Eclampsia Flashcards
Name 2 main causes death in gestational hypertension
- Cerebral haemorrhage: control dangerous ht
- pulmonary edema:fluid overload
Name 7 risk factors gestational hypertension
History
- Prior pre-eclampsia
Comorbidities
- chronic ht
- pre-gestational diabetes
- maternal BMI > 35
- anti-phospholipid syndrome /sle
Current Pregnancy
- multiple gestation
- assisted reproduction
Treatment gestational hypertension (2)
- Calcium supplement 500g
- start aspirin at 12-14 weeks (up to 20/52)
Alpha methyldopa 500mg oral 8 hourly
Define and manage gestational pre-ht
Bp 130 - 139 / 85 - 89
- repeat after 30 min - 2 hours
- if persistent review after 3-7 days
- if normal follow up as low risk
Define hypertension in pregnancy
Systolic 140 or more
Or diastolic 90 or more
On >2 occasions at least 2 hours apart
Severe > 160 /110
Before 20 weeks
Define gestational hypertension
Systolic 140 - 160
Or diastolic 90 - 110
Without proteinuria
On >2 occasions at least 2 hours apart
After 20 weeks
Define pre-eclampsia (7)
Ht after 20 weeks with 1 or more:
- proteinuria!
- renal impair: creatinine > 100; doubling creatinine
- liver impair: transaminases x2 normal
- haematological impair: platelets <100
- neurological impair: cerebral /visual symptoms
- growth restriction
- Pulmonary oedema
Management hypertension in pregnancy?
- Alpha methyldopa 500 mg TDS (aldomet)
- refer to District Hospital within 3 days to check bp, urine
Or nifedipine, labetolol, prazocin (third line)
Management pre-eclampsia (9)
- Stabilise mom then deliver fetus if needed; terminate pre-viable, call a CAB
- cab, position, iv, big 5 forgotten 4 core 1
- when stable, monitor fetus with 6 hourly ctg - treat and prevent fits (mgso4)
- treat dangerously raised bp. Repeat in 20 min
- attention to fluid balance
- loading dose 200 ml NaCl
- maintain ringers ml /h
- if output <30 / h give 200 ml ringers bolus
- still < 30 - continue iv at 80 ml /h without further boluses otherwise will cause cerebral + pulmonary oedema. No diuretics! (Capillary leak) - prevent complications; assess foetus. If prem, steroids. Admit to high care
Define severe pre-eclampsia (5)
- Bp 160/110 or more, or
- proteinuria 3+ or
- symptomatic pre-eclampsia / imminent eclampsia (headache, visual disturbances, nausea vomiting, epigastric pain,jittery)
- HELLP syndrome
- AKI
- pulmonary oedema
- CNS dysfunction: cerebral/visual disturbance, severe headache, altered mental status
Dose mgso4? (4)
Loading dose 14g
- 4g in 200 ml ns iv over 20 minutes
- 5g with 1 ml 2% lignocaine IM in each buttock
Maintenance
- 5g with 1 ml 2% lignocaine IM every 4 hours until 24 hours after birth or 24 hours after last convulsion
Recurrence
- additional 2g iv over 10-15 minutes
When should maintenance dose of mgso4 not be given and what is given instead
- first sign toxicity: Absent knee jerk
- urine output < 25 ml /h or <100 ml in last 4 h
- Rr <16
If rr < 16, stop mg. Give calcium gluconate 10% 1g iv over 10 minutes
Name 4 indications mgso4
- Severe pre-eclampsia
- imminent eclampsia
- Eclampsia
- concern when transferring
How manage severe ht > 160/110 in pregnancy ( at risk cva) (2)
Oral nifedipine 10 mg po (ccb)
- repeat every 30 min
- max 4 doses or until bp < 160/110
And/or
Parental labetalol 20,40, 80, 80 and 80 mg (max 300 mg )
- bolus every 10 minutes until bp < 160/110
Name 3 contraindications nifedipine
- Pulse > 120
- cardiac lesion
- unable to swallow (oral med)
Name 2 contraindications labetolol
- Asthma
- IHD
How do organ system evaluation when resuscitating? (10)
Big 5
- CNS: avpu
- CVS
- resp
- liver, git
- Renal
Forgotten 4
- haematological: hb, plt
- immunological: HIV, temp
- endocrine: glucose
- musculoskeletal: DvT
Core 1
- abdo
Core 2
- vaginal
Name 5 indications to deliver in pre-eclampsia
Only once mom stable
- Imminent/ eclampsia after MgS04,
- can’t control bp,
- deteriorating organ function
- fetal compromise,
- known foetal maturity
Define HELLP syndrome
- Haemolysis (ldh 600 or more, or bili 0,2 or more
- elevated liver enzymes (ast/alt 70 or more)
- low platelet count 100 or less
Treatment is always delivery
Maternal biochemical testing in pre-eclampsia? (6)
- Urinalysis: protein to creatinine ratio
- Pulse oximetry
- hb, platelet count
- urea and creatinine
- AST or alt
- LDH (elevated = severe prognostic marker. Signal cellular death /haemolysis. )
Foetal testing in pre-eclampsia? (3)
- Ctg if viable every 6 hours
- ultrasound for foetal growth
- Doppler of umbilical cord , middle cerebral arteries, ductus venosus
Name complications pre-eclampsia/eclampsia during pregnancy (9)
- End organ damage
- abruptio placenta
- preterm labour
- still birth
- cerebro vascular accident
- convulsions
- HELLp syndrome
- occipital lobe blindness
- DVT
Name complications pre-eclampsia/eclampsia after pregnancy (5)
- pph
- ht later in life
- ischaemic heart disease later in life
- DvT
- stroke
Initial management eclampsia (6)
- Call for help
- call a cab
- position left lateral
- iv access
- mgso4
- big 5, forgotten 4, core 1
