Pre-eclampsia And Eclampsia

Question 1

Definition of preeclampsia

Answer 1

The presence of hypertension of at least 140/90 mm Hg recorded on two separate occasions at least 4 hours apart and in the presence of at least 300 mg protein in a 24 hours collection of urine arising de novo after the 20th week gestation in a previously normotensive women and resolving completely by the sixth postpartum week

Question 2

Classification of Pre-eclampsia

Answer 2

Mild PE
Classification of Pre-eclampsia Severe PE
Diastolic blood pressure 90- <110mmHg
Urine protein <3+
Normal heamatological and
biochemical parameters
No fetal compromise

Severe PE

BP>160/110mmHg
Urine protein > 5grams (3+)
Abnormal haematological and biochemical parameters, abnormal fetal findings

Question 3

Risk factors for PE

Answer 3

Condition in which the placenta is enlarged Diabetes
hydrops
Pre-existing hyertension or renal diseases
Primagravid
Age (<18 years or > 35 years)
Pre-existing vascular disease Diabetes
autoimmune vasculitis Change of partners
Smoking

Question 4

Symptoms & Signs of preeclampsia

Answer 4

Symptoms
1. Headache
2. May be symptomless
3. Visual symptoms
4. Epigastric and right abdominal pain
Signs
1. Hypertension
2. Non dependent oedema
3. Brisk reflexes
4. Ankle clonus (more than 3 beats)
5. Fundal height

Question 5

Investigations of PE

Answer 5

Maternal
Urinalysis by dipstick
24hours urine collection
Full blood count(platelets & haematocrit)
Renal function(uric acid, serum creatinine, urea)
Liver function tests
Coagulation profile

Foetal
Uss (growth parameters, fetal size, AF)
 CTG
 BPP
Doppler

Question 6

Management of preeclampsia

Answer 6

Principles
Management of preeclampsia
Early recognition of the syndrome
Awareness of the serious nature of the condition
Adherence to agreed guidelines(protocol)
Well timed delivery
Postnatal follow up and counselling for future pregnancy
Mild PE aim for term delivery
Severe PE aim for DBP of <100mmHg
NOTE: Delivery is the only cure for preeclampsia

Question 7

Drugs to treat PE and other Hypertensive disorders in pregnancy

Answer 7

Methyl dopa - central acting- Depression Headache Sedation- Late onset 24hours

hydralazine-Direct vasodilator-Direct vasodilator- Drug of emergency

labetalol-Beta & alpha blocker-Nausea Vomiting h.block- Avoid in Asthma and HF

nifedipine - Ca.channel blocker-Severe headache-For quick control of BP

Question 8

Other drugs considered when managing PE & other Hypertensive disorders in pregnancy

Answer 8

Prophylaxis
aspirin 75mg PO OD from around started before PE onset in high risk individuals and stop
around 34-36 weeks GA Prevention of seizures
Magnesium sulphate
LD: Give 4g (20mL) of 20% Magnesium sulphate IV over 5minutes, follow promptly with 10g 50% Magnesium sulphate; give 5g (10mL) of 50% MgSO4 in each buttock as deep IM, add 2mls of 2% Lignocaine in the same syringe
• If convulsions re-occur give 2g (10mL) of 20% Magnesium sulphate IV over 5minutes
MD: Give 5g 50% Magnesium sulphate with 1ml of 2% Lignocaine in the same syringe by deep IM injection into alternate buttocks every 4hrs. Continue treatment for 24hrs after delivery or convulsion whichever comes last.
NOTE: Calcium gluconate 1g intravenously is used for the management of magnesium toxicity.
Fetal lung maturation if GA is less than 34 weeks & prevention of transient tachypnea if scheduled for C-section GA less than 39 weeks
Dexamethasone 12mg IM 12hourly X 4 doses or betamethasone 12mg IM 12 or 24hrly X 2 doses
5/20/202

Question 9

Complications of preeclampsia

Answer 9

ECLAMPSIA
Maternal
CVA
HEELP syndrome
Pulmonary oedema
Adult RDS
Renal failure
Fetal
IUGR
IUFD
Abruptio placenta

Question 10

Definition of eclampsia

Answer 10

Is a life threatening complications of pre-eclampsia, defined as tonic-clonic convulsions in a pregnant woman in the absence of any other neurological or metabolic causes
It is an obstetric emergency
It occurs during antenatal, intrapartum, postpartum (after
delivery 24-48hs)
5/20/2020

Question 11

Management of eclampsia

Answer 11

Turn the patient on her side
Ensure clear airway(suction, mouth gag)
Maintain iv access
Stop fits(mgso4, diazepam)
Control BP(hydralazine, labetalol)
Intake & output chart
Investigations(urine, FBC, RFT, LFT, clotting profile, cross match)
Monitor patient and her fetus
After stabilization(BP controlled, no convulsions,
hypoxia controlled) deliver
5/20/2020

Question 12

Magnesium sulphate

Answer 12

Drug of choice in eclampsia
Given iv, im (depending on protocol for the hospital)
Acts as cerebral vasodilator and membrane stabilizer
Over dose lead to respiratory depression and cardiac arrest
Monitor patient
Tendon reflexes
Respiratory rate (should not be < 16bpm)
Pulse (should not be < 60bpm)
Urine out put (should not be < 100mL/4hrs)
Blood pressure
Antidote cal. gluconate 1g (10ml 10%) IV