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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 alchol
C coarctation of aorta
D drugs
E Endocrine disease
P PIH
R 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:  Risk factor decrease :

 Primigravida  Smokers
 age  Prolong exposure to
 Past history paternal antigen
 Change the husband
 Condition in which
placenta enlarge
 Pre-existing disease
 Low socioeconomic
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SYSTEMIC EFFECTS

1. CVS
2. Blood
3. Renal system
4. Liver
5. 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 Sign: may be

 Asymptomatic  High BP

 Headache  Fluid retension

 Visual disturbance  Brisk reflexs

 Epigastric pain  Fundel level less than

 oedema date
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IMPENDING ECLAMPSIA
TRANSITIONAL CONDITION CHARACTERIZE BY
INCREASE IN

Symptoms: signs:
 Headache  Agitation

 Visual disturbance  Hyperreflexia

 Epigastric pain  Facial &peripheral

 Nausea oedema
 Restlessness  Rt upper quadrant

 Swelling
tendernes
 Poor urine output
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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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EDEN’S 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. Epilepsy
2. CVA
3. SOL
4. 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. Usually unnecessary to try to stop the initial

convulsion which usually last about 60-90
seconds
2. IV Diazepam slowly 5mg over 1 min
3. 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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