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EPH-GESTOSIS

EPH-GESTOSIS. Definition:

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EPH-GESTOSIS

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  1. EPH-GESTOSIS

  2. Definition: EPH-Gestosis is a disease of disturbed gestation, i.e. a high risk pregnancy. If this disturbance is demonstrated by abnormal body water retention (Edema) and/or excretion of pathological amounts of urinary proteins (Proteinuria) and/or elevated blood pressure (Hypertension), then it can be labeled as a special subgroup named EPH-Gestosis.. EPH-Gestosis is not one single well defined disease of pregnancy, yet it is a syndrome which involves many body systems e.g., cardiovascular, renal, hepatic, respiratory and central nervous system (El-Kabarity, 2000).

  3. Incidence: EPH-Gestosis is the main cause of maternal mortality and is associated with five-fold increase in perinatal mortality in developing countries (Jaramillo et al., 2001). EPH-Gestosis is primarily a disease of primigravida and is not usually a recurrent condition. EPH-Gestosis occurs in around 10-15 % of first pregnancies and 5-10 % of subsequent pregnancies. Most of the cases are diagnosed after 34th weeks of pregnancy (Robson, 1999).

  4. Classification & Grading:EPH-Gestosis has the following "Modified Gestosis Index" (El-Kabarity's Formula):(El-Kabarity, 2000):

  5. Grading of EPH-Gestosis: • Mild EPH-Gestosis: (Score < 4). • Severe EPH-Gestosis: (Score 4 - 8). • Imminent eclampsia: (score > 8): Severe EPH-gestosis plus mental, visual, auditory hallucinations with cloudiness and/or epigastric pain & vomiting. • Fulminating EPH-Gestosis: Symptoms & signs proceeding from normal to severe or imminent eclampsia within a period of 12 hours or less. • Eclampsia: EPH-Gestosis with convulsive fits. Eclampsia may be antepartum, intrapartum or postpartum.

  6. Management Guidelines of EPH-Gestosis: • Current protocol of management of cases EPH-Gestosis at Ain Shams University Maternity Hospital: • Principles: • Team approach. • Obstetric intensive care management. • Magnesium sulfate administration • Control of hypertension. • Termination of pregnancy after stabilization of the general condition of the patient withliberal tendency towards Cesarean section.

  7. How to reduce maternal mortality due to EPH-Gestosis: • By raising the standard of prenatal (antenatal) care provided to pregnant women with early referral of high risk cases. • Centralization of case management in a tertiary care hospitals. • On admission, all the above mentioned principles and guidelines should be strictly followed.

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