PREECLAMPSIA

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PREECLAMPSIA ECLAMPSIA
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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.

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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.

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Classification of hypertensive disorders of
pregnancy

• Preeclampsia / eclampsia
• Chronic hypertension
• Chronic hypertension with superimposed
• preeclampsia
• Gestational or transient hypertension

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

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

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Pathophisiology-

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

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• Liver,subendothelial fibrin deposition
• elevated liver,hemorrhage,infarction,liver
  rupture and epigastric pain.
• Blood thrombocytopenia,DIC,HELLP syndrome.
• Placental vasospasm placental
  infarction,placental abruptio uteroplacental
  perfusion IUGR.
• CNS vasospasmoedema headache,
• visual symptons(blurred vision,spots,

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

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

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• 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

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• A Mild preeclampsia
• Diastolic blood pressure 90-95mmhg
• minimal proteinurea,normal heamatological
• and biochemical parameters,no fetal
• compromise.Deliver at term.
• B severe preeclampsia (BPgt160/110MMHG,
• urine protein 5grams 3 )
• Abnormal haematological and biochemical
• parameters,abnormal fetal findings
• 1. Control blood pressure(aim to keep
• BP 90-95mmgh )

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Drugs-
comment Side effect dose action agent
Late onset 24hours dpression 500-4000 mg central Methyl dopa
Drug of emergency Headache, Flushing palpitation 5mg10mg Direct vasodilator hydralazine
Avoid in h.Failure b.asthma Nausea Vomiting h.block 20mg40mg every 10m Betaalpha blocker labetalol
For emergency Severe headache 5mg sub. Ca.channel blocker nifedipine
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• 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.

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• 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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• 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)

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• 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

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• 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.

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