Pregnancy Induced Hypertension, Preeclampsia, Eclampsia

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Information about Pregnancy Induced Hypertension, Preeclampsia, Eclampsia
Health & Medicine

Published on March 11, 2014

Author: mahmoodi2000


Seyed Morteza Mahmoodi

Gestational Hypertension Pre eclampsia and Eclampsia Chronic Hypertension Contents Complications



 Hypertension  Pregnancy-induced hypertension  Gestational hypertension  Transient hypertension of pregnancy  Chronic hypertension  Pre-eclampsia  Eclampsia  Increment of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure (Levine, 2000; North and colleagues, 1999)

Abnormality Nonsevere Severe Diastolic blood pressure <110 mm Hg 110 mm Hg Systolic blood pressure <160 mm Hg 160 mm Hg Proteinuria 2+ 3+ Headache Absent Present Visual disturbances Absent Present Upper abdominal pain Absent Present Oliguria Absent Present Convulsion (eclampsia) Absent Present Serum creatinine Normal Elevated Thrombocytopenia Absent Present Serum transaminase elevation Minimal Marked Fetal-growth restriction Absent Obvious Pulmonary edema Absent Present

-Defective trophoblastic invasion -Immunological maladaptive tolerance -Maternal maladaptation to CV changes in normal pregnancy -Abnormal placentation. -Genetic and nutritional factors

Residual HT Recurrent pre- eclampsia Chronic renal disease

 Injuries  Pulmonary: -Edema -pneumonia, aspiration -ARDS -Embolism  Hyperpyrexia  LVF  RF Hepatic necrosis  Subcapsular haematoma  Cerebral hemorrhage  Disturbed vision  Haematological, DIC Postpartum -Shock -Sepsis -Psychosis

 Insidious, slow course.  Mild symptoms:Mild symptoms: -Ankle edema -Extend to be generalized  Alarming symptoms:Alarming symptoms: Acute onset -Headache -Disturbed sleep -Oliguria -Epigastric pain -Eye symptoms, restlessness.

 Raised BP  Abnormal weight gain,  Oedema.  Pulmonary oedema  Retinal,  Neurological examination,  Abdominal examination,  Secondary and end organ damage,

 EpilepsyEpilepsy  HysteriaHysteria  EncephalitisEncephalitis  MeningitisMeningitis  Puerperal cerebral thrombosis.Puerperal cerebral thrombosis.  PoisoningPoisoning  Cerebral malariaCerebral malaria  Intra-crainal tumours.Intra-crainal tumours.

 Blood values: CBC, serum sodium, potassium, creatinine, and glucose levels, LFT, coagulation profile creatinine.  Urine  Serum uric acid, biochemical marker of pre-biochemical marker of pre- eclampsiaeclampsia.  Serum lipids  Radiological  ECG, EEG  Fetal monitoring

 More than 100 clinical, biophysical, and biochemical tests have been reported to predict preeclampsia  Low-Salt Diet  Fish Oil Supplementation  Antioxidants  CALCIUM SUPPLEMENTATION  ASPIRIN  There is currently no proven way to prevent preeclampsia

 Mild preeclapsia:Mild preeclapsia: -Maternal evaluation (history & ex.) -Lab: CBC & Electrolyte RFT: BUN, creatinine ,uric acid LFT & coagulation profile: PT, PTT, D-diamers Urine analysis 24hhr urine for protein & creatinine clearance.

 Fetal evaluation of CTG, USG, doppler flow.  Bed rest in left lateral decubitus position.  No use of diuretics & AntiHT

 Stabilize & deliverStabilize & deliver, the only cure .  Vaginal induction is preferred.  Admit & complete maternal evaluation. -Keep NPO -Start IV, cross & type -Foley catheter  Monitoring urine output, input & vitals.

 Fetal evaluation: electronic fetal monitoring, doppler flow.  Anticonvulsant therapy: -to seizure thresholdto seizure threshold -baseline Mg bld level -Mg sulfateMg sulfate 4g IV boluse over 20min,. Folowed by maintenance of 2-4g/hr Oliguric pt needs low infusion rate.Oliguric pt needs low infusion rate. Management of severe preeclampsia:

 Signs of Mg sulfate toxicity: -DTR -RR<10/min -Urine output< 25 cc/hr -Decrease muscle tone -CNS or cardiac depression  Antagonist: calcium gluconatecalcium gluconate 10% 10ml, 1g IV over 2min.

 Antihypertensive therapy: -Indicated if BP >140-160/90-110 -Labetalol 20-50mg IV q 10mins. -Methyldopa or nifedipine. ACE-inhibitors avoided.ACE-inhibitors avoided.

 Resuscitation, ABCABC  Oxygen  Arrest convulsions, valium or phenytoin.  Ventilatory support, prevent aspiration, auscultate lungs after every seizure.  Haemodynamic stabilization, control BP.  Send investigation.  Deliver by 6-8hrs.  Postpartum care, intensive.

 Mgsulfate,Mgsulfate, continue to 24hr after last fit.  Lytic coktail regime:Lytic coktail regime: Chlorpromazine, phenergan & pethidine.  AntiHT & diuretics. Status eclampticus:Status eclampticus: thiopentone Na0.5gm, dissolved in 20% dextrose givin slowly.

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