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

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Eclampsia


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Pre- eclampsia

Impending

Eclampsia

  • It is a disease of pregnancy characterized by

  • BP 140/ 90 or more.

  • After 20 week gestational age.

  • In previous normotensive pt.

  • Reading taken twice at interval 6 hours.

  • Exclude other causes of 2.ry hypertension (ACDEPR)


renal disease

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alchol

A

C

D

E

P

R

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

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But diagnosis can be by:

This condition is associated with significant protienuria


  • ???

  • Not related to the fetus or uterus

  • Failure of placentation

  • Abnormal lipid metabolism

  • Decrease Ca++ in diet

    All pathogenesis due to vasospasm & endothelial dysfunction

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Aetiology:


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  • Risk factor decrease :

  • Smokers

  • Prolong exposure to paternal antigen

  • Risk facctors:

  • Primigravida

  • age

  • Past history

  • Change the husband

  • Condition in which placenta enlarge

  • Pre-existing disease

  • Low socioeconomic


Systemic effects

  • CVS

  • Blood

  • Renal system

  • Liver

  • CNS

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Systemic effects


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

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Incidence & Epidemiology


Pre eclampsia

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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


Impending eclampsia transitional condition characterize by increase in

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Impending eclampsiatransitional conditioncharacterize by increase in

Symptoms:

  • Headache

  • Visual disturbance

  • Epigastric pain

  • Nausea

  • Restlessness

  • Swelling

  • Poor urine output

signs:

  • Agitation

  • Hyperreflexia

  • Facial &peripheral oedema

  • Rt upper quadrant tendernes


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Eclampsia


Clinical feature

it is grand mal convulsion which pass through stages of:

  • Tonic contraction

  • Clonic

  • Coma

    Usually take about 60-90 seconds.

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Clinical feature


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

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Eden’s criteria of severity


Differential diagnosis

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Differential diagnosis


Managments

  • Aim of it :

    1-maintain patent airways

    2-prevents the fits

    3-terminate the pregnancy

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Managments


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www.doctor.sd which usually last about 60-90 seconds

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 MgSO4 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 NaHCO3

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.


www.doctor.sd which usually last about 60-90 seconds

After resuscitation

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)


www.doctor.sd which usually last about 60-90 seconds

After the mother become stable

  • 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.


www.doctor.sd which usually last about 60-90 seconds

Post natal management

It is attention to fluid balance , BP , Renal & Hepatic function & CNS

1.More aggressive control of BP

2.MgSO4 maintained for 48 hrs at 1g/hr iv

3.Subcutaneous heparin prophylaxis


www.doctor.sd which usually last about 60-90 seconds

Maternal complications of eclampsia

1.During the fit

tounge bitting

head trauma

bone #

Aspiration

2.permanent CNS damage

3.Intracranial haemorrhage

4.Renal failure

5.Death


www.doctor.sd which usually last about 60-90 seconds

Causes of Neonatal death

1.Prematurity

2.placenta infarction

3.IUGR

4.Abruptio placentae

5.Fetal hypoxia


www.doctor.sd which usually last about 60-90 seconds

Thank You


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