Preeklamsia - Ian

PREECLAMPSIA / ECCLAMPSIA
BACKGROUND
• In Indonesia, preeclampsia caused 1.5 % - 25 % of maternal death, with probability of
neonatal death 45 – 50 %
• With global statisticc showed 50.000 death per annum, 10% of all maternal death.
DEFINITION
• Pregnancy specific syndrome that can affect virtually every organ system with newly onset
proteinuria > 300 mg / 24 hours and hypertension after 20 weeks of gestation
RISK FACTORS
■ Primigravida
■ Multiple gestations
■ Hydatidiform mole
■ Diabetes mellitus
■ Very young or advanced maternal age
CLASSIFICATION OF HYPERTENSIVE
DISORDERS COMPLICATING PREGNANCY
1. Preeclampsia and eclampsia syndrome
2. Gestational hypertension—formerly termed pregnancy-induced hypertension.
3. Preeclampsia syndrome superimposed on chronic hypertension
4. Chronic hypertension.
CRITERIA
CLASSIFICATION
 Preeclampsia is new onset hypertension
 BP 140/90 mm Hg after 20 weeks' gestation
 Proteinuria 300 mg/24 hours or 1+ dipstick
INCREASED CERTAINTY OF PREECLAMPSIA
• BP 160/110 mm Hg
• Proteinuria 2.0 g/24 hours or 2+ dipstick
• Serum creatinine >1.2 mg/dL unless known to be previously elevated
• Platelets < 100,000/L
• Microangiopathic hemolysis—increased LDH
• Elevated serum transaminase levels—ALT or AST
• Persistent headache or other cerebral or visual disturbance
• Persistent epigastric pain
Eclampsia:
• Seizures that cannot be attributed to other causes in a woman with preeclampsia
Superimposed Preeclampsia On Chronic Hypertension:

• New-onset proteinuria 300 mg/24 hours in hypertensive women but no proteinuria before 20 weeks'
gestation
• A sudden increase in proteinuria or blood pressure or platelet count < 100,000/L in women with
hypertension and proteinuria before 20 weeks' gestation
Chronic Hypertension:
• BP 140/90 mm Hg before pregnancy or diagnosed before 20 weeks' gestation not attributable to
gestational trophoblastic disease
• Hypertension first diagnosed after 20 weeks' gestation and persistent after 12 weeks postpartum
Gestational Hypertension:
• Systolic BP 140 or diastolic BP 90 mm Hg for first time during pregnancy
• No proteinuria
• BP returns to normal before 12 weeks postpartum
• Final diagnosis made only postpartum
• May have other signs or symptoms of preeclampsia, for example, epigastric discomfort or
thrombocytopenia
ETIOPATHOGENESIS
Gestational hypertensive disorders are more likely to develop in women with following
characteristic :
1. Are exposed to chorionic villi for the first time
2. Are exposed to a superabundance of chorionic villi as with twins or hydatidiform mole
3. Have preexisting conditions of endothelial cell activation or inflammation such as diabetes
or renal or cardiovascular disease
4. Are genetically predisposed to hypertension developing during pregnancy
ETIOLOGY
1. Placental implantation with abnormal trophoblastic invasion of uterine vessels.
2. Immunological maladaptive tolerance between maternal, paternal, and fetal tissues
3. Maternal maladaptation to cardiovascular or inflammatory changes of normal pregnancy
4. Genetic factors including inherited predisposing genes and epigenetic influences
• 2013 Task Force recommends that women with either eclampsia or severe preeclampsia
should be given magnesium sulfate prophylaxis.
ANTIHYPERTENSIVE AGENTS
• Hydralazine
most commonly used in USA.
5 mg IV followed by 5 – 10 mg doses at 15 – 20 min intervals until a satisfactory response is achieved
• Labetalol
alfa nonselective beta blocker
some prefer it dt fewer side effects
if the BP has not decreased to desirable level in 10
min give 20 mg  incremental dose until max 220
mg per treatment cycle
ACOG recommends initial 20 mg IV repeated in 10 min followed by
40 mg then 80 mg every 10 min
• Nifedipine
calcium channel blocking agent 
10 mg initial oral dose repeated in 30 min
Nifedipine given sublingually is no longer recommended
HELLP SYNDROME
• HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) severe variant of
preeclampsia.
• HELLP syndrome is more common in the multigravida patient.
HELLP SYNDROME
• The initial management of HELLP syndrome is similar to that of severe preeclampsia or
eclampsia.
• Magnesium administration, blood pressure control, and stabilization of the mother’s condition
are critical.
• In addition, any coagulopathy should be corrected as necessary. The definitive treatment is
delivery of the fetus, especially if the patient is at ≥34 weeks’ gestation.
THANK YOU

Preeklamsia - Ian

Uploaded by

Copyright:

Available Formats

Preeklamsia - Ian

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Preeklamsia - Ian

Uploaded by

Copyright:

Available Formats

PREECLAMPSIA / ECCLAMPSIA

2. Gestational hypertension—formerly termed pregnancy-induced hypertension.

3. Preeclampsia syndrome superimposed on chronic hypertension

Superimposed Preeclampsia On Chronic Hypertension:

You might also like