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Pre- eclampsia

Impending

Eclampsia

It is a disease of pregnancy characterized


by
BP 140/ 90 or more.
After 20 week gestational age.
In previous normotensive pt.
Reading taken twice at interval 6 hours.
Exclude other causes of 2.ry hypertension
(ACDEPR)

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A
C
D
E
P
R

alcho
lcoarctation of
aorta
drugs
Endocrine
disease
PIH
renal disease

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But diagnosis can be


by:

DBP110 or more
Increase in SBP by 30 mmHg
Increase in DBP by 15mmHg
2 read of MABP 105 or more OR increase by 20

This condition is associated with significant


protienuria

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Aetiology:

???
Not related to the fetus or uterus
Failure of placentation
Abnormal lipid metabolism
Decrease Ca++ in diet

All pathogenesis due to vasospasm & endothelial


dysfunction

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Risk facctors:
Primigravida

age

Past history
Change the
husband
Condition in which
placenta enlarge
Pre-existing
disease
Low socioeconomic

Risk factor
decrease :
Smokers
Prolong exposure to
paternal antigen

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SYSTEMIC EFFECTS
1.
2.
3.
4.
5.

CVS
Blood
Renal system
Liver
CNS

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INCIDENCE & EPIDEMIOLOGY

Occur in 5-10% pregnancy


Death about 2% in UK
Death increase in Eclampsia which
occur in intrapartum &post partum
due to:
-Relax of observation during these period
-Increase in release of pathogenic factor

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PRE-ECLAMPSIA
Symptoms: may be
Asymptomatic
Headache
Visual disturbance
Epigastric pain
oedema

Sign: may be
High BP
Fluid retension
Brisk reflexs
Fundel level less
than date

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Symptoms:
Headache
Visual disturbance
Epigastric pain
Nausea
Restlessness
Swelling
Poor urine output

signs:
Agitation
Hyperreflexia
Facial &peripheral
oedema
Rt upper quadrant
tendernes

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Eclampsia

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CLINICAL FEATURE
it is grand mal convulsion which pass
through stages of:
1. Tonic contraction
2. Clonic
3. Coma
Usually take about 60-90 seconds.

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EDENS CRITERIA OF SEVERITY


Coma take 6 hours or more
SBP reach 200 mmHg
Tm 39 or more
Pulse rate 120/min
RR 40/min
2 fits or more
All this can end in maternal brain
death

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DIFFERENTIAL DIAGNOSIS
1.
2.
3.
4.

Epilepsy
CVA
SOL
Drugs reaction

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MANAGMENTS

Aim of it :
1-maintain patent airways
2-prevents the fits
3-terminate the pregnancy

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1.

2.
3.

Usually unnecessary to try to stop the


initial convulsion which usually last
about 60-90 seconds
IV Diazepam slowly 5mg over 1 min
3. Roll the patient on his left side to
avoid maternal injury

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4. Apply Suction to the secretion from her mouth


5. Adequate Oxygen should be maintained by face
mask & airways to prevent swallowing of tongue
6. Prevent further convulsions by MgSO4 by IV
bolus of 4 6 g over 15 min. If convulsion recur
further bolus of 2g.
7. Acidosis should be corrected if necessary by IV
NaHCO3
8. SBP 170 mmHg or more, DBP 110 mmHg is risk
factor for CVA so should be lowered by either
Nifedipine 10 20 mg SL. Or Hydrallazine 5mg
followed by infusion.

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1.Insert canula size 10


2.Send blood to Lab for Hb, blood
group, Platelet count, RFT, LFT, Uric
acid concentration, coagulation
study, RBS
3.Urine catheter (to urine output &
protein)

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1.Assessment of state of fetus (U/S,


Doppler CTG)
2.either : - Deliver the baby regardless
of the gestational age
intense monitoring maternal health in
hope of improvement fetal
outcome by increase gestational
age.

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It is attention to fluid balance , BP , Renal


& Hepatic function & CNS
1.More aggressive control of BP
2.MgSO4 maintained for 48 hrs at 1g/hr iv
3.Subcutaneous heparin prophylaxis

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1.During the fit


tounge bitting
head trauma
bone #
Aspiration

2.permanent CNS damage


3.Intracranial haemorrhage
4.Renal failure
5.Death

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1.Prematurity
2.placenta infarction
3.IUGR
4.Abruptio placentae
5.Fetal hypoxia

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