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PTM Obstetrics

Pre-eclampsia and Eclampsia

Four types of hypertensive diseases that affect pregnant women. Gestational hypertension. Preeclampsia and eclampsia syndrome. Preeclampsia superinposed on chronic hypertension. Chronic hypertension.
Leading causes of maternal death according to WHO in developed countries. 1. Hypertensive disorders. 2. Haemmorrhage. 3. Abortion. 4. Sepsis.
How may weeks is full term? 40 weeks 10 months
Key features of gestational hypertension. Systolic BP ≥ 140mmHg. Diastolic BP ≥ 90mmHg Must be evident over 2 BP recordings 2 hours apart. And no proteinuria.
Is gestational hypertension transient? Yes it returns to normal within 12/52 post partum.
Does women with gestational diabetes develop preeclampsia? Yes 50% does.`
Define preeclampsia. A pregnancy specific syndrome that can affect virtually every organ system with unpredictable, widespread and variable manifestations.
Preeclampsia minimum diagnostic criteria. BP ≥ 140/90mmHg after 20/40 Proteinuria.
Preclampsia clinical diagnosis can be made if gestational hypertension and on of the following is present. Proteinuria. Renal insufficency. Liver disease. Neurological sequale. Haematological disturbance. Fetal growth restriction.
Pre eclampsia risk factors. Genetics - African americans, family Hx. Medical factors: Pre-existing hypertension. Renal disease. Diabetes. Connective tissue disease. Thrombophilla. Genaral: Age >40 years (double risk) Obesity.
Obstetric pre-eclampsia risk factors. Nulliparity/primiparity X2-3 fold increase. Multiple gestation X2 increase. Previous preeclampsia - x7 increase. Long birth interval - x2-3 Hydrops with large placenta Hydatidiform mole. Triplodiy.
Crises associated with preeclampsia. Eclampsia Cerebral haemmorrhage. Placental abruption. HELLP syndrome. Disseminated intravascular coagulation. Pulmonary oedema. Renal Failure. Hepatic Rupture. Cortical Blindness. Fetal hypoxia associated mortality/morbidity.
Define HELLP Syndrome Haemolysis. Elevated liver enzymes. Low platlets.
Is the etiology of preeclampsia known? No.
What is the management preeclampsia? Support ABC's. 8mg oral Ondansetron. 4mg IV Ondansetron if vomiting is continuous. Oz therapy - if under 95%. IV. Quite, calm environment. Restrict IV fluids. Position left lateral to avoid supine hypotension syndrome.
What are the contraindications for Ondansetron? Known Allergy. First trimester of pregnancy.
Define eclampsia. The onset of convulsions in a woman with preeclampsia that cannot be attributed to another cause.
When does the majority of convulsions occur? Within 48 hours of birth.
Are teenagers more likely to have eclampsia? Yes.
How does eclampsia present? Tonic-clonic seizure that is typically self limiting.
What are signs that a seizure is likely? Severe hypertension. ( 170/110 mmHG) Severe headache. Visual disturbances. Hyper-reflexia (brisk reflexes). Clonus ≥ 2 beats - twitching reflexes after stimilation. Epigastric pain. (late sign) Pain between shoulder blades.
What is the most common cause for death associated with eclampsia? Pulmonary oedema.
What are other other causes for fatality in the eclampsia patient? Brain pathology. (1/3 of cases.) Liver rupture - failure or haematoma. HELLP syndrome. Fetal growth restriction, hypoxia, death.
What is the management for eclampsia? Exclude cardiac arrest. Place left laterally and protect airway. O2- 6-10 lpm via Acute mask. IV access - avoid fluids. Magnesium sulphate - if in scope. Monitor SPO2, breathing rate, BP, pulses and reflexes. LOAD AND GO. Quite ride as possible. R
How does magnesium sulphate act in the eclampsia case? Vasodilation of cerebral vasculature. Inhibition of platelet aggregation. Protection of endothelial cells from free radicals. Prevention of Ca+ entry into ischaemic cells. Decreasing the release of acetecholine at motor endplates.Plus morereference sl
Created by: boermedic