PREECLAMPSIA & ECLAMPSIA

1. PREECLAMPSIA & ECLAMPSIA

2. 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 preeclampsia & eclampsia is delivery.

3. 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.

4. Classification of hypertensive disorders of pregnancy • Preeclampsia /eclampsia • Chronic hypertension • Chronic hypertension with superimposed preeclampsia • Pregnancy induced hypertension

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

7. Risk Factors for preeclampsia • Condition in which the placenta is enlarged (DM,MP,hydrops) • Pre-existing hypertension or renal diseases. • Pre-existing vascular disease (diabetes,autoimmunevasculitis)

9. Symptoms of preeclampsia • Headache • Visual symptoms • Epigastric and right abdominal pain Signs of preeclampsia • Hypertension • Non dependent oedema • Brisk reflexes • Ankle clonus(more than 3 beats) • Fundal height

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

11. Fetal • Uss(growth parameters,fetal size,AF) • 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

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

14. Drugs:-

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

16. Complications of preeclampsia:- • ECLAMPSIA Maternal • CVA • HELLP syndrome • Pulmonary oedema • Adult RDS • Renal failure Fetal • IUGR • IUFD • Abruptio placenta

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

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

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

21. Eclamptic seizure identified Treatment & Prphylaxis of Seizures • Diazepam 5mg IV repeated as needed up to 20 mg to stop seizure • Secure airway • Place patient in recovery position • Facial oxygen • Contraindication to magnesium sulphate? • Heart block • H/o myocardial infarction • Consider alternative agents (diazepam or thiopentone) • Provide supportive therapy(maintain fluid balance, blood pressure control, etc..) • Once seizures are controlled, blood pressure is sustained and hypoxia corrected, delivery can be expedited in applicable cases Yes No • Start magnesium sulfate therapy • Provide supportive therapy(maintain fluid balance, blood pressure control, etc..) • Once seizures are controlled, blood pressure is sustained and hypoxia corrected, delivery can be expedited in applicable cases

23. Treatment & Prphylaxis of Seizures Monitor patellar reflex & respiratory rate at hourly intervals Regular monitoring of serum Mg Sulfate, particularly in women with renal disease, output <100 ml/4 hours. Therapeutic range 2-4 mmol/l • Signs of hypermagnesaemia? • Respiratory rate <16/min • Knee jerk reflexes absent Withhold further Mg sulfate until signs of hypermagnesaemia resolve Significant respiratory depression will require calcium gluconate IV Yes No Continue mag. sulfate Clinical signs of hypermagnesaemia resolves Mg sulfate 2 gm Iv over 5-10 min and continue maintenance dose Yes Recurrent seizures? No Consider alternative agents ( diazepam or thiopentone) No Yes Continue mag. Sulfate for 24 hours after last seizure Repeated seizures?