PET ECLAMPSIA.ppt

COMPLICATIONS IN PREGNANCY

1. Division of Reproductive Health
PRE-ECLAMPSIA/ECLAMPSIA
PRESENTER:-Mr. MUSINDI
TOPIC:- pet/eclampsia
DATE:- 29
th
september 2010
WELCOME

2. Division of Reproductive Health
LEARNING OBJECTIVES
At the end of the session, health care provider will:
•Define pre-eclampsia and eclampsia
•Identify risk factors for pre-eclampsia and
eclampsia
•Diagnose and classify pre-eclampsia
•Diagnose eclampsia
•Manage a woman with pre-eclampsia and
eclampsia
•Referral

3. Division of Reproductive Health
Epidemiology
•This is the third most common cause of
maternal mortality worldwide and in Kenya
as well.
•Eclampsia is estimated to occur in about 1
in 100 -1700 deliveries
•In Kenyatta National Hospital the
incidence of eclampsia among 14,730
deliveries over a two-year period (Jan
1999 -Dec 2000) was 147, approximately
10 per 1000 deliveries

4. Division of Reproductive Health
Statistics from Webuye district hospital as from January 2010-september
2010;
Month
2010
Admissions DeliveredP.E.TEclampsiaM/Deaths
Jan 341 253 42 0
Feb 282 213 60 0
Mar 422 286 43 0
Apr 345 245 66 1
May 381 318 73 1
Jun 340 274 43 1
July 381 323 51 1
Aug 406 311 41 0
Sept 71 1
TOTAL2898 2223 4720 5
(10%)

5. Division of Reproductive Health
Risk Factors for Pre-eclampsia
•Nulliparas
•Maternal age >40
•Twin gestation
•Family history of
pre-eclampsia or
eclampsia
•Chronic
hypertension
•Chronic renal
disease
•Diabetes mellitus
•Angiotensin gene
T235

6. Division of Reproductive Health
Pre-Eclampsia
•WHOdefines pre-eclampsia as "A
condition specific to pregnancy, arising
after 20th week of gestation,
characterised by hypertension (BP
>140/90) and Proteinuria. Oedema may
also be present“
•Hypertension and Proteinuria must be
present on two occasions >6 hr apart

7. Division of Reproductive Health
Eclampsia
•Eclampsia is a condition peculiar to
pregnant or newly delivered women.
•It is characterized by convulsions (fits) in
the absence of other medical conditions
predisposing to convulsions.
•The woman usually has pre-eclampsia
(hypertension and Proteinuria).
•The fits may occur in the ante-partum,
intra-partum or post-partum periods.

8. Division of Reproductive Health
Clinical picture of Pre-eclampsia and Eclampsia
ײPresentAbsentDiminishedfoetal
Movement
ײPresentAbsentOliguria
ײPresentAbsentUpperabdominalpain
ײPresentAbsentVisualdisturbance
ײPresentAbsentHeadache
ײ2+orgreater
Persistently
present
Traceor1+
Absent
Proteinuria
Generalisedoedema:
includingfaceand
hands.
As in severe pre-
eclampsia plus
fits
Rises>20mmHgor
absolutelevelis
>100
Rises15-20mmHg
orabsolutelevelis
>90but<100
Diastolicblood
pressure
EclampsiaSevere
Pre-eclampsia
Mild
Pre-eclampsia
Finding

9. Division of Reproductive Health
ECLAMPTIC MOTHER IN COMA

10. Division of Reproductive Health
Laboratory investigations
Routine tests include
•Full haemogram
•Platelet count
•Urinalysis for
Proteinuria
•Urea and electrolytes
•Liver function tests
•Serum Creatinine
levels
•Uric acid
•24hr urine for protein
•Coagulation screen
•Tests to rule out other
causes of convulsions
e.g. malaria, epilepsy,
meningitis
•Obstetric Ultrasound
scan

11. Division of Reproductive Health
Management of mild PET
•Establish if the mother can rest at home
•Advise patient and relatives on importance of bed rest
•Give oral anti-hypertensive (Aldomet 250mg three
times daily) Maintain diastolic BP at 90-100 mmHg
•Monitor maternal and foetal condition weekly
•Admit if coming too far away from hospital advise on
worsening signs of the conditions and should report if
any be present
•If no improvement refer to hospital if at a health centre
•Deliver at 37 completed weeks

12. Division of Reproductive Health
33-34 weeks
Delivery
Delivery Decisions -Severe Preeclampsia
Maternal deterioration?
Severe IUGR?
Fetal compromise?
In labor?
>34 weeks gestation?
28-32weeks
•Corticosteroids
•Antihypertensive drugs
•Daily evaluation of
maternal and fetal
conditions until 33-34
weeks
Yes Delivery
within 24
hours
Amniocentesi
s
Immature fluid
•Corticosteroids
•Deliver 48
hours later
Mature fluid
No
Adapted from University of Tennessee, Memphis, management plan for patients with
severe preeclampsia, Sibai, BM, in Obstetrics: Normal and Problem Pregnancies, 3
rd
Edition, Gabbe, SG, Niebyl, JR, Simpson, JL.

13. Division of Reproductive Health
Magnesium sulphate schedules for severe pre-eclampsia and eclampsia 1
•Loading Dose
•Magnesium sulphate 20% Solution, 4g IV for 10-15
minutes
•Follow promptly with 10g of 50% magnesium sulphate
solution, 5g in each buttock as deep IM injection with
1mL of 2% Lignocaine in the same syringe
•Ensure that aseptic technique is practised when giving
magnesium sulphated deep IM injection. Warn the
woman that a feeling of warmth will be felt when
magnesium sulphate is given.
•If convulsions occur after 15 minutes, give 2g
magnesium sulphate (50% solution) IV over 5 minutes

14. Division of Reproductive Health
Magnesium sulphate schedules for severe pre-eclampsia and eclampsia 2
Maintenance Dose
•5g magnesium sulphate (50% solution) + 1 mL
lignocaine 2% IM every 4 hours into alternate
buttocks. Continue treatment with magnesium
sulphate for 24 hours after delivery or at the last
convulsion, whichever occurs last.
Before repeat administration, ensure that:
•Respiratory rate is at least 16 per minute
•Patellar reflexes are present
•Urinary output is at least 30 mL per hour over
preceding four hours

15. Division of Reproductive Health
Magnesium sulphate schedules for severe pre-eclampsia and eclampsia 3
WITHHOLD OR DELAY DRUG IF:
•Respiratory rate falls below 16 per minute
•Patellar reflexes are absent
•Urinary output falls below 30mL per hour over the
preceding 4 hours
KEEP ANTIDOTE READY:
•In case of respiratory arrest:
•Assist ventilation (mask and bag, anaesthesia
apparatus, intubation)
•Give Calcium Gluconate 1g (10mL of 10% solution) IV
slowly until respiration begins to antagonise the effects
of magnesium sulphate.

16. Division of Reproductive Health
Management of fitting patient:
•Patient should be put in semi prone position so
that mucous and saliva can drain out
•Tight fitting dresses around the neck should be
loosened or removed
•Clean mouth and nostrils gently and remove
secretions (Dentures should be removed if
possible)
•No attempt should be made to insert any
instrument into the mouth

17. Division of Reproductive Health
Management cont..
•Give Oxygen (if available) continuously
during fit and for 5 minutes after each fit
•Fitting should be allowed to complete its
course without physically attempting to hold
the patient down.
•Privacy and dignity of patient must be
observed -pull screens around her.
•Administer diazepam or magnesium
sulphate as per regime to control fits

18. Division of Reproductive Health
Prevention and control
( no proven benefits)
•Correct nutritional deficiencies
–Magnesium
–Zinc
–Omega 3 fatty acids
•Change prostacyclin / thromboxane
balance:
–Aspirin (only beneficial in low risk
groups)

19. Division of Reproductive Health
Nursing care;
•Admit patient if severe PET
•Bed rest-Nurse patient in Semi prone
position (helps secretions to drain easily)
•Ensure a clear airway
•Administer antihypertensive as indicated
•Take & Monitor vital signs ½ to 1 hourly

20. Division of Reproductive Health
CARE CONT;
•Watch for impending eclampsia signs i.e.
(continuous rising Bp, increasing oedema of
the face and hands, heavy Proteinuria,
Oliguria, headache and visual disturbances,
vomiting, epigastric pains, reduced fetal
movements)
•Take samples for lab. Investigation-
urinalysis, full haemogram

21. Division of Reproductive Health
CARE CONT;
•Monitor urinary output
•Fluid balance chart daily. 85mls total / hr
input: fluid overload leads to oedema and
sometimes ARDS( Adult respiratory distress
syndrome).
•Avoid:-undue noise, bright light, painful
procedure, discomfort, full bladder, strained
position in bed.
•Prepare patient for C/S if indicated
•Document findings & procedures done

22. Division of Reproductive Health
THE END;
QUOTE OF THE WEEK:-
KINDNESS IS AN INTEGRAL
VIRTUE FOR A REAL
MEDICAL PRACTITIONER
‘’MERCI’’
THANKS FOR LISTENING!!