Arterial hypertension during pregnancy.ppt

Arterial hypertension

1. Doc.of med.sc., prof.BobikY.Y.,
Lemish N.Y.
Arterial hypertension and
pregnancy

2. Arterial hypertension
- increase of systolic blood pressure by 140 mm Hg. or
higher and / or diastolic blood pressure by 90 mm Hg. or
higher, measured twice at rest with an interval of at least 4
hours, or blood pressure of 160 / 110mm Hg. measured
at least once.

3. Classification of hypertension states during
pregnancy
1. Chronic hypertension – hypertension that was
observed before pregnancy or appeared before 20 weeks
of pregnancy.
2. Gestational hypertension – hypertension, that was
diagnosed after 20 weeks of pregnancy and was not
accompanied by proteinuria.
)
а
Transitory- normalization of the BP in woman
with gestational hypertension during 12 weeks after
delivery
b) Chronic- Hypertension, that appeared after 20
weeks of pregnancyand lasts after 12 weeks after delivery.

4. Classification of hypertensive states during
pregnancy
3. Preeclampsia – hypertension, that appeared after 20
weeks of pregnancy accompanied by proteinuria.
4. Eclampsia – seizures in pregnant woman with
preeclampsia.
5. Accompanied preeclampsia - preeclampsia in case of
accompanied extragenital diseases (chronic hypertension,
renal disease, liver).
6. Unspecified hypertension – hypertension that was
revealed after 20 weeks of pregnancy without evident
information about the BP before 20 weeks of pregnancy.

5. Chronic hypertension
Arterial
hypertension
Systolic BP (mm .
Hg.)
Diastolic BP (mm.
Hg.)
Mild (1 stage) <160 90 - 100
Moderate (2stage) 160 - 180 100 - 110
Severe (3 stage) >180 >110
Isolated systolic >140 <90

6. Chronic hypertension

І
stageEvidence of organic damage to target organs missing

ІІ
stage
There is objective evidence of organic damage to target
organs but without clinical symptoms on their part or
dysfunction:
- Left ventricular hypertrophy (electrocardiogram,
echocardiography);
- Generalized or focal narrowing of the retinal arteries;
- Microalbuminuria or proteinuria, or a slight increase in
creatinine concentration in plasma (up to 177 mmol / l).

7. Chronic hypertension

ІІІ
stage
There is objective evidence of organic damage to
target organs, with the presence of clinical symptoms
or dysfunction:
- Heart - heart attack, heart failure stage IIA or
higher;
- Brain - stroke, transient ischemic attack,
hypertensive encephalopathy, vascular dementia;
- The retina - hemorrhages and exudates in retinal
edema of the optic nerve or without;
- Kidney - concentration in plasma creatinine> 177
mmol / l;
- Vessels - dissecting aortic aneurysm

8. Contraindications for pregnancy in case of
AH
- severe hypertension (grade 3) -
BP> 180/110 mm Hg.;
- Severe damage to target organs:
a) heart (myocardial infarction, heart failure)
b) brain (stroke, transient ischemic attacks, hypertensive
encephalopathy);
c) the retina (exudates and hemorrhages, edema of the optic nerve);
d) Kidney (renal failure);
e) vessels (dissecting aneurysm of the aorta);
- Malignant course of hypertension (diastolic blood pressure> 130 mm
Hg, eye fundus changes by type of neuro retinopathy).

9. Prevention of combined preeclampsia
1. Aspirin 60-100 mg / day, starting from 20 weeks of
pregnancy;
2. medications calcium 2 g / day (in terms of elemental
calcium), ranging from 16 weeks of pregnancy;
3. Inclusion in the diet of seafood high in polyunsaturated
fatty acids;
Do not limit the use of salt and fluid.!!!

10. Symptoms of preeclampsia accession
1. The appearance of proteinuria> 0.3 g / day in the
second half of pregnancy.
2. The progression of hypertension and reducing the
effectiveness of antihypertensive therapy.
3. The emergence of generalized edema.
4. Appearance threatening symptoms (severe persistent
headache, blurred vision, pain in the epigastrium,
hyperreflexia, oliguria).

11. Early detection of pathological
symptoms
1. The daily self-monitoring blood pressure at home with a
written fixation results.
2. Overview of ophthalmoscopy by optician at the first prenatal
visit, at 28 and 36 weeks of pregnancy.

12. Fetal monitoring
1. Ultrasound scan in 9-11, 18-22 and 30-32 weeks.
2. Aktografy - self Registration of daily movements of the fetus after 28
weeks of gestation with a note in the diary.
3. Research on hormonal kolpocytology, and after 30 weeks -
cardiotocography, Doppler placental - fetal blood flow

13. Indications for hospitalization of
pregnant women with chronic
hypertension
1. Uncontrolled severe hypertension, hypertensive crisis
- Occurrence or progression of changes in the eye fundus;
- disorders of cerebral circulation;
- Coronary pathology;
- Heart failure;
- Renal dysfunction.
2. Joining of preeclampsia
3. fetal growth retardation
4. The threat of premature birth

14. Indications for abortion in later
gestational period
malignant hypertension course;
dissecting aortic aneurysm;
acute cerebrovascular or coronary circulation (only after
stabilization of the patient);
early accession of preeclampsia, which is not subject to
intensive care.

15. Medical tactics
Pregnant women with mild to moderate hypertension
who received permanent antihypertensive therapy before
pregnancy, medical treatment after the diagnosis of
pregnancy is abolished. Drugs which are a subject to
withdrawal syndrome (b-blockers, clonidine) are abolished
gradually. Further, a pregnant woman is carefully
observed and informed of the need for daily self-
monitoring of blood pressure at home.

16. Medical tactics
 Patients with severe hypertension, permanent
antihypertensive therapy is continued during pregnancy. If
pregnancy treatment was conducted by angiotensin-
converting enzyme inhibitors or angiotensin receptor
blockers II, the patient is "transferred" to another drug
application that is safe for the fetus.

17. Treatment of hypertension during
pregnancy
A. Non medicational treatment:
    Protection mode (exclusion of significant psychological stress,
rational mode of work and rest, a two-hour rest day);
    Balanced diet (high protein and polyunsaturated fatty acids, limiting
animal fats, cholesterol, foods that cause thirst);
    Psychotherapy (indication);
Not recommended: limit of consumption of salt and fluid, reducing
excess body weight before the end of pregnancy, exercise.
Usefulness bed regime is not proved, even in cases of preeclampsia
accession.

18. Drug treatment of chronic hypertension
 The drug of choice is α-metildofa, because of its proven
safety for the fetus. Assigned by 250-500mh 3-4 times
daily (maximum 3-4 g).
Beta - blockers may affect the fetus and newborn.
(Fetus growth retardation, bradycardia, hypotension,
hypoglycemia, respiratory depression). However, in case
of treatment failure by metildofa labetalol is the possible
appointment taken by 100-400 mg 2-3 times daily or –
atenolol 25-100mg 1 per day.

19. Drug treatment of chronic hypertension
 With some restrictions may be used clonidine (alpha
blockers central agonist) - 0,075-0,2 mh2-4 times, which
can cause withdrawal symptoms in the newborn (agitation,
sleep disorders in the first 3-5 days after birth, large doses -
CNS depression in newborn.
Side effects of the mother - dry mouth, drowsiness,
depression).

20. Drug treatment of chronic hypertension
Hydralazine (10-50 mg 2-3 times) is still very widely
used during pregnancy, especially in the case of severe
pre-eclampsia. Recently, there is an increasing number
of reports of adverse effects on the newborn
(thrombocytopenia) and lack of efficacy in chronic
hypertension, especially in the case of monotherapy.

21. Drug treatment of chronic hypertension
Sodium nitroprusside (v / v infusion 0,25-0,5mkh / kg
/ min.) Is used only for the rapid reduction of blood
pressure in threatening cases under the condition of
ineffectiveness of other means. The maximum duration
of infusion - 4 hours because cyanides are formed in the
body, the concentration of which may reach toxic levels
after 4 hours.

22. Drug treatment of chronic hypertension
Diuretics interfere with physiological fluid retention and lead to
a decrease in CBV below the optimum level. This is especially
dangerous when joining of preeclampsia.
    Are used only in patients with hypertension and heart failure
or renal disease. (mainly thiazide - hydrochlorothiazide).
    Furosemide in early pregnancy may act embryotoxic.
Potassium-sparing diuretics are not appointed to pregnant
women.

23. Drug treatment of chronic hypertension
Inhibitors of the angiotensin-converting enzyme
are strictly contraindicated in pregnant (inhibit fetal renal
excretory function, causing oligohydramnios).
    The patient to be "transferred" to other antihypertensive
agents, immediately after the diagnosis of pregnancy
(preferably at the stage of planning). The same tactic is used
for angiotensin II receptor blockers.

24. Indications for cesarean section in
case of chronic hypertension
Uncontrolled hypertension.
Severe damage to target organs.
Severe intrauterine growth retardation.

25. Contraindications to breastfeeding and
lactation
Malignant hypertension,
Severe damage to target organs.
Temporary contraindications - uncontrolled hypertension.
It is not advisable to use atenolol, clonidine,
angiotensin II receptor blockers., Inhibitors of angiotensin-
converting enzyme are used not earlier than one month
after delivery

26. Late gestosis of the pregnant
hypertension that occurred after 20 weeks of pregnancy, in
combination with proteinuria (protein content of 0.3 g / l in
midstream urine collected twice with an interval of 4 hours
or more, or excretion of 0.3 g protein per day).

27. Preeclampsia is one of the most difficult pathologies of
pregnancy
The frequency is 2.3 - 28.5% and does not tend to decrease
Approximately 50 thousand women die every year in the world
from the causes, related to pregnancy and delivery
Perinatal mortality in gestosis is 3 - 4 times higher than in the the
population and is 18-30% and also does not tend decrease

28. The pathogenesis of late gestosis
Lack of trophoblast invasion.
Pathological transformation of the spiral arteries of the muscular
layer of the myometrium.
The decrease of between villi circulation.
Hypoxia.
Lesions of vascular endothelium.
Violation of production of mediators (reduced prostacyclin,
prostaglandin E, increased prostaglandin F, thromboxane)

29. The pathogenesis of late gestosis
Vascular spasm.
Stasis of blood vessels and increasing discernment.
The increase vascular resistance.
Increased blood pressure:
a) myocardium - reduction in stroke volume;
b) kidneys - reducing filtration proteinuria;
c) CNS - edema, convulsions;
d) the uterus - chronic hypoxia, IUGR.
Aggregation of platelets (DIC).
Hypovolemia.
Impaired function of all organs and systems.

30. Classification of late gestosis
Mild preeclampsia.
Preeclampsia of moderate severity.
Severe preeclampsia.
Eclampsia.

31. Classification of late gestosis
Specific forms of gestosis - HELLP-syndrome
and acute fat hepatosis

32. Peculiarities of combined gestosis
Early start (up to 25 - 30 weeks).
Severe course.
Mono symptoms of exposure.
The presence of atypical clinic manifestations: motor
restlessness, insomnia, paresthesia, weakness and others.
The severity of treatment.

33. Risk factors for late gestosis
 Extragenital pathology: kidney disease, liver disease,
hypertension, systemic connective tissue disease ...
     Obstetric risk factors: LGP in an ancestral history,
LGP during a previous pregnancy, age less than 19,
pregnant and over 30 fetal malnutrition, polyhydramnios,
multiple pregnancy, anemia during pregnancy.
     Social and domestic factors: bad habits, occupational
hazard, not a balanced diet. Single status or remarriage.

34. Management of pregnant women from the risk
groups of developing LGP in women’s
policlinics
 Women at risk of LGP are recommended conception so
that the middle of pregnancy accounted for the summer and
autumn.
Intensive outpatient observation: in the first half of gestation 1
time in two weeks, and the second - 1 per week.

35. Clinical and laboratory criteria for
preeclampsia
 MIld preeclampsia, uric acid <0.35 mmol / l; urea
<4.5 mmol / L; creatinine <75 mmol / l; platelets>
150 × 10 9 / L.
     Preeclampsia of the moderate stage: 0,35-0,45 uric
acid; urea 4,5-8,0; kreatynin75-120; platelets 80-150 x
10 9 / L.
     Severe preeclampsia: uric acid> 0.45; urea> 8.0;
creatinine> 120 or oliguria; platelets <80 x 10 9 / L.

36. Preeclampsia of the mild stage
Diastolic blood pressure less than 100 mmHg., daily proteinuria
less than 0.3 g / day;

37. Management of the pregnant in case of mild
preeclampsia
 Before 37 weeks of pregnancy the supervision in a hospital day
care is possible.
    Training of patient self-measured blood pressure, control fluid
balance and edema, check fetal movements is conducted.
     Laboratory testing: urinalysis, daily proteinuria, creatinine and
urea plasma, hemoglobin, hematocrit, platelet count, coagulation,
ALT and AST, determining fetal (non stress test)
Drug therapy is not prescribed. Do not limit fluid intake
and salt.

38. Indications for hospitalization with mild
preeclampsia
 Gestational age more than 37 weeks;
- The emergence of at least one of the signs of preeclampsia
moderate;
- Violation of the fetus.

39. Preeclampsia moderate severity
Diastolic blood pressure ranging from 100 to 110 mm Hg.
Daily proteinuria 0.3 - 5 g / l,
Edema of the face, hands.

40. Clinical management of pregnant women with
preeclampsia moderate stage of severity
 At pregnancy 37 weeks or more - planned admission to
hospital level II for delivery.
In less than 37 weeks of pregnancy, preeclampsia progression or
breach presentation of the fetus - admission to hospital of III
level.

41. Clinical management of pregnant women with
preeclampsia moderate stage of severity
 Laboratory examination: complete blood count,
hematocrit, platelet count, coagulation, ALT and AST, blood
type and Rh factor (in the absence of precise information),
urinalysis, determination of daily proteinuria, creatinine,
urea, uric acid plasma electrolytes (sodium and potassium),
evaluation of the fetus.

42. Clinical management of pregnant women
with preeclampsia moderate stage of
severity
 Recommended semi bed rest, restriction of physical and
mental stress.
     Nutrition, food with high protein, without restriction of salt
and water, the use of products that do not cause thirst
     Complex vitamins and micronutrients for pregnant women.

43. Clinical management of pregnant women
with preeclampsia moderate stage of
severity
 When diastolic blood pressure> 100 mm Hg - The
appointment of antihypertensive drugs (0.25-0.5 g metildofa to
3-4 times a day (daily dose - 4 g), if necessary - nifedipine 10 mg
2-3 times a day (daily dose - 100 mg ).
     When pregnancy up to 34 weeks for the prevention of
respiratory distress syndrome (RDS) - dexamethasone 6 mg
every 12 hours - four times in 2 days.

44. Close observation
BP Control - every 6 hours the first day, then - twice a day;
Auscultation of the fetal heart every 8 hours;
Urine - daily;
Daily proteinuria - every day;
Haemoglobin, hematocrit, coagulation, platelet count, ALT
and AST, creatinine, urea - every 3 days;
Fetal monitoring: the number of movements for 1 hour,
heart rate - daily;
Assessment of fetal biophysical profile (if indicated);
Cardiotocography (if indicated).

45. Labour management of pregnant women with
preeclampsia of moderate severity
 The method of delivery is determined by the readiness of the
birth canal or fetus condition.
If the cervix is sufficiently mature, labor induction is conducted
and delivery is managed per vias naturalis.

46. Labour management of pregnant women
with preeclampsia of moderate severity
 When failure of conducted preparation of birth canal by
prostaglandins - cesarean section is performed.
     If the condition of the pregnant is stable, blood pressure
values do not exceed the average of moderate preeclampsia
criteria magnesian therapy is not conducted during labour.

47. Transition to management the pregnant by the
algorithm of severe preeclampsia
- Diastolic blood pressure> 110 mm Hg .;
- Occurrence of headache;
- Blurred vision;
- Pain in the epigastric region;
- Signs of liver failure;
- Oliguria (<25 mL / h);
- Thrombocytopenia (<100 · 109 / l);
- Signs of DIC;
- Increased activity of ALT and AST.

48. Severe preeclampsia
 Diastolic blood pressure greater than 110 mm Hg.
     Daily proteinuria greater than 5 g / l;
     Generalized edema, headache, visual disturbances, epigastric
pain, hyperreflexia.

49. Signs of the severe preeclampsia
diastolic blood pressure> 110 mm Hg
headache
visual disturbances (flicker "flies" in front of the eyes
epigastric pain or right upper quadrant
oliguria (<25 mL / h <500 ml per day)
thrombocytopenia (<100 × 10 9 \ l)
signs of DIC
signs of liver failure
increased ALT and AST activity

50. Monitoring the state of the pregnant
women with severe preeclampsia
BP control - every hour
Auscultation of the fetal heart rate - every 15 minutes.
Urinalysis - every 4 hours
Control of hourly urine output
Blood test: Hb, hematokrit, platelets, functional liver function
tests, creatinine plasma - daily

51. Monitoring the state of the pregnant
women with severe preeclampsia
 Estimation of the state fetus: the number of movements
per hour, heart rate, Doppler monitoring of blood flow in
the fetoplacental complex, fetal brain vessels
Assessment of fetal biophysical profile, including fetal
monitor
Determining the amount of amniotic fluid

52. Treatment of severe preeclampsia
Delivery is made on the first day after diagnosis.
Protection mode.
Complex of vitamins and minerals.
When pregnancy up to 34 weeks - prevention of RDS fetus: 6
mg dexamethasone every 12 hours. within 2 days (24 mg).
If necessary, preparation of the birth canal by Prostoglandins.
Antihypertensive therapy (blood pressure brought to 150/90,
160 \ 100 mmHg)

53. Antihypertensive therapy
Antihypertensive therapy is carried out with magnesium therapy if
diastolic pressure is higher than > 110 mm Hg
MEDICATIONS:
Labetalol (lakardiya) - 2 mL, 10 mg i/ v, if no effect, diastolic
pressure remained> 110 mmHg, another 4 ml. BP control in 10
minutes. If no effect 40 mg and 80 mg are injected. (maximum
dose of 300 mg.)

54. Nifedipine - in the absence of labetalol is applicable nifedipine
5-10 mg sublingually (0.5-1 tablet).
Hydralazine (apresyn) - 1 ml (20 mg) solution in 20 ml of
0.9% Sol. NaCl. Is injected slowly every 10 minutes, 5 ml (up to
90-100 mm Hg diastolic pressure). If necessary, is repeated
Methyldopa (dopehit) - 0.25 g * 4 tab. per day (Table 10).
Klonidin (clonidine) - 0.5-1 ml. 0.01% sol. i / v or 1 tablet.
(0.15 mg sublingually 4-6 times)

55. Caution
The rapid and acute decrease of blood pressure can cause
deterioration of the mother and fetus state.
On the background magnesium sulfate usage, the
administration of nifedipine can cause acute hypotension.
On the background of methyldopa (dopehit) usage
thiopental sodium can lead to collapse.

56. Magnesian therapy in severe
preeclampsia
Magnesian therapy - a bolus of 4 g of dry matter of magnesium
sulfate, followed by continuous intravenous infusion at a rate
that depends on the state of the patient.
Magnesium therapy is started after hospitalization if diastolic
blood pressure> 110 mm Hg
The purpose of magnesian therapy - support concentration of
magnesium ions in the blood of pregnant level needed for the
prevention of seizures

57. Magnesian therapy in severe
preeclampsia
Starting dose - 4 g dry matter (16ml of 25% solution of
magnesium sulfate) is injected by a siringe very slowly
within 15 minutes (in the case of eclampsia - within 5
minutes).
Starting dose of magnesium sulfate is dissolved in 0.9%
sodium chloride solution. To do this 4 g of magnesium
sulphate (16ml 25% solution) is injected in a sterile vial
with 34ml of solution.

58. Magnesian therapy in severe
preeclampsia
Maintenance therapy with start with doses of 1g start
dry matter magnesium sulfate per hour. With this speed
the introduction of magnesium concentration in serum
reaches 4-8 mmol / l (therapeutic concentration) in 18
hours. When administered at 2 g / h. - 8 hours and at a
rate of 3 g / h. - 2 hours.
  These speed injection of magnesium sulphate are
possible only under conditions of normal urine output

59. Magnesian therapy in severe
preeclampsia
Signs of magnesian intoxication are possible even
against therapeutic concentrations of magnesium in
plasma in combination with other drugs, especially
calcium channel blockers.
With signs of toxicity magnesium sulfate administered 1
g calcium gluconate (10 ml of 10% solution) / v, which
should always be at the bedside.

60. Diasepam administration algorithm
The starting dose of 10 mg (2 ml) intravenously for 2 minutes in 10 mL of
0.9% sodium chloride solution. If seizures resumed or did not stop repeat the
starting dose. In excess doses of 30 mg for 1 hour may be depression or apnoe
of the patient!
Maintenance dose of 40 mg dissolved in 500 mL of 0.9% sodium chloride
solution and injected i/v (6-7 drops per minute). If necessary, the daily dose
can be increased to 80 mg. Perhaps intramuscular injection of 10 mg of the
drug to every 3-4 hours.
Rectal administration of the inability to provide intravenous diazepam 20
mg should be dissolved in 10 mL of 0.9% sodium chloride solution, introduce
a syringe with a solution to the rectum to half its length and injected the
contents.

61. Infusion therapy in case of severe gestosis
The condition of adequate infusion therapy is strict control of volume of
administered and drunk fluids and urine output. Diuresis must be at least 50
ml / h.
The total volume of fluid injected must meet the daily physiological needs of
women (average 30-35ml / kg).
The speed of the fluid should not exceed 85 ml / h.
Drugs of choice of infusion therapy until the delivery is isotonic saline (Ringer,
NaCl 0,9%).
If necessary, restore the CBV is possible by solutions of hydroxyethyl 6% or
10%.
Before infusion-transfusion programs it is appropriate to include frozen donor
plasma

62. Management of labor
In case of “ready” birth organs amniotomy is done with
ongoing labor induction by oxytocin.
Delivery is carried out based on obstetric situation.
Preferred delivery through the birth canal with adequate
anesthesia (epidural anesthesia or nitrous oxide
inhalation).
If unprepared cervix and no effect of preparation by
prostaglandins, or if the progression of hypertension,
threatening seizures, worsening fetus condition delivery is
carried out by caesarean section.

63. Labor management
The indication for elective caesarean section in case of severe pre-eclampsia
or preeclampsia is progressing deterioration of the fetus state in pregnant in
case of immature birth canal.
With the deterioration of the pregnant woman or the fetus in the second
stage of labor forceps or vacuum extraction is carried out against the
background of adequate anesthesia.
In the third stage of labor - uterotonic therapy to prevent bleeding (oxytocin
intravenously).
Metylerhometyn is not applied!

64. Eclampsia
The appearance of seizures (one or more) on the
background of different severity of preeclampsia

65. Eclampsia
The high risk signs of eclampsia: severe headache, high hypertension (diastolic
blood pressure> 120 mm Hg), nausea, vomiting, blurred vision, pain in the right
upper quadrant and / or epigastric region.
The main objectives of emergency:
- Termination of the seizures;
- Restoration of the respiratory function.
Tasks of intensive care after termination of seizures:
 Prevention of recurrent seizures;
 Elimination of hypoxia and acidosis (respiratory and metabolic)
 Prevention of aspiration syndrome;
 Immediate delivery

66. First aid in case of eclampsia
Treatment begins in a place where the seizures started.
Hospitalization in ICU.
The patient is placed on a flat surface. The mouth is opened, respiratoty
pathways are released, introduced duct.
Inhalation of 100% oxygen ventilation.
Catheterization of vein and bladder.
I/V administered in 4 g of magnesium sulfate for 5 min. (16 ml. 25% district)
then 1.2 grams per hour.
If the seizures do not disappear additionally injected 8 ml. Sol. magnesium
sulfate, or 2 ml. diazepam (Seduxen, relanium, sibazon).
Do not use ketamine!

67. Investigation
Is done after the seizures termination.
Consultation neurologist and ophthalmologist..
Laboratory tests: complete blood count (trobmocyty,
hematocrit, hemoglobin, coagulation time), total protein,
albumin, glucose, urea, creatinine, transaminases,
electrolytes, levels of calcium, magnesium, and fibrinogen
degradation products, prothrombin and prothrombin time
analysis urine, daily proteinuria
Monitor of blood pressure, urine output hourly definition,
evaluation of clinical symptoms with compulsory
registration in the births history every hour.

68. Indications for mechanical
ventilation of lungs
Absolute:
Eclampsia during pregnancy.
Eklamptic coma or eklamptic status.
Acute RDS of adults.
Convulsive readiness on the background of surface anesthesia.
The combination of preeclampsia with shock of any origin.
Relative:
DIC.
Blood loss during surgery than 15 ml / kg.

69. Indications for cessation of
mechanical ventilation
Full recovery of consciousness.
Absence seizures without the use of anticonvulsants.
The stabilization of hemodynamics.
Termination of the action of muscle relaxants.
The absence of RDS adults.
Normal coagulation.
Hemoglobin of 80 g / l.

70. Delivery is performed immediately.
If obstetric situation does not allow for immediate delivery through the
vaginal route (eklamptic attack occurred in the second stage of labor) - C-
section.
Delivery is carried out immediately after the elimination of seizures on the
background of continuous administration of magnesium sulfate and
antihypertensive therapy.
With the continuing seizures prompt delivery is carried out after the transfer
of the patient to the mechanical ventilator.
After the surgery ventilation is continued to stabilize the patient.
After birth, treatment continues according to the patient state. Magnesium
therapy should continue for at least 48 hours.

71. Observation of a woman who suffered
preeclampsia / eclampsia / after discharge from the
maternity hospital
In a women's clinic involving therapist conducting clinical supervision for a
woman who suffered of medium or severe preeclampsia or eclampsia:
- Nursing home,
- Consultation of relevant specialists
- Comprehensive examination 6 weeks after birth.
Women who need treatment by antihypertensive drugs after discharge from the
maternity hospital are weekly reviewed with mandatory laboratory control of
proteinuria and creatinine concentration in blood plasma.
Incase of continued hypertension within 3 weeks of postpartum period women
are admitted to therapeutic department.
The duration of clinical supervision after undergoing of medium or severe
preeclampsia or eclampsia - 1 year.

72. The extent and terms of
examination after birth
 urinalysis - at 1, 3, 6, 9 and 12 months after
birth;
complete blood count - at 1 and 3 months;
ophthalmoscopy - at 1, 3 and 12 months;
ECG - 1 month, then - by appointment of the
therapist;
measuring blood pressure - each time you visit
your doctor of any profile.

73. New approaches to the tactics of
women with preeclampsia
Excluded the following criteria:
- Increased blood pressure during pregnancy - systolic of 15 mm Hg
- Moderate swelling of the legs, abdomen and face.
What matters is only the value of diastolic blood pressure.
Medication antihypertensive therapy not be initiated if the BP.
<150/100 mm Hg. c.
Drug of choice of antihypertensive agents are metildofa, nifedipine,
labetalol; second row: clonidine, verapamil, hidrolazyn, prazosin.
Proved harmful restriction of salt and fluid.
Proved that magnesium sulfate prevents and cures eclampsia.
The only radical treatment for pre-eclampsia and eclampsia is
delivery.