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Eclampsia

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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  1. www.doctor.sd Eclampsia

  2. www.doctor.sd 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)

  3. renal disease www.doctor.sd alchol A C D E P R coarctation of aorta drugs Endocrine disease PIH

  4. 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 www.doctor.sd But diagnosis can be by: This condition is associated with significant protienuria

  5. ??? • Not related to the fetus or uterus • Failure of placentation • Abnormal lipid metabolism • Decrease Ca++ in diet All pathogenesis due to vasospasm & endothelial dysfunction www.doctor.sd Aetiology:

  6. www.doctor.sd • 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

  7. CVS • Blood • Renal system • Liver • CNS www.doctor.sd Systemic effects

  8. 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 www.doctor.sd Incidence & Epidemiology

  9. www.doctor.sd 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

  10. www.doctor.sd 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

  11. www.doctor.sd Eclampsia

  12. it is grand mal convulsion which pass through stages of: • Tonic contraction • Clonic • Coma Usually take about 60-90 seconds. www.doctor.sd Clinical feature

  13. 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 www.doctor.sd Eden’s criteria of severity

  14. Epilepsy • CVA • SOL • Drugs reaction www.doctor.sd Differential diagnosis

  15. Aim of it : 1-maintain patent airways 2-prevents the fits 3-terminate the pregnancy www.doctor.sd Managments

  16. Usually unnecessary to try to stop the initial convulsion which usually last about 60-90 seconds • IV Diazepam slowly 5mg over 1 min • 3. Roll the patient on his left side to avoid maternal injury www.doctor.sd

  17. www.doctor.sd 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.

  18. www.doctor.sd 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)

  19. www.doctor.sd 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.

  20. www.doctor.sd 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

  21. www.doctor.sd 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

  22. www.doctor.sd Causes of Neonatal death 1.Prematurity 2.placenta infarction 3.IUGR 4.Abruptio placentae 5.Fetal hypoxia

  23. www.doctor.sd Thank You

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