Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.

Pih and eclampsia

1 462 vues

Publié le

Publié dans : Santé & Médecine
  • Identifiez-vous pour voir les commentaires

Pih and eclampsia

  1. 1. PIH and Eclampsia Dr. V. L. Deshmukh Associate Professor Dept. of OBGY Govt. Medical College AURANGABAD
  2. 2. Maternal Mortality Major causes of maternal mortality are • PIH • Eclampsia • APH • PPH • Puerperal sepsis • Obstructed labour • Unsafe abortions
  3. 3. Introduction • Hypertensive disorders in pregnancy • Significant maternal morbidity • Fetal morbidity and mortality • Includes PIH, pre-eclampsia, eclampsia, chr. Hypertension, chr. Hypertension with superadded PIH
  4. 4. Definition • Multi systemic disorder • After 20 wks • B.P. > 140/90 mmHg • Proteinuria • Edema • Excessive wt. Gain
  5. 5. Classification Finding Mild pre-eclampsia Severe pre-eclampsia B.P. •The diastolic pressure rises 1`5-20 mmHg above the “usual’ level, OR •The absolute level of BP is >140/90 mmHg but <160/110 mmHg The diastolic pressure rises >20 mmhg above the ‘usual’ level; OR The absolute level of BP is 160/110 mmhg Proteinuria Present, but 2+ or less 3+ or persistently greater Generalized edema (including in the face and hands) May or may not be present Present Headache Absent Present Visual distrubances Absent Present Upper abdominal pain Absent Present Oliguria Absent Present Diminished fetal movement Absent Present
  6. 6. Eclampsia • Characterized by convulsions and/or coma • Women has PIH • Types antepartum, intrapartum and postpartum. • No lower limit of B.P. for eclampsia can even occur at 120/80 mmHg
  7. 7. Fulminating Eclampsia Symptoms : • Severe headache • Drowsiness • Mental confusion • Visual distrubances • Epigastric pain • Nausea, vomiting • Decreased urinary output
  8. 8. Signs • A sharp rise in B.P. • Increased proteinuria • Exaggerated knee jerk
  9. 9. Status Eclampticus • Continuous convulsions • Dangerous for mother and fetus • Can lead to fetal and maternal mortality
  10. 10. Stage of Eclampsia • Premonitory • Tonic • Clonic • Coma
  11. 11. Eclampsia • Can occur regardless of severity of hypertension • Difficult to predict • Tonic clonic • Rapid sequence • Can occur in the absence of hyper- reflexia, headache and visual disturbances.
  12. 12. D/D of Eclampsia • Epilepsy • Cerebral malaria • Meningitis • Encephalitis • Tetanus • Head injury
  13. 13. Effect on Mother • Asphyxia • Aspiration • Pulmonary edema • Bronchopneumonia • Cardiac failure • Brain hemorrhage • Cerebral thrombosis • Cerebral edema
  14. 14. Effect on Mother • ARF • HELLP • DIC • Temporary blindness • Injuries • Tongue bite
  15. 15. Effect on Fetus • Hypoxia * IUGR * Stillbirth
  16. 16. High risk for Eclampsia • Teenagers / elderly primi. • Essential HT • Twins • Women with DM, polyhydramnios, V. mole • H/o eclampsia • Obese women
  17. 17. Mortality due to Eclampsia • Failure to monitor B.P. in ANC • Failure to monitor proteinuria • Lack of clear-cut mgt. strategy for PIH • Lack of proper equipment and drugs. • Late referral • Failure to counsel women & her relatives about S/s of PIH & ANC • Failure to timely manage complications of Eclampsia.
  18. 18. Diagnosis • Pregnant women or PNC complaints of severe headache, blurred vision • Unconscious • Convulsions • Elevated B.P.
  19. 19. Mgt. of PIH • ANC • Check B.P. • Proteinuria • Body edema • Weight • Regular ANC check-up • Rise in B.P. • Refer
  20. 20. Mild PIH • B.P. 140/90 mmHg but less than 160/110 mmHg. • < 37 wks • > 37 wks - TERMINATE
  21. 21. Mild PIH < 37 wks. • Bed rest • Wkly visit • Check B.P. • Proteinuria • Wt. Of the patient • Body edema • Exclude S/o severe PIH • DFMC • Check FHS
  22. 22. Mild PIH BOOK THE PATEINT FOR DELIVERY AT BEmOC CENTER.
  23. 23. Mild PIH > 37 wks. • Assess cervix • Accelerate delivery • Check B.P. 4 hrly.(2 hrly if severe PIH) • Bed rest • Proteinuria B.D. • Monitor FHS
  24. 24. Mild PIH • Give sedation • Give antihypertensive • Only if diastolic B.P. is > 110 mmHg
  25. 25. Eclampsia Six major steps : 1. Maintain airway 2. Control fits 3. Control B.P. 4. Deliver the pt. 5. Maintain fluid balance 6. Give after care of delivery
  26. 26. Eclampsia Maintain airway : 1. LLP 2. Gentle section 3. Oxygen 4. Place padded tongue blade in her mouth to prevent aspiration and tongue bite DO NOT ATTEMPT THIS DURING CONVULSIONS
  27. 27. Eclampsia Control fits : MAGSULF THERAPY • Dose – Inj. MgSo4 – 4 gm (20 ml of 20% sol.) slow I.V. at the rate of 1 ml / min. NOT TO BE GIVEN AS BOLUS • Maintenances dose 5 gm deep I.M. every 4 hrly.
  28. 28. Eclampsia • If convulsions recur give additional 2 gm magsulf (10 ml of 20% sol.) I.V. over 20 min. • Wait for 15 min. • If still convulsions recur – give diazepam REFER
  29. 29. Eclampsia Monitoring of MgSo4 therapy 1. Output atleast 100 ml/4 hrs. 2. Knee jerk present 3. Respiratory rate 16 breath/min POSTPONE THE NEXT DOSE IF ABOVE CRITERIA NOT MET
  30. 30. Eclampsia Precautions : Do not give 1. 50% MgSo4 without diluting it to 20% 2. Rapid I.V. infusion as it may cause respiratory failure and death If respiratory depression occurs (RR < 16/min) 1. Discontinue MgSo4 2. Give calcium gluconate - 1 gm I.V. (10 ml of 10% solution) over a period of 10 min.
  31. 31. Eclampsia Other options available are : 1. Diazepam (10 mg I.V. slowly over 2 min.) 2. Phenytoin sodium 3. Largactil MgSO4 IS SUPERIOR TO ALL ABOVE DRUGS IN ECLAMPSIA
  32. 32. Eclampsia Controlling the B.P. • Tab. Depine – 10 mg t.d.s. • Tab. Labetelol – 50 mg b.d. • Other drugs available – Hydralazine
  33. 33. Eclampsia Controlling fluid balance : 1. Intake output chart 2. Output 100 ml/4 hrs. 3. 60 ml /hr fluid intake 4. Extra fluid if vomiting, excessive blood loss or diarrhoea. PROPER MAINTENANCE OF FLUID BALANCE TO PREVENT WATER INTOXICATION, DEHYDRATION, HYPONATREMIA OR PULMONARY EDEMA.
  34. 34. Eclampsia DIURETICS SHOULD NOT BE USED, IT IS DANGEROUS
  35. 35. Eclampsia Delivering the baby 1. If PIH deliver within 24 hrs. 2. If eclampsia deliver within 12 hrs. 3. If vg. Delivery is not anticepated or Cx is unfavourable or S/o fetal distress, REFER
  36. 36. Eclampsia Delivery 1. Before labour - Control B.P. - Control fits REFER 2. Late 1st stage / 2nd stage - Carry out Vg. delivery REFER
  37. 37. Eclampsia Difficult deliveries : 1. Labour not progressing quickly 2. Big size baby REFER GIVE MgSO4
  38. 38. Rule of Thumb • Pt. with severe PIH comes early 1st stage of labour – REFER • Pt. comes in late labour or 2nd stage – conduct delivery, give MgSO4 – REFER Rule of Thumb
  39. 39. Eclampsia – Postpartum Care 1. Refer pt. After one hr. of delivery after ruling out PPH 2. If pt. Has fits, observe for 48 hrs. after convulsions. 3. Closely observe her consciousness, output 4. Monitor B.P. every hrly. 5. Given anti-hypertensives till B.P. comes down to 100 mmHg diastolic
  40. 40. Eclampsia – Postpartum Care • Do not give excessive IV fluid • If after 72 hrs. there are no convulsions, output is good, and B.P. is 100 mmHg diastolic – discharge the pt. • Arrange for follow-up – 7 to 10 days after delivery. CONTINUED FITS – REFER WITHOUT DELAY
  41. 41. Eclampsia – Postpartum Care Following Eclampsia B.P. may : 1. Return to normal within 48-72 hrs. 2. Return to normal after a few wks. May remain high permanently.
  42. 42. Referral • Should be transported by the quickest mode of transport • 3 delays
  43. 43. Through a team approach all of the skills of the health care members involved can be combined to provide the best possible approach to meet the pregnancy’s need. The role of patient education can not be over emphasized. Incorporating the mother as an active member in her health care is an investment in time and effort that is cost effective both during pregnancy and labour.
  44. 44. A systematic & a well begun programme with a positive thinking will definitely show road to success to accept this challenge

×