Hypertensive Disorders in Pregnancy PDF

PREECLAMPSIA AND ECLAMPSIA Presented by NSENGA BAKINAHE LECTURER CHUK  PLAN INTRODUCTION DEFINITION RISK FACTORS PATHOPHYSIOLOGY CLINICAL PRESENTATION COMPLICATIONS INVESTIGATIONS MANAGEMENT  1.INTRODUCT...

PREECLAMPSIA AND ECLAMPSIA Presented by NSENGA BAKINAHE LECTURER CHUK  PLAN INTRODUCTION DEFINITION RISK FACTORS PATHOPHYSIOLOGY CLINICAL PRESENTATION COMPLICATIONS INVESTIGATIONS MANAGEMENT  1.INTRODUCTION Preeclampsia occurs in approximately 4-10% of all pregnancies. in 20-25% of women with chronic HTA 10% of preeclampsia occur in pregnancies of discontinue the drug , 1g of cagluconate MgSO4 is discontinued 24 hr after delivery once started  B.Acute treatment of severe hypertension in pregnancy The goal of HTA treatment is to maintain BP around 140/90-105 mm Hg. Medications used for BP control : Hydralazine Labetalol Nifedipine alpha methyl dopa  Hydralazine is administered in 5 - 10mg doses at 15- to 20-minute intervals until a satisfactory response is achieved: a decrease in diastolic blood pressure to 90 to 100 mm Hg(CO=BP/PR) Nifedipine short acting 10-mg oral dose to be repeated in 20-30 minutes if necessary Max dose 120mg daily Aldomet 250mgTID max 2g/24h  C.IV fluids management Diuretics should be avoided risk of hypovolemia---fetal acidemia … Aggressive volume resuscitation may lead to pulmonary edema …kydney are compromised Patients should be fluid restricted when possible Total fluids should generally be limited to 80 -100mL/hr or 1 mL/kg/hr  D.Delivery Delivery is the only cure for preeclampsia: Mild preeclampsia: - IOL after 37 weeks of GA. - Before 37weeks of GA: Hospitalization and monitoring of worsening preeclampsia or complications of preeclampsia, Corticosteroids(less than 34 weeks of GA) for lung maturity in preparation for early delivery. Severe preeclampsia: - IO delivery should be considered after 34 weeks of GA. -The severity of disease must be weighed against the risks of infant prematurity. -In the emergency setting, control of BP and seizures should be priorities and deliver  9.REFERENCES Williams Obstetrics 22 Edition Uptodate Preeclampsia: Clinical features and diagnosis J Turk Ger Gynecol Assoc. 2010; 11(2): 115–117. http://apps.who.int/iris/bitstream EMEDICINE.MEDSCAPE.COM