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Preeclampsia 1: Etiology, Diagnosis and Treatment 2015

A slide show on the management of preeclampsia
by

Chukwuma Onyeije

on 8 March 2015

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Transcript of Preeclampsia 1: Etiology, Diagnosis and Treatment 2015

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. 0NYEIJE, M.D.
ATLANTA PERINATAL ASS0CIATES

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
N0T
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
Normal 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
MILD
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 > 5 grams in 24 hours
See other symptoms of SEVERE preeclampsia.
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.
New onset of
end-organ dysfunction
after 20 weeks of gestation
Worsening or resistant
blood pressure elevation
.
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