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Preeclampsia 1: Etiology, Diagnosis and Treatment

A slide show on the management of preeclampsia
by

Chukwuma Onyeije

on 29 July 2013

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Transcript of Preeclampsia 1: Etiology, Diagnosis and Treatment

Presented by Chukwuma I. Onyeije
Atlanta Perinatal Associates
http://onyeije.net/present
Preeclampsia is a common cause of pregnancy related complications.
The cause of preeclampsia REMAINS unknown
P. I. H.
PREECLAMPSIA
Preeclampsia is
Easy to
Understand
Diagnosis:
Hypertension

Edema

Proteinuria
Treatment:
Delivery
Diagnosis and Management of Preeclampsia/Eclampsia
PART 0NE
PRESENTED BY
CHUKWUMA I. ONYEIJE, M.D.
ATLANTA PERINATAL ASS0CIATES
http://preeclampsiaonline.net
http://onyeije.net/present
CASE NUMBER 1.
A 26 yo para 1 with an uncomplicated first pregnancy, now 31 weeks of gestation her blood pressure is 142/100 and 150 / 106 when repeated after 30 min.

She has 1+ proteinuria on urinary dipstick. Her previous blood pressures during this pregnancy have ranged from 120/70 mm Hg to 130/80 mm Hg. What is your recommendation?
OPTIONS:
A) Strict bed rest at home
B) Hospitalization for further evaluation
C) Outpatient antihypertensive therapy
D) Immediate delivery
LECTURE HIGHLIGHTS
Why is delivery not always the best treatment of preeclampsia for the fetus?

What are the two main goals of management of women with preeclampsia during labor and delivery?

What risk factors are associated with the development of preeclampsia?
Hypertensive Disorders of Pregnancy
1. Gestational Hypertension
2. Preeclampsia
3. Eclampsia
4. Chronic Hypertension
5. Superimposed Preeclampsia
1. Gestational Hypertension
Blood Pressure≥140/90
No proteinuria
NL BP Postpartum
May have other signs or symptoms (epigastric pain, low platelets)
(Diagnosis is made in Retrospect)
Associated with some adverse outcomes
N0TE:
10% of eclamptics seize without proteinuria
2. Preeclampsia
DIAGN0STIC
SBP > 140 mm hg or DBP of 90 mm Hg
Proteinuria of 300 mg in 24 hours
SEVERE
SBP > 160 mm Hg or DBP > 110 mm Hg
Proteinuria of > 2 g in 24 hours
Increased serum creatinine > 1.2 mg/dL
Platelet count < 100,000 cells/ mm3 or evidence of microangiopathic hemolytic anemia
3. Eclampsia
Seizures not attributable to
another causes
in a woman with preeclampsia
? ( + / - ) Aura
Loss of consciousness
Tonic phase: generalized body stiffening
(30 to 60 seconds),
Clonic phase: rapid, violent, contraction and relaxation of muscles
(30 to 60 seconds)
Post-ictal phase: deep sleep after-seizure
4. Chronic Hypertension
5. Superimposed Preeclampsia
High BP before pregnancy
High BP prior to 20 wks EGA
Hypertension first seen after 20 weeks but persisting >12 weeks PP
New proteinuria in chronic hypertensive after 20 weeks
Sudden increase in protein, pressures,
0ther findings in patients with nephrotic syndrome and hypertension prior to 20 weeks
Underlying Issues in Preeclampsia
Reduced tissue perfusion due to vasospasm and endothelial activation
Glomerular lesions and proteinuria typically occur late in gestation
Clinical manifestation may be months after presumed onset
Normal Placentation
Abnormal Placentation
Full transcript