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Case presentation: Eclampsia

Case presentation: Eclampsia. By R2 王鎮華. Brief history . A 30y/o female G1P0, GA:33+ weeks Hypertension and proteinuria since AP 11 w Prenatal examination at a local clinic. Brief history. Dyspnea occurred 2 days ago Dyspnea recurred with conscious change

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Case presentation: Eclampsia

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  1. Case presentation: Eclampsia By R2 王鎮華

  2. Brief history • A 30y/o female • G1P0, GA:33+ weeks • Hypertension and proteinuria since AP 11 w • Prenatal examination at a local clinic

  3. Brief history • Dyspnea occurred 2 days ago • Dyspnea recurred with conscious change • BT:36.1,HR:110,BP:221/173,RR:44, SpO2:78,BW:>90Kg • Breath sound:coarse and crackle over bilateral lungs

  4. Brief history • Seizure attack at our ER • On endotracheal tube • Impression:Eclampsia • ASA:4

  5. Brief history • HR:112, BP:165/120, SpO2:98 when arrived at OR • On A-line, CVP before induction • CVP:12 • Induction agent:Fentanyl,Nimbex • Tidal volume:500ml, PEEP:6cmH2O, airway pressure:30cmH2O after induction

  6. Brief history • Frothy secretion flowed through endotracheal tube • SpO2 dropped slowly from 98% to 92% • Suction+Lasix 1 amp • Everything went well until birth of the baby • BP dropped quickly from 142/80mmHg to 68/48mmHg

  7. Brief history • IV fluid fully ran • Intermittent bolus of levophed • Dopamine ran 12mic g/Kg/min • Operation duration:75min. • Intake:1200ml, urine output:300ml • The patient was transferred to ICU after operation(HR:100, BP:110/78, SpO2:97)

  8. Eclampsia • Preeclampsia+seizure • Preeclampsia may present as a syndrome of multiorgan failrue including neurologic, renal, liver, hematologic, cardiorespiratory, and fetoplacental abnormalities • Definition of preeclampsia:hypertension, proteinuria>300mg/24hr,oliguria, elevated liver enzymes,headache,visual disturbances, hematologic disturbances, intrauterine growth retardation

  9. Classification of preeclampsia:Mild and Severe • Systolic pressure <160mmHg • Diastolic pressure <110mmHg • Urinary protein <5g/24hr,dipstick+or2+ • Urine output >500ml/24hr • No headache • No visual disturbance

  10. Classification of preeclampsia:Mild and Severe • No cyanosis • No HELLP syndrome • Platelet count>100,000/mm3 • No pulmonary edema

  11. Pathophysiology of preeclampsia • The pathogenesis of preeclampsia is incompletely understood. • Anatomic changes in blood vessels of placental bed • Acute atherosis:partial luminal obstruction by lipid-laden cells • Endothelial perturbation and altered vascular reactivity

  12. Pathophysiology of preeclampsia • Augmented release of a host of vasoconstrictors (platelet-derived thromboxane, endothelin, catecholamines) • The expression of cell adhesion molecules • Postmortem studies reveal evidence of vascular injury ( interstitial edema, intravascular dehydration, intensified peripheral vasospasm,diminished perfusion )

  13. Clinical presentation of preeclampsia • A non-life-threatening disease for most women that resolves on delivery • Leading causes of maternal mortality: eclampsia,pulmonary complications, HELLP syndrome and renal failure

  14. Principles of management for eclampsia • Prevent recurrent seizures • Control airway • Plasma volume expansion • Control hypertension • Termination of the pregnancy always secures remission of the disease

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