preeclampsia Flashcards
1
Q
clinical signs
A
- mild preeclampsia
i) BP > 140/90 or ↑ in diastolic > 15mm / ↑ in systolic > 30mm
ii) Proteinuria of 1-2 on dipstick or ≥ 300mg/day
iii) edema of face or upper extremities
iv) absence of convulsions, DIC findings
v) mild hemoconcentration , No oliguria, no pulmonary edema, no cyanosis
* fetus growth retardation - severe preeclampsia
i) BP ≥ 160/110 mmHg on 2 occasion at least 6hrs apart
ii) proteinuria > 3-4+ on dipsticks or > 5g/day
iii) clinical sympt
● Headache
● Visual disturbances
● Scotoma
● Epigastric pain
iv) clinical signs
● ↑ BP
● Pulmonary edema
dt ↑ capillary memb permeability, seizures, coma, Cerebrovascular accident, IUGR - mild :
- rise of b/p >140/90 but <160 systole or <110 diastole w/o proteinuria - severe
- sustained rise of b/p of 160 systolic or >110 diastolic or w proteinuria
- presence of adverse sympt eg headache, vomit, oliguria, epigastric pain, cerebral or visual disturbance
- women may hv gen unease n appear unwell
- facial edema may be evident
- peripheral edema may be marked although ‘dry’ pre-eclampsia may exist
- some abd tenderness n hyperflexia
- abd may be smaller than expected n there may be suspicion of oligohydramnios
2
Q
diagnosis
A
- some Ix r done :
● urine for protein testing
● hematological n clotting index
● renal function test
● liver function test
3
Q
lab findings
A
● Oliguria, proteinuria
● Renal failure
● Hepatocellular injury
● Serum transaminase level > 2x N
● Thrombocytopenia
● Coagulopathy
● HELLP synd ( hemolysis → Hb n Ht ↑, elevated liver enz, low platelet count )
4
Q
Definition
A
- def = is a triad of edema, HT n proteinuria occurring often in nulliparous women after 20th wk of gestation age n near term frequently
5
Q
classification
A
- acc time of onset
1. during preg after 20th wk gestation
2. during delivery
3. during puerperium – just after delivery - acc severity
1. mild
2. moderate
3. severe
6
Q
Management
A
- etiologic Tx
- induction of delivery either vaginal or C-section
- abortion in case of failure of other Tx
- if baby is premature < 36wks → give dexamethasone to accelerate the maturity of fetal lung tissue
- Indication for delivery by PgE2 as ergometrin is avoided coz it ↑ HT
● BP > 100mmHg diastolic
● Rising of serum creatinine
● Persistent severe headache
● Epigastric pain
● abN liver function test
● thrombocytopenia
● HELLP synd
● Eclampsia
● abN fetal HR testing - Pathogenetic Tx
- β-blockers eg labetalol, atenolol, metoprolol
- α-blocker eg methyldopa
- CCB wh inhibits Ca2+ entry into slow channels → relaxes sm m n also prevents abruption of placenta eg nifedipine
- vasodilators eg nitroprusside, hydralazine 10-20mg IV
- ACE inhibitors eg captopril, enalapril
- Glanglionic blockers eg reserpine
- removal of immune complexes eg plasmapheresis
- antioxidant wh ↓ tissue hypoxia eg Vit E, A, C Actovigin
- anti-convulsant eg Phenytoin, MgSO4 ( sedative, relaxant of uterus, aniHT, anticonvulsive effect )
- duration of drug Tx depends on severity
● moderate – for 1 wk → no result → etiologic Tx
● severe – 1 day pathogenetic + symptomatic
● eclampsia – 1-2days consist of pre-operative management
● eclampsia w convulsions – intermediate preparation for delivery, intubation + artificial ventilation - Symptomatic Tx
a) CNS
● anticonvulsants therapy eg diazepam, phenobarbitol, MgSO4
● sedatives eg tranquilizers, diazepams in severe cases, bed rest, herbs in mild cases ( Valeriana )
● Neurolept analgesia eg properidan, phentange
- dt hypoxia of adrenal gl → ↓ cortisol production
- dexamethasone to mature fetal lung n development of sulfactant
- lucin is susceptible to hepatic necrosis thus use hepatoprotectors
b) Lungs
● O2 therapy eg hyperboric O2
c) CVS
● Avoid diuretics coz can cause heart failure
● Infusion therapy w colloid, crystalline of plasma n albumin, vol expanders
