Good morning!!. Eclampsia. ─A Case Presentation & Review R2 陳世昱. www.anaesthesia.co.in [email protected] Brief History (1)- general data. Name: 簡○○ Gender: female Age: 34y/o 居住地： 台北縣樹林鎮 Pregnancy at 38 th wks. Brief History (2)- background.
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Eclampsia → PIH
Failure of the invasion of trophoblast cells
Maladaptation of maternal spiral arterioles
Poor villous development results in placental insufficiency
Secondary damage, such as fibrin deposition and thrombosis
From vascular endothelial to multisystem disorder with various forms.
Strong maternal inflammatory Rs, and far broader immun-ological systemic activity.
Awaited to clarifyPhatho-physiology:
The presence of pre-existing diabetes, collagen vascular disease, H/T, or renal disease
Maternal age(<18y or>35y)
Maternal weight (<100lbs or obese)
Family history of PIH
Low socio-economic status
Late entry or no prenatal careRisk Factors
SBP160 and/or DBP110mmHg on 2 occasions at least 6 hrs apart with the p’t on the bedrest
Impaired liver function demonstrated by RUQ/epigastric pain and/or other liver function tests
Oliguria,<400-500ml of u/o in 24hrs
Cerebral or visual disturbance
Pulmonary or cardiac involvement
↑serum creatinine >1mg/dL
Intra-uterine growth restriction
Proteinuria 5g in 24hrs or 3-4+ on dipstickCriteria of Severe Preeclampsia
Upper airway edema
Decreased intravascular volume
Increased arteriolar resistance
If DBP is higher than 110 mmHg for maternal pharmacologic management of severe preeclampsia-HELLP synd. :
If GA>34wks and any jeopardy to mother or fetus, or the labor has begun, deliver.
If GA<24 wks, consider termination of pregnancy.
If GA is 24-28 wks, begin maternal counseling, institute prophylactic magnesium sulfate therapy and antihypertensive therapy as indicated, and monitor maternal and fetal status daily. Deliver if there is evidence of fetal lung maturity and maternal or fetal deterioration.Management (2) :
Diuretics and high concentrations colloid solutions for peripheral edema→further ↓ intra-vascular volume and increase risk of pul. edema and utero-placental insufficiency.
Valium is no longer the first-line agent to stop seizure activity related to the depressant effect on the fetus and mother.
A rapid bolus of valium may lead to apnea, cardiac arrest, or both; also someone who is skilled in intubation must be available.
Heparin should not be administered as prophylaxis against coagulopathy because of the compromise in the maternal vascular system.Inappropriate or controversial Managements :