www.doctor.

sd
 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)
 www.doctor.sd

A alcho
C lcoarctation of
D aorta
drugs
E Endocrine
P disease
PIH
R renal disease
 www.doctor.sd

But diagnosis can be

by:
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

This condition is associated with significant

protienuria
 www.doctor.sd

Aetiology:

???
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

Risk facctors: Risk factor

Primigravida decrease :
age Smokers
Past history Prolong exposure to
Change the paternal antigen
husband
Condition in which
placenta enlarge
Pre-existing
disease
Low socioeconomic
 www.doctor.sd

SYSTEMIC EFFECTS

1. CVS
2. Blood
3. Renal system
4. Liver
5. CNS
 www.doctor.sd

INCIDENCE & EPIDEMIOLOGY

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

PRE-ECLAMPSIA

Symptoms: may be Sign: may be

Asymptomatic High BP

Headache Fluid retension

Visual disturbance Brisk reflexs

Epigastric pain Fundel level less

oedema than date

 www.doctor.sd

Symptoms: signs:
Headache Agitation

Visual disturbance Hyperreflexia

Epigastric pain Facial &peripheral

Nausea oedema
Restlessness Rt upper quadrant

Swelling
tendernes
Poor urine output
 www.doctor.sd

Eclampsia
 www.doctor.sd

CLINICAL FEATURE

it is grand mal convulsion which pass

through stages of:
1. Tonic contraction

2. Clonic

3. Coma

Usually take about 60-90 seconds.

 www.doctor.sd

EDENS CRITERIA OF SEVERITY

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

DIFFERENTIAL DIAGNOSIS

1. Epilepsy
2. CVA
3. SOL
4. Drugs reaction
 www.doctor.sd

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

1. Usually unnecessary to try to stop the

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

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)
 www.doctor.sd

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.
 www.doctor.sd

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
 www.doctor.sd

1.During the fit

tounge bitting
head trauma
bone #
Aspiration

2.permanent CNS damage

3.Intracranial haemorrhage
4.Renal failure
5.Death
 www.doctor.sd

1.Prematurity
2.placenta infarction
3.IUGR
4.Abruptio placentae
5.Fetal hypoxia
www.doctor.sd