic and clonic convulsions.  The definite cure of preeclamsia & eclampsia is delivery.

Defenition of preeclampsia:The presence of hypertension of at least 140/90 mm Hg recorded on two separate occasions at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hours collection of urine arrising de novo after the 20th week gestation in a previously normotensive women and resolving completetly by the sixth postpartum week. .

Classification of hypertensive disorders of pregnancy    Preeclampsia / eclampsia Chronic hypertension Chronic hypertension with superimposed preeclampsia Gestational or transient hypertension  .

Aetiology of preeclampsia:(Genetic predisposition) (Abnormal immunological response) (Deficient trophoplast invasion) (Hypoperfused placenta) (Circulating factors) (Vascular endothelial cell activation) (Clinical manifestations of the disease) .

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Epidemiology  More common in primigravid  There is 3-4 fold increase in first degree relatives of affected women. Incidence 3% of pregnancies. .

Risk Factors for preeclampsia  Condition in which the placenta is enlarged (DM.hydrops)  Pre-existing hyertension or renal diseases.MP.autoimmune vasculitis) .  Pre-existing vascular disease (diabetes.

reduced uric excretion and oligouria.  Vasospasm hypertension  Endothelial cell damage oedema. Cytokines) vascular endothelial cell activation.Pathophisiology:Defective trophoplast invasion hypoperfused placenta release factors (growth factors. .glomeruloendotheliosis proteinuria. hemoconcentration  Kidneys.

liver rupture and epigastric pain.HELLP syndrome.  Placental vasospasm placental infarction.DIC.infarction.  CNS vasospasm&oedema headache.hemorrhage.spots.placental abruptio& uteroplacental perfusion IUGR. scotoma) hyperreflexia and convulsions. Liver. visual symptons(blurred vision.subendothelial fibrin deposition elevated liver. .  Blood thrombocytopenia.

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Fundal height . Ankle clonus(more than 3 beats) 5. Epigastric and right abdominal pain Signs of preeclampsia 1. Brisk reflexes 4. Hypertension 2. Headache 2.Symptoms of preeclampsia 1. Non dependent oedema 3. May be symptomless 3. Visual symptoms 4.

Investigations Maternal  Urinalysis by dipstick  24hours urine collection  Full blood count(platelets&haematocrit)  Renal function(uric acid.creatinine.urea)  Liver function tests  Coagulation profile .s.

CTG BPP Doppler Management of preeclampsia Principles  Early recognition of the syndrome  Awarness of the serious nature of the condition  Adherence to agreed guidelines(protocol)  Well timed delivery  Postnatal follow up and counselling for future pregnancy  REMEMBER: Delivery is the only cure for preeclampsia . 4.Fetal 1.fetal size. 3.AF) 2. Uss(growth parameters.

Control blood pressure(aim to keep BP 90-95mmgh ) .no fetal compromise. urine protein 5grams 3+ ) Abnormal haematological and biochemical parameters.abnormal fetal findings 1.normal heamatological and biochemical parameters. B severe preeclampsia (BP>160/110MMHG.A Mild preeclampsia Diastolic blood pressure 90-95mmhg minimal proteinurea.Deliver at term.

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Flushing palpitation labetalol Beta&alpha 20mg…40m Nausea blocker g every Vomiting 10m h.block Ca. Severe headache Avoid in h.Drugs:agent Methyl dopa action central dose 500-4000 mg 5mg…10m g Side effect comment dpression Late onset 24hours Drug of emergency hydralazine Direct vasodilator Headache.asthma For emergency nifedipine .Failure b.channel blocker 5mg sub.

Deliver c/s or vaginal. . If fetus is preterm give mother 12mg Dexamethasone im twice 12hs apart to enhance lung maturity. Avoid ergometrine in 3rd stage. Give anticoagulant.Delivery:Transfer patient to tertiary center if her Condition permits.

Complications of preeclampsia: ECLAMPSIA Maternal  CVA  HEELP syndrome  Pulmonary oedema  Adult RDS  Renal failure Fetal  IUGR  IUFD  Abruptio placenta Prophylaxis(aspirin.antioxidant) .

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It is an obstetric emergency.Eclampsia:Is a life threatening complications of preeclampsia.defined as tonic.postpartum (after delivery 24-48hs) . It occurs antenatal.intrapartum.clonic convulsions in a pregnant woman in the absence of any other neurological or metabolic causes.

Intake & output chart 7.RFT.Investigations(urine.Control BP(hydralazine.Ensure clear airway(suction.hypoxia controlled) deliver .Stop fits(mag.LFT.cross match) 8.Monitor patient and her fetus 9.Maintain iv access 4.no convulsions.FBC.Turn the patient on her side 2.Management(carried out by a team) 1.diazepam) 5.After stabilization(BPcontrolled. clotting profile.mouth gag) 3.sul.labetalol) 6.

.urine output)  Antidote cal.gluconate 10ml 10%.1-2gr maintenance)  Acts as cerebral vasodilator and menbrane stabilizer  Over dose lead to respiratory depression and cardiac arrest  Monitor patient(reflexes.im(4-6gr bolus dose.RR.Mag.sulphate: Drug of choice in ecclampsia  Given iv.