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Preeclampsia and eclampsia
1.
2. Objective:-ď‚—A unique disease (syndrome) of pregnant woman in the
second half of pregnancy.
ď‚—Carries significant maternal & fetal morbidity and
mortality.
ď‚—Two criteria for diagnosing preeclampsia
hypertension & proteinuria, in eclampsia
tonic and clonic convulsions.
ď‚—The definite cure of preeclamsia & 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
ď‚— Preeclampsia / eclampsia
ď‚— Chronic hypertension
ď‚— Chronic hypertension with superimposed
preeclampsia
ď‚— Gestational or transient hypertension
5. Aetiology of preeclampsia:-
(Genetic predisposition)
(Abnormal immunological response)
(Deficient trophoplast invasion)
(Hypoperfused placenta)
(Circulating factors)
(Vascular endothelial cell activation)
(Clinical manifestations of the disease)
8. Risk Factors for preeclampsia
ď‚—Condition in which the placenta is enlarged
(DM,MP,hydrops)
ď‚—Pre-existing hyertension or renal diseases.
ď‚—Pre-existing vascular disease (diabetes,autoimmune
vasculitis)
12. Symptoms of preeclampsia
1. Headache
2. May be symptomless
3. Visual symptoms
4. Epigastric and right abdominal pain
Signs of preeclampsia
1. Hypertension
2. Non dependent oedema
3. Brisk reflexes
4. Ankle clonus(more than 3 beats)
5. Fundal height
14. Fetal
1. Uss(growth parameters,fetal size,AF)
2. CTG
3. BPP
4. 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
15. A Mild preeclampsia
Diastolic blood pressure 90-95mmhg
minimal proteinurea,normal heamatological
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
1. Control blood pressure(aim to keep
BP 90-95mmgh )
16.
17. Drugs:-agentagent actionaction dosedose Side effectSide effect commentcomment
MethylMethyl
dopadopa
centralcentral 500-4000500-4000
mgmg
dpressiondpression Late onsetLate onset
24hours24hours
hydralazinehydralazine DirectDirect
vasodilatorvasodilator
5mg…10mg5mg…10mg HeadacheHeadache,,
FlushingFlushing
palpitationpalpitation
Drug ofDrug of
emergencyemergency
labetalollabetalol Beta&alphaBeta&alpha
blockerblocker
20mg…20mg…
40mg every40mg every
10m10m
NauseaNausea
VomitingVomiting
h.blockh.block
Avoid inAvoid in
h.Failureh.Failure
b.asthmab.asthma
nifedipinenifedipine Ca.channelCa.channel
blockerblocker
5mg sub5mg sub.. SevereSevere
headacheheadache
ForFor
emergencyemergency
18. 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.
21. 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)
22. 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
23. Mag.sulphate:-
ď‚—Drug of choice in ecclampsia
ď‚—Given iv,im(4-6gr bolus dose,1-2gr maintenance)
ď‚—Acts as cerebral vasodilator and menbrane stabilizer
ď‚—Over dose lead to respiratory depression
and cardiac arrest
ď‚—Monitor patient(reflexes,RR,urine output)
ď‚—Antidote cal.gluconate 10ml 10%.