Antenatal testing nonstress test or biophysical profile. The biophysical profile is an assessment of fetal well-being. Fetuses that are well oxygenated behave normally by twisting, squirming, flexing and extending extremities, and breathing. Fetuses that are hypoxic lie still, trying to conserve oxygen. A hour urine collection for protein. The goals of treatment are to prevent seizures, lower blood pressure to avoid maternal end-organ damage, and expedite delivery.
Magnesium sulfate is still the drug of choice for preventing and arresting eclamptic seizures. It has the additional benefit of reducing the incidence of placental abruption Serum magnesium levels should be monitored in women with elevated serum creatinine levels, decreased urine output, or absent deep tendon reflexes Magnesium toxicity can lead to respiratory paralysis, cen tral nervous system depression, and cardiac arrest.
The antidote is calcium gluconate, 1 g infused intravenously over two minutes Antihypertensive medications are used solely to prevent maternal morbidity and have no effect on disease progression or preventing eclampsia.
Medications must be given with caution: if blood pressure is lowered too fast, it can have a dramatic effect on uteroplacental perfusion and can cause an already compromised fetus to rapidly decompensate and become bradycardic. Preferred medications are hydralazine mg intravenous bolus every minutes , labetalol, nicardipine, and sodium nitroprusside. Intravenous labetalol and hydralazine are commonly used for the acute management of preeclamp sia 22 , Diuretics are usually contraindicated because of the already collapsed intravascular volume.
However, if the pulmonary capillary wedge pressure is high, diuretics are necessary. Intravenous hydration for oliguria must be given cautiously to avoid pulmonary edema, ascites and cardiopulmonary overload. If there is no evidence of pulmonary edema, a trial of fluid resuscitation mL over an hour should be given. Delivery is the only cure for preeclampsia. Corticosteroids are administered to accelerate fetal lung maturity 8. Interventionist management advocates induction or cesarean delivery 12 to 24 hours after corticosteroid administration Contraindications to expectant management include persistent severe symptoms, multiorgan dysfunction, severe IUGR i.
Method of delivery can be vaginal delivery or caesarean section. Caesarean section is indicated in foetal distress, late deceleration occurs with oxytocin challenge test, failure of induction of labour and other indications as contracted pelvis and malpresentations.
Some experts recommend cesarean delivery for fetuses younger than 30 weeks when the cer vix is not ripe, but a trial of induction may be considered 8 , In patients with HeLLP syn drome, cesarean delivery carries special risks, such as bleeding from thrombocytopenia and difficulty controlling blood pressure because of depleted intravascular volume 15 , Eclampsia may occur postpartum; the greatest risk of postpartum eclampsia is within the first 48 hours Magnesium sulfate is continued for 12 to 24 hours, or occasionally longer if the clinical situation warrants.
Generally, once the placenta is delivered, the disease rapidly improves. Large fluid shifts should occur immediately postpartum, and diuresis indicates that the syndrome is resolving. However, women with severe and early onset of disease may worsen before getting better.
The physiologic changes of preeclampsia are completely reversible after delivery. However, maternal morbidity caused by severe hypertension, hemorrhage, or anesthetic complications may be permanent. Eclampsia is the development of convulsions in a preexisting pre-eclampsia or it may appear unexpectedly in a patient with minimally elevated blood pressure and no proteinuria.
The exact cause is unknown but cerebral ischaemia and oedema were suggested. The timing of an eclamp tic seizure can be antepartum 53 percent , intrapar tum 19 percent , or postpartum 28 percent The hourly output of urine is charted.
Proteinuria, haematuria and specific gravity are noticed. Efficient nursing in a single quiet semi-dark room to prevent any auditory or visual stimuli. Magnesium sulfate is the drug of choice because it is more effective in preventing recurrent seizures than phenytoin Dilantin or diazepam Valium 28 , 29 - If a patient has already received a prophylactic loading dose of magnesium sulfate and is receiving a continuous infusion, an additional 2 g should be given intravenously.
Otherwise, a 6-g loading dose is given intravenously over 15 to 20 minutes, followed by maintenance infusion of 2 g per hour. A total of 8 g of magnesium sulfate should not be exceeded over a short period of time 20 , In conclusion, although many pregnant women with high blood pressure have healthy babies without serious problems, high blood pressure can be dangerous for both the mother and the fetus.
Women with pre-existing, or chronic, high blood pressure are more likely to have certain complications during pregnancy than those with normal blood pressure. However, some women develop high blood pressure while they are pregnant often called gestational hypertension. The effects of high blood pressure range from mild to severe. High blood pressure can harm the mother's kidneys and other organs, and it can cause low birth weight and early delivery.
In the most serious cases, the mother develops preeclampsia-or "toxemia of pregnancy"-which can threaten the lives of both the mother and the fetus. National Center for Biotechnology Information , U. Journal List J Prenat Med v. J Prenat Med. Author information Copyright and License information Disclaimer.
This article has been cited by other articles in PMC. Keywords: Gestational hypertension, preeclampsia, chronic hypertension, eclampsia. Types of pregnancy-Related Hypertension types of hypertension in pregnancy include: Chronic Hypertension in pregnancy Chronic hypertension is high blood pressure that either precedes pregnancy, is diagnosed within the first 20 weeks of pregnancy, or does not resolve by the week postpartum checkup.
Gestational Hypertension Gestational hypertension, formerly known as pregnancy-induced hypertension or PIH, is the new onset of hypertension after 20 weeks of gestation. Preeclampsia Preeclampsia is a multiorgan disease process of unknown etiology 11 characterized by the development of hypertension and protein uria after 20 weeks of gestation. Hematologic changes include: Thrombocytopenia—platelets are dramatically reduced, probably consumed by endothelial injury.
Management of preeclampsia Preeclampsia places both mother and fetus at risk. Delivery Decisions in Severe Preeclampsia Delivery is the only cure for preeclampsia.
Postpartum Management Eclampsia may occur postpartum; the greatest risk of postpartum eclampsia is within the first 48 hours Eclampsia Eclampsia is the development of convulsions in a preexisting pre-eclampsia or it may appear unexpectedly in a patient with minimally elevated blood pressure and no proteinuria. Maternal mortality was non-significantly lower among women allocated magnesium sulphate.
There were no significant differences in other measures of serious maternal morbidity, or in perinatal morbidity or mortality. Maternal mortality was nonsignificantly lower among women allocated magnesium sulphate. Women allocated magnesium sulphate were also less likely to be ventilated, to develop pneumonia, and to be admitted to intensive care facilities than those allocated phenytoin. None the less, as indicated in the Magpie study, magnesium is associated with side effects, and some of these for example, respiratory and cardiac arrest can be life threatening.
For safety in developing countries it is important to assess in which patients the benefit from being given magnesium is sufficient to justify this risk.
Treatment is certainly justified in women with eclampsia, in whom evidence from meta-analysis indicates that magnesium reduces mortality. In this group it was necessary to treat 63 women to prevent one seizure.
In women who did not have such severe pre-eclampsia patients had to be treated to prevent a seizure. Thus, the Magpie study indicates a very favourable ratio of benefit to risk for magnesium, given according to the protocol, in women with severe pre-eclampsia or requiring antihypertensive treatment.
For the loading and intravenous doses this is considerable lower than has been recommended by some, and the safety of higher doses is not assured by this study. None the less, as carried out in this protocol with simple clinical assessment and without determining magnesium concentration, treatment with magnesium was safe.
Despite the evidence, this effective treatment has not been used widely. We have few examples in obstetric practice of treatments that have been tested in randomised controlled trials to show efficacy and even fewer that address treatment in the field. Why has this treatment not become part of the armamentarium of providers of obstetric care throughout the world? The answer is complex, but at least part of the explanation is that this inexpensive generic treatment has no industrial advocate to facilitate licensing, production, and distribution.
Another factor is the reluctance of care providers and administrators to change healthcare practice. We urge nations in which eclampsia has a major impact on maternal mortality to institute policies to ensure that this inexpensive and life saving treatment is made available and that care providers are trained to use it safely. Competing interests: None declared. National Center for Biotechnology Information , U.
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