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Pre- eclampsia / Eclampsia

Pre- eclampsia / Eclampsia. Pre- eclampsia : hypertension >140/90, proteinuria >0.3g/L Eclampsia : seizures Incidence : Pre- eclampsia : 2-10% of all pregnancies Eclampsia : 2-6 in 10000 deliveries 1.8% maternal mortality. History & Examination. Symptoms Headache Visual disturbance

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Pre- eclampsia / Eclampsia

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  1. Pre-eclampsia/Eclampsia

  2. Pre-eclampsia: hypertension >140/90, proteinuria >0.3g/L • Eclampsia: seizures • Incidence: • Pre-eclampsia: 2-10% of all pregnancies • Eclampsia: 2-6 in 10000 deliveries • 1.8% maternal mortality

  3. History & Examination • Symptoms • Headache • Visual disturbance • Epigastric pain • Fetal movements • Signs • BP, proteinuria • Hepatic tenderness • Clonus, hyperreflexia • Papilloedema

  4. Antihypertensives • Labetolol • Orally • Intravenous • Nifedipine • Orally • Hydralazine • intravenous • Methyldopa – slow acting

  5. Anticonvulsants • Magnesium Sulphate • 4g IV push • Maintenance dose 1-2g/hour • Monitor for signs of toxicity • Loss of deep tendon reflexes • Respiratory depression • Coma • Cardiac arrest • Calcium gluconate

  6. Scenario • A patient at 30 weeks gestation on the ward was found fitting by the staff midwives • She is hypertensive 160/120, with +4 proteinuria • You are called to attend

  7. ABCs!!! • Help – midwives, senior obstetrician, anaesthetist • IV access • Lab investigations • FBC, U&Es, LFTs, coag • Stabilise patient before fetus

  8. Mg SO4 • Antihypertensives • Fluid restriction – no more than 80ml/hour • HDU monitoring • Delivery when stabilised

  9. Summary • ABC’s • Stabilise patient • Antihypertensives/anticonvulsants • Delivery

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