World Pre-Eclampsia Day-2025.pptx.SIMULATION BASED LEARNING

World Pre-Eclampsia Day-2025.pptx.SIMULATION BASED LEARNING.ASK ME ABOUT PREECLAMPSIA-ECLAMPSIA, MANAGEMENT AND MAGNESIUM SULPHATE MEDICATION.

1. CIRCULATORY CHANGES IMBALANCE IN DIFFERENT COMPONENTS OF PROSTAGLANDINS DEFICIENCY OF VASODILATOR PROSTAGLANDINS (PROSTACYCLIN & PROSTAGLANDIN) INCREASED SYNTHESIS OF THROMBOXANE, ANGIOTENSIN-II, ENDOTHELIN-I A POTENT VASOCONSTRICTOR IN PLATELETS INTENSE VASOSPASM-IMPAIRED CIRCULATION FORMATION OF THROMBI DAMAGE OF THE VASCULAR WALLS INC.ENDOTHELIAL INTEGRITY CELL PERMEABILITY INCREASES-EDEMA HEMOLYSIS HELLP

2. UTERO-PLACENTAL CHANGES THE ENDOVASCULAR INVASION OF CYTOTROPHOBLAST INTO SPIRAL ARTERIES FAILS TO OCCUR BEYOND DECIDUA-MYOMETRIAL JUNCTION VASOCONSTRICTOR STIMULI DECREASE BLOOD FLOW (POORLY PERFUSED PLACENTA) IUGR FETAL JEOPARDY

3. RENAL CHANGES ASSOCIATED SPASM OF THE DIFFERENT GLOMERULAR ARTERIOLES PATCHY AREAS ON KIDNEYS REDUCED RENAL BLOOD FLOW GLOMERULAR FILTRATION RATE DECREASES BY 25% IMPAIRED TUBULAR REABSORPTION RENAL NECROSIS OLIGURIA PROTEINURIA

4. OBSTETRICAL MANAGEMENT To prevent injury To prevent complications To deliver by 6-8 hours Effective Postpartum care.

5. The term eclampsia is derived from a Greek word, meaning ‘like a flash of lightening’. It may occur quite abruptly, without any warning manifestations. Pre-eclampsia when complicated with grand mal seizures ( Generalized tonic- clonic convulsions) and / or coma is called eclampsia.

6. INCIDENCE The incidence varies widely from country to country and even between different zones of the same country. Eclampsia contributes significantly to the maternal deaths. The hospital incidence in India ranges from 1 in 500 to 1 in 30. It is more common in primigravidae (75%) 5 times more common in twins and occurs between the 36 th week and term in more than 50% cases.

7. Causes Anoxia-Spasm of cerebral vessels- increased cerebral vascular resistance-fall in cerebral oxygen consumption – anoxia. Cerebral edema Excessive release of excitatory neurotransmitters (Glutamate). Loss of cerebrovascular Autoregulation with forced dilatation and vasospasm.

8. Onset of Fits Antepartum Eclampsia (50%) Intrapartum Eclampsia (30%) Postpartum Eclampsia (20%)

9. Clinical Features Eclamptic Convulsions or Fit: They are epileptiform and consist of 4 stages: Pre-monitory stage: the patient becomes unconscious. There is twitching of the muscles of the face, tongue and limbs. Eyeballs roll or turned to one side and become fixed. This stage lasts for about 30 seconds. Tonic Stage: the whole body goes into a tonic spasm. The trunk- opisthotonus , limbs are flexed and hands clenched. Respiration ceases and the tongue protrudes between them the teeth. Cyanosis appears .eyeballs become fixed. This stage lasts for about 30 seconds.

10. OPISTHOTONUS

11. Clonic Stage: All the voluntary muscles undergo alternate contraction and relaxation. The twitching start in the face then involve one side of the extremities and ultimately the whole body is involved in the convulsion. Biting of the tongue occurs. Breathing is stertorous and blood stained frothy secretions fill the mouth. Cyanosis gradually disappears. This stage last for 1-4 minutes.

12. Stage of Coma: Following the fit, the patient passes on to the stage of coma, it may last for a brief period or in others deep coma persists till another convulsion. The fits are usually multiple, recurring at varying intervals. When it occurs in quick succession, it is called status eclampticus.

13. REGIMENS OF MgSO4 for the management of severe preeclampsia and eclampsia Pritchard Regimen: 4g (20% Solution) IV over 3-5min followed by 10g (50%), deep IM (5g in each buttock)-Loading Dose 5g (50%) IM 4 hourly in alternate buttock. Labetalol 20mg IV stat is given to control severe preeclampsia.