Pre-eclampsia and Eclampsia
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| Four types of hypertensive diseases that affect pregnant women. | Gestational hypertension.
Preeclampsia and eclampsia syndrome.
Preeclampsia superinposed on chronic hypertension.
Chronic hypertension.
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| Leading causes of maternal death according to WHO in developed countries. | 1. Hypertensive disorders.
2. Haemmorrhage.
3. Abortion.
4. Sepsis.
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| How may weeks is full term? | 40 weeks
10 months
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| Key features of gestational hypertension. | Systolic BP ≥ 140mmHg.
Diastolic BP ≥ 90mmHg
Must be evident over 2 BP recordings 2 hours apart.
And no proteinuria.
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| Is gestational hypertension transient? | Yes it returns to normal within 12/52 post partum.
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| Does women with gestational diabetes develop preeclampsia? | Yes 50% does.`
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| Define preeclampsia. | A pregnancy specific syndrome that can affect virtually every organ system with unpredictable, widespread and variable manifestations.
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| Preeclampsia minimum diagnostic criteria. | BP ≥ 140/90mmHg after 20/40
Proteinuria.
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| 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.
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| 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.
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| 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.
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| 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.
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| Define HELLP Syndrome | Haemolysis.
Elevated liver enzymes.
Low platlets.
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| Is the etiology of preeclampsia known? | No.
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| 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.
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| What are the contraindications for Ondansetron? | Known Allergy.
First trimester of pregnancy.
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| Define eclampsia. | The onset of convulsions in a woman with preeclampsia that cannot be attributed to another cause.
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| When does the majority of convulsions occur? | Within 48 hours of birth.
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| Are teenagers more likely to have eclampsia? | Yes.
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| How does eclampsia present? | Tonic-clonic seizure that is typically self limiting.
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| 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.
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| What is the most common cause for death associated with eclampsia? | Pulmonary oedema.
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| 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.
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| 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
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| 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
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boermedic
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