PREECLAMPSIA .pptx

A description of Preeclampsia

1. PRE-ECLAMPSIA Guided By :- Maj Kirti Maan Presented By:Capt Yashoda Gaur

2. Pre- eclampsia / E clampsia . Chronic hypertension. Chronic hypertension with superimposed preeclampsia. Gestational or transient hypertension. HYPERTENSIVE DISORDERS..

3. INTRODUCTION… A pregnancy specific syndrome characterized by variable degrees of placental dysfunction and a maternal response featuring systemic inflammation.

4. The presence of hypertension of at least 140/90 mm Hg recorded on two separate occasions at least 4 hours apart. The presence of at least 300 mg protein in a 24 hours collection of urine. After the 20th week gestation. DEFINITION

5. Common in Primigravida (75%) than multigravida (25 %) Preeclampsia causes 50000 – 60000 deaths per year worldwide. Commonly occurs between 36 week to term INCIDENCE

6. MECHANISM(NORMAL PREGNANCY) I nvasive cytotrophoblasts of fetal origin invade the maternal spiral arteries T ransforms them from small-caliber resistance vessels to high-caliber capacitance vessels C apable of providing placental perfusion adequate to sustain the growing fetus

7. MECHANISM …( Contd ) C ytotrophoblasts fail to adopt an invasive endothelial phenotype I nvasion of the spiral arteries is shallow and they remain small caliber, resistance vessels P lacental ischemia Preeclampsia Preeclampsia

8. MECHANISM Soluble Flt-1 (sFlt-1) causes endothelial dysfunction by antagonizing vascular endothelial growth factor (VEGF) and placental growth factor ( PlGF ) In normal pregnancy, the placenta produces modest concentrations of VEGF, PlGF , and soluble Flt-1 In preeclampsia, excess placental soluble Flt-1 binds circulating VEGF and PlGF and prevents their interaction with endothelial cell-surface receptors decreased prostacyclin nitric oxide production release of procoagulant proteins ENDOTHELIAL

9. Deficient placental implantation and platelet aggregation within the placental bed placental ischaemia and release of Vasoactive substances widespread endothelial damage and Platelet adherence/Increased vascular permeability profound vasospasm with multisystem effects PATHOPHYSIOLOGY..

10. Primiparity pre- eclampsia in a previous pregnancy Chronic hypertension or renal disease Extremes of maternal age Obesity Risk factors

11. Hemoconcentration Hyperuricemia Decreased urinary calcium excretion Roll over test Hyperhomocysteinemia Uterine artery doppler PREDICTORS ..

12. Severe headache Problems with vision Vomiting Sudden swelling of the face, hands or feet Papilledema and hyperreflexia P etechiae and bruising right upper quadrant or mid epigastric tenderness SYMPTOMS

13. CBC BLOOD GROUP HEPATITIS B & C Urine analysis Proteinuria 2+ or higher is significant and warrants further evaluation to rule out preeclampsia. A 24-hour urine collection with more than 300 mg of protein RFT’s UREA > 40 mmol /l or >11 mg/dl, Creatinine >1 mg/dl Serum uric acid levels >6.3 mg/dl LFT’s AST or ALT >50 IU/L Biluribin >25 IU/L Clotting profile- PT/APTT BASELINE INVESTIGATIONS

14. Discussed under following Antihypertensive treatment Anticonvulsant treatment Steroids for lung maturation Fluid balance Mode and timing of birth Fetal monitoring in high risk patient Intrapartum care Postnatal monitoring,treatment and investigations MANAGEMENT

15. ANTIHYPERTENSIVE DRUGS

16. Magnesium Sulfate – First-line therapy for seizure prophylaxis. Antagonizes calcium channels of smooth muscle. Adult Dose 4-6 g IV over 20 min, with maintenance of 1-2 g/h Overdose calcium gluconate , 10-20 mL IV magnesium level should be checked one hour after initiation of therapy with goal of therapeutic level of 4-7 mEq /L ANTI-CONVULSANTS

17. Phenytoin ( Dilantin ) -- The major site of action is the motor cortex Adult Dose 20 mg/kg IV infused at a rate of 12.5 mg/min, not to exceed 1500 mg/24hr Contd..

18. Diazepam (Valium) -- For treatment of seizures resistant to magnesium Increasing activity of GABA. Adult Dose 5-10 mg IV, repeat to total of 30 Precautions Monitor respiratory status during administration Contd …

19. Fetal lung maturation give two doses of B etamethasone * 12 mg intramuscularly 12hours apart in women between 24 and 36 weeks CORTICOSTEROIDS

20. Maintenance fluids to 80 ml/hour unless there are other ongoing fluid losses ( eg.haemorrhage ). FLUID BALANCE

21. Carry out cardiotocography Ultrasound Umbilical artery doppler velocimetry . Severe pre- eclampsia - Repeat cardiotocography . FETAL MONITORING

22. Blood pressure hourly in women with mild or moderate hypertension Continue use of antenatal antihypertensive treatment during labour . Haematological and biochemical monitoring Do not preload women who have severe pre- eclampsia with intravenous fluids INTRAPARTUM CARE

23. Recommend operative birth for women with severe hypertension whose hypertension has not responded to initial treatment. MANAGEMENT DURING 2 ND STAGE

24. Methergin ( Ergometrine ) is better avoided Continue observation of the mother for 48 hours. Anti- hypertensive drugs are continued in a decreasing dose for 48 hours. POSTPARTUM CARE •

25. Magnesium sulfate is indicated for all patients with preeclampsia with severe features as seizure prophylaxis . Lorazepam and phenytoin may be used as agents for treatment of seizures. Contd …

26. Blood pressure hourly in women with mild or moderate hypertension Continue use of antenatal antihypertensive treatment during labour . Haematological and biochemical monitoring Do not preload women who have severe pre- eclampsia with intravenous fluids INTRAPARTUM CARE

27. Recommend operative birth for women with severe hypertension whose hypertension has not responded to initial treatment. MANAGEMENT DURING 2 ND STAGE

28. Maternal complications Abruption placenta DIC/HELLP syndrome Acute Renal Failure Eclampsia Liver failure & Hemmorhage Stroke Death Long term cardiovascular morbidity COMPLICATIONS..

29. Neonatal complications Preterm delivery IUGR Hypoxic neurological injury Perinatal death Low birth weight with long term morbidity Contd..

30. Frequent vital sign. Assess deep tendon reflexes. Assess FHR and observe for labor. Test urine for protein, I&O ,Foley catheter Bed rest. Have oral airway,O2,and suction available. Decrease environmental stimuli. Implement seizure precautions. Mgso4 with close observation. Calcium Gluconate prn . NURSING MANAGEMENT

31. Risk of developing eclampsia . Excessive fluid volume. Activity intolerance. Sleep pattern disturbance. Fear related to hospitalization. NURSING DIAGNOSIS

32. Advised to follow a prescribed medication Take enough rest ,small exercise, eat balance diet and proper hygiene. Schedule visit to evaluate condtion . Advised continue breastfeeding and immunization of children. Next pregnancy should attend ANC services early. HEALTH EDUCATION

33. Hypertensive disorders in pregnancy are an indication of early delivery. Based upon combination of factors including disease severity, maternal and fetal condition, and gestational age. It require close assessment and monitoring for preeclampsia and its complications. CONCLUSION

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