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2. Pre- eclampsiaPre- eclampsia ImpendingImpending EclampsiaEclampsia
It is a disease of pregnancy characterized byIt is a disease of pregnancy characterized by
• BP 140/ 90 or more.BP 140/ 90 or more.
• After 20 week gestational age.After 20 week gestational age.
• In previous normotensive pt.In previous normotensive pt.
• Reading taken twice at interval 6 hours.Reading taken twice at interval 6 hours.
•Exclude other causes of 2.ry hypertensionExclude other causes of 2.ry hypertension
(ACDEPR)(ACDEPR)
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3. renal diseaserenal disease
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AA
CC
DD
EE
PP
RR
alcholalchol
coarctation of aortacoarctation of aorta
drugsdrugs
Endocrine diseaseEndocrine disease
PIHPIH

4. DBP110 or moreDBP110 or more
Increase in SBP by 30 mmHgIncrease in SBP by 30 mmHg
Increase in DBP by 15mmHgIncrease in DBP by 15mmHg
2 read of MABP 105 or more OR increase by 202 read of MABP 105 or more OR increase by 20
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But diagnosis can be by:But diagnosis can be by:
This condition is associated with significantThis condition is associated with significant
protienuriaprotienuria

5.  ??????
 Not related to the fetus or uterusNot related to the fetus or uterus
 Failure of placentationFailure of placentation
 Abnormal lipid metabolismAbnormal lipid metabolism
 Decrease CaDecrease Ca++++
in dietin diet
All pathogenesis due to vasospasm & endothelial dysfunction
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Aetiology:Aetiology:

6.  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
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7. SYSTEMIC EFFECTSSYSTEMIC EFFECTS
1.1. CVSCVS
2.2. BloodBlood
3.3. Renal systemRenal system
4.4. LiverLiver
5.5. CNSCNS
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8. INCIDENCE & EPIDEMIOLOGYINCIDENCE & EPIDEMIOLOGY
 Occur in 5-10% pregnancyOccur in 5-10% pregnancy
 Death about 2% in UKDeath about 2% in UK
 Death increase in Eclampsia which occur inDeath increase in Eclampsia which occur in
intrapartum &post partum due to:intrapartum &post partum due to:
-Relax of observation during these period-Relax of observation during these period
-Increase in release of pathogenic factor-Increase in release of pathogenic factor
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9. PRE-ECLAMPSIAPRE-ECLAMPSIA
Symptoms:Symptoms: may bemay be
 AsymptomaticAsymptomatic
 HeadacheHeadache
 Visual disturbanceVisual disturbance
 Epigastric painEpigastric pain
 oedemaoedema
Sign:Sign: may bemay be
 High BPHigh BP
 Fluid retensionFluid retension
 Brisk reflexsBrisk reflexs
 Fundel level less thanFundel level less than
datedate
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10. Symptoms:Symptoms:
 HeadacheHeadache
 Visual disturbanceVisual disturbance
 Epigastric painEpigastric pain
 NauseaNausea
 RestlessnessRestlessness
 SwellingSwelling
 Poor urine outputPoor urine output
signs:signs:
 AgitationAgitation
 HyperreflexiaHyperreflexia
 Facial &peripheralFacial &peripheral
oedemaoedema
 Rt upper quadrantRt upper quadrant
tendernestendernes
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11. EclampsiaEclampsia
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12. CLINICAL FEATURECLINICAL FEATURE
it is grand mal convulsion which pass throughit is grand mal convulsion which pass through
stages of:stages of:
1.1. Tonic contractionTonic contraction
2.2. ClonicClonic
3.3. ComaComa
Usually take about 60-90 seconds.Usually take about 60-90 seconds.
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13. EDEN’S CRITERIA OF SEVERITYEDEN’S CRITERIA OF SEVERITY
 Coma take 6 hours or moreComa take 6 hours or more
 SBP reach 200 mmHgSBP reach 200 mmHg
 Tm 39 or moreTm 39 or more
 Pulse rate 120/minPulse rate 120/min
 RR 40/minRR 40/min
 2 fits or more2 fits or more
All this can end in maternal brain deathAll this can end in maternal brain death
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14. DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS
1.1. EpilepsyEpilepsy
2.2. CVACVA
3.3. SOLSOL
4.4. Drugs reactionDrugs reaction
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15. MANAGMENTSMANAGMENTS
 Aim of it :Aim of it :
1-maintain patent airways1-maintain patent airways
2-prevents the fits2-prevents the fits
3-terminate the pregnancy3-terminate the pregnancy
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16. 1.1. Usually unnecessary to try to stop the initialUsually unnecessary to try to stop the initial
convulsion which usually last about 60-90convulsion which usually last about 60-90
secondsseconds
2.2. IV Diazepam slowly 5mg over 1 minIV Diazepam slowly 5mg over 1 min
3.3. 3. Roll the patient on his left side to avoid3. Roll the patient on his left side to avoid
maternal injurymaternal injury
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17. 4. Apply Suction to the secretion from her mouth4. Apply Suction to the secretion from her mouth
5. Adequate Oxygen should be maintained by face5. Adequate Oxygen should be maintained by face
mask & airways to prevent swallowing of tonguemask & airways to prevent swallowing of tongue
6. Prevent further convulsions by MgSO6. Prevent further convulsions by MgSO44 by IVby IV
bolus of 4 – 6 g over 15 min. If convulsion recurbolus of 4 – 6 g over 15 min. If convulsion recur
further bolus of 2g.further bolus of 2g.
7. Acidosis should be corrected if necessary by IV7. Acidosis should be corrected if necessary by IV
NaHCONaHCO33
8. SBP 170 mmHg or more, DBP 110 mmHg is risk8. SBP 170 mmHg or more, DBP 110 mmHg is risk
factor for CVA so should be lowered by eitherfactor for CVA so should be lowered by either
Nifedipine 10 – 20 mg SL. Or Hydrallazine 5mgNifedipine 10 – 20 mg SL. Or Hydrallazine 5mg
followed by infusion.followed by infusion.
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18. 1.Insert canula size 101.Insert canula size 10
2.Send blood to Lab for Hb, blood2.Send blood to Lab for Hb, blood
group, Platelet count, RFT, LFT, Uricgroup, Platelet count, RFT, LFT, Uric
acid concentration, coagulationacid concentration, coagulation
study, RBSstudy, RBS
3.Urine catheter (to urine output &3.Urine catheter (to urine output &
protein)protein)
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19. 1.Assessment of state of fetus (U/S,1.Assessment of state of fetus (U/S,
Doppler CTG)Doppler CTG)
2.either : - Deliver the baby regardless2.either : - Deliver the baby regardless
of the gestational ageof the gestational age
intense monitoring maternal health inintense monitoring maternal health in
hope of improvement fetalhope of improvement fetal
outcome by increase gestationaloutcome by increase gestational
age.age.
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20. It is attention to fluid balance , BP , RenalIt is attention to fluid balance , BP , Renal
& Hepatic function & CNS& Hepatic function & CNS
1.More aggressive control of BP1.More aggressive control of BP
2.MgSO2.MgSO44 maintained for 48 hrs at 1g/hr ivmaintained for 48 hrs at 1g/hr iv
3.Subcutaneous heparin prophylaxis3.Subcutaneous heparin prophylaxis
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21. 2.permanent CNS damage2.permanent CNS damage
3.Intracranial haemorrhage3.Intracranial haemorrhage
4.Renal failure4.Renal failure
5.Death5.Death
1.During the fit1.During the fit
tounge bittingtounge bitting
head traumahead trauma
bone #bone #
AspirationAspiration
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22. 1.Prematurity1.Prematurity
2.placenta infarction2.placenta infarction
3.IUGR3.IUGR
4.Abruptio placentae4.Abruptio placentae
5.Fetal hypoxia5.Fetal hypoxia
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