ECLAMPSIA

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Eclampsia

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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)

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renal disease A C D E P R alchol coarctation of aorta drugs Endocrine disease PIH

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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 But diagnosis can be by: This condition is associated with significant protienuria

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??? Not related to the fetus or uterus Failure of placentation Abnormal lipid metabolism Decrease Ca++ in diet All pathogenesis due to vasospasm & endothelial dysfunction Aetiology:

Risk facctors: Primigravida age Past history Change the husband Condition in which placenta enlarge Pre-existing disease Low socioeconomic Risk factor decrease : Smokers Prolong exposure to paternal antigen

Systemic effects : 

Systemic effects CVS Blood Renal system Liver CNS

Incidence & Epidemiology : 

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

Pre-eclampsia : 

Pre-eclampsia Symptoms: may be Asymptomatic Headache Visual disturbance Epigastric pain oedema Sign: may be High BP Fluid retension Brisk reflexs Fundel level less than date

Impending eclampsiatransitional condition characterize by increase in : 

Impending eclampsiatransitional condition characterize by increase in Symptoms: Headache Visual disturbance Epigastric pain Nausea Restlessness Swelling Poor urine output signs: Agitation Hyperreflexia Facial &peripheral oedema Rt upper quadrant tendernes

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Eclampsia

Clinical feature : 

Clinical feature it is grand mal convulsion which pass through stages of: Tonic contraction Clonic Coma Usually take about 60-90 seconds.

Eden’s criteria of severity : 

Eden’s 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

Differential diagnosis : 

Differential diagnosis Epilepsy CVA SOL Drugs reaction

Managments : 

Managments Aim of it : 1-maintain patent airways 2-prevents the fits 3-terminate the pregnancy

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Usually unnecessary to try to stop the initial convulsion which usually last about 60-90 seconds IV Diazepam slowly 5mg over 1 min 3. Roll the patient on his left side to avoid maternal injury

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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.

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After resuscitation 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)

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After the mother become stable 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.

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Post natal management 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

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Maternal complications of eclampsia 2.permanent CNS damage 3.Intracranial haemorrhage 4.Renal failure 5.Death 1.During the fit tounge bitting head trauma bone # Aspiration

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Causes of Neonatal death 1.Prematurity 2.placenta infarction 3.IUGR 4.Abruptio placentae 5.Fetal hypoxia

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THE END