Pre- eclampsia ImpendingEclampsia It is a disease of pregnancy characterized by BP 140/ 90 or more. BP 140/ 90 or more. After 20 week gestational age. After 20 week gestational age. In previous normotensive pt. In previous normotensive pt. Reading taken twice at interval 6 hours. Reading taken twice at interval 6 hours. Exclude other causes of 2.ry hypertension (ACDEPR)Exclude other causes of 2.ry hypertension (ACDEPR)

renal disease A C D E P R alchol coarctation of aorta drugs Endocrine disease PIH

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 But diagnosis can be by: This condition is associated with significant protienuria

?????? NNNNot related to the fetus or uterus FFFFailure of placentation AAAAbnormal lipid metabolism DDDDecrease Ca++ in diet All pathogenesis due to vasospasm & endothelial dysfunction Aetiology:

 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

SYSTEMIC EFFECTS 1. CVS 2. Blood 3. Renal system 4. Liver 5. CNS

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

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

Symptoms:  Headache  Visual disturbance  Epigastric pain  Nausea  Restlessness  Swelling  Poor urine output signs:  Agitation  Hyperreflexia  Facial &peripheral oedema  Rt upper quadrant tendernes

Eclampsia

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

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

DIFFERENTIAL DIAGNOSIS 1. Epilepsy 2. CVA 3. SOL 4. Drugs reaction

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

1. Usually unnecessary to try to stop the initial convulsion which usually last about seconds 2. IV Diazepam slowly 5mg over 1 min Roll the patient on his left side to avoid maternal injury

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 MgSO 4 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 NaHCO 3 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.

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)

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.

It is attention to fluid balance, BP, Renal & Hepatic function & CNS 1.More aggressive control of BP 2.MgSO 4 maintained for 48 hrs at 1g/hr iv 3.Subcutaneous heparin prophylaxis

2.permanent CNS damage 3.Intracranial haemorrhage 4.Renal failure 5.Death 1.During the fit tounge bitting head trauma bone # Aspiration

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