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ttt of preeclampsia

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أمةالله حسن

on 3 March 2013

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Transcript of ttt of preeclampsia

under supervision of /
Dr / Ahmed El-Nezamy Treatemant of Preeclampsia Definition CLASSIFICATION :- Prepared by / Risk Factors :- Amro Ehab Ahmed
Ahmed Gamal Gharib
Karim sayed
Mohamed Ahmed Shouman
Amira Mohamed El-desawy
Abd El-Rahman El-tokhy
Rehab Hassan Mostafa
Esraa Fawzy Mousaa
Shimaa Abd El-Fattah BENHA University.Faculty of medicine
.Department of Gynecology & Obstetrics  Role of Doppler
in
diagnosis Recent lap investigations
for
pre-eclampsia Treatment Prevention Pre-eclampsia
is a medical condition occurs in a human female
during pregnancy .
It is characterized by
*high blood pressure,
*significant amounts of protein in the urine
and / or edema (at least 2 signs for diagnosis).
It occurs usually after 20 weeks of pregnancy.
However, it might occur earlier in cases of vesicular mole,
polyhydramnios & multiple pregnancies.If left untreated,
it can develop into eclampsia, the life-threatening
occurrence of seizures in pregnancy...  *Low socioeconomic class

*Multiple foetuses, or hydatidiform mole

*Maternal age <20 or >35yrs

*Primigravidas

*Gestational or pre-gestational DM
Renal disease chronic Hypertension

*Abnormal placentation as Hydrobs fetalis
Family history- four times the risk PREDICTION Why prediction is important?

The ideal screening test

Methods

I. Preconception factors

II. Pregnancy-Related Factors

1. Risk factors

2. Markers

conclusion Uterine artery Doppler studies at 18-24 weeks may reveal a high resistance index (RI) , with diastolic notching , that may identify up to 80% of women who subsequently develop PE . Laboratory values for preeclampsia and HELLP syndrome Renal values are as follows Proteinuria of >300 mg/24 h
Urine dipstick >1+
Protein/creatinine ratio >0.3
Serum uric acid >5.6 mg/dL
Serum creatinine >1.2 mg/dL Platelet/coagulopathy-related results are as follows: Platelet count < 100,000/mm3
Elevated PT or aPTT
Decreased fibrinogen Hemolysis-related results are as follows: Abnormal peripheral smear
Indirect bilirubin >1.2 mg/dL
Lactate dehydrogenase >600 U/L Algorithm for treatment preeclampsia :- Obstetric ttt
(termination of pregnancy ) Treatment Medical ttt antihypertensive drugs Magnesium sulfate(MgSO4)and diazepam
Indication *Not documented in mild preeclampsiahowever the most commonly used drug is : alpha methyl dopa (Aldomet)

*In case of severe preeclampsia :BP 160/110 or more persistant protinuria (2+ or more OR 5 gm / 24 h)
Abnormal haematological and biochemical
parameters & Abnormal fetal findings
e.g : Hydralazine , labetalol , nifidipine Aldomet (alpha methyl dopa) * Dose : - 250 mg orally t.d.s but the allowed maximum dose is 2 gm/day . * Onset :- - it has delayed onset of action :it’s full effect is obtained after 48 hours . so it can't be used in emergencies. * Side Effects :-
***Psychological :
-Depression , Apathy ,Anxiety Impaired attention,
-Fatigue , Sedation
-Cognitive and memory impairment , mildpsychosis
***Physiological :
 - Gastrointestinal disturbances :
diarrhea and/or constipation
 -amenorrhoea.
 -Bradycardia ,Hypotension
 -Hepatitis, hepatotoxicity, or liver dysfunction
 -Haemolytic anaemia ,
 -Hypersensitivity such as lupus erythematosus Labetalol * Mode of action Combined á- and B-adrenergic blocker. * Administration I.V • Give 5-20mg boluses slowly IV at 10 minute
intervals to a maximum of 50mg. Alternatively, start IV infusion at 20 mg/hour.
Double infusion rate every 30 minutes as needed
to a maximum of 160 mg/hour • May be given orally (dose: 100-200mg PO hourly,
until BP controlled - maintenance dose is given
12 hourly). Absorption may be reduced in labour Dose; The intravenous regimen; is given as a 4g dose, followed by a maintenance infusion of 1 to 2 g/h by controlled infusion pump. Monitoring Measure hourly;
- urine out put : >120 ml after 4 hours .
-Respiratory system : stop if RR < 10 per min .
-Patellar reflex : check every 2-4 h , if depressed stop infusion .
-Blood pressure : if (DBP) > 110 mmhg start antihypertensive therapy .
-Continuous CTG (cardiotocograph) monitoring of foetus if available .
-Monitor serum Mg2+ level 4-6 hourly , if available .
-After delivery : check uterus is contracted and whether there is any vaginal bleeding If any sign of overdose;
-stop MgSo4 infusion .
–call for help .
-Assess and resuscitate guided by ABC .
-Calcium gluconate should be available to treat magnesium toxicity , administrate 10ml 10% calcium gluconate (1g) IV over 2-3 minutes . Depending on severity of the case gestational age by * induction of labour * caeserian section 2) sever pre eclampsia immediate delivery after stabilization by : -hospitalization
-antihypertinsive drug(haydralazine, labetalol,nifidipine)

-prophylatic anti convulsant mgso4 Mode of delivery 1-Induction of labour indication:-soft effaced cervix
-adequate pelvis
-good fetal condition
method
iv oxytocin
Vaginal PG
(with or withoutamniotomy) 2- C.S Indications -Cervix is unripe
-Non reassuring ante-partum or intra-partum fetal surveillance tests.
-Extremely premature or LBW fetus .
-Other indications for C.S as
PP
previous C.S ,
oligohydroaminos ,
severe IUGR 1- Role of aspirin :
*aspirin is a cyclooxygenase inhibitor It decrease production of pGI2 and TXA2
*Aspirin therapy should be considered in women with historical risk factor
*non significant 12%reduction in proteinuric HTN
*low dose aspirin administrated as early as 14 -16 weeks of gastation to pregnant woman may reduce or modify The course of severe preeclampsia 2- Role of Calcium Supplementation
Reduces the risk of preeclampsia , particularly in populations that have diets deficient in calcium
Up to studies : There was a modest reduction in high blood pressure with calcium supplementation . The effect was greatest for women at high risk of hypertension and those with low baseline dietary calcium 3- Role of antioxidant supplementation Antioxidants, such as vitamin C, vitamin E, selenium and lycopene, can neutralize free radicals. However no reduction in pre-eclampsia, high blood pressure or preterm birth with the use of antioxidant supplements. When antioxidants were assessed separately, there were insufficient data to be clear about whether there was any benefit or not, except for vitamin C and E. The current evidence does not support the use of antioxidants to reduce the risk of pre-eclampsia or other complications in pregnancy, but there are trials still in progress. Aya Fathy Ali
Doaa Shoukry Mohamed
Rehab Salah Saad
Eman Hassan Ali
Shourok Mohamed sayed
Thorya Sabry El-sayed
Abd Allah Samy Soliman
Mohamed Ibrahem Ameen
Mohamed Ragab Labeb In addition,
elevated liver enzymes
(serum AST >70 U/L)
are found in preeclampsia * Contraindications Asthma cardiac failure
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