Presentation on theme: "HYPERTENSIVE DISEASE IN PREGNANCY WITH ASSOCIATED NEONATAL OUTCOMES Presented by Dr.Kagema Frank."— Presentation transcript:
HYPERTENSIVE DISEASE IN PREGNANCY WITH ASSOCIATED NEONATAL OUTCOMES Presented by Dr.Kagema Frank
DISCUSSION 1.Introduction 2.Diagnosis of PE/E[pre eclampsia/eclampsia] 3.Management of PE/E 4.Screening and management of PE/E in kenya 5.. Effects of pre-eclampsia on late preterm fetal outcomes 6.Optimizing fetal outcomes in PE/E 7.Prevention of PE/E and conclusion
1. INTRODUCTION Hypertensive diseases in pregnancy are a major cause of significant maternal and neonatal morbidity and mortality Currently 300,000 women + 3 million babies die annually due to pregnancy and delivery. Worldwide, hypertensive disease is the 2 nd largest cause of maternal mortality – 12% after PPH-27%. According to WHO systematic review of preterm births 2009/2010, 15-20% were due to medically indicated or elective preterm deliveries.
Neonatal Outcomes introduction Pre-eclampsia is a progressive disorder, necessitating delivery to halt the pregnancies for the benefit of mother and fetus. Late preterm infants account for about ⅔ of all preterm deliveries and are at significant risk of morbidity and mortality and represents the fastest growing subset of preterm births. PE/E is an important contributor to late preterm births due to the need for premature delivery and placental insufficiency.
2. DIAGNOSIS OF PE/E Mild PE – Systolic BP 140 ≤ 160mmHg Diastolic BP >90 ≤ 110mmHg Proteinuria > 300mg ≤ 5g/day Severe PE: Multi-organ involvement Systolic BP >160mmHg Diastolic BP >110mmHg Thrombocytopenia <100,000/ul Pulmonary edema Oliguria < 500mls/day Convulsions
3.MANAGEMENT PRINCIPLES IN PE/E Definitive cure for PE/E is delivery to minimize the maternal morbidity and mortality. Balance the need for achieving in utero fetal maturation with fetal maternal risks of continuing pregnancy. Generally, for mild PE delivery is recommended at 37 weeks and severe PE at no later than 34 weeks..
PE/E basic management principles Control of BP using antihypertensive -only 24% of labor ward facilities [QOC Survey 2010] had Hydralazine. Monitor end organ effects especially hematological, renal and hepatological. Prevent eclampsia by judicious use of MgSO4- for severe PE/E; 80% of labor ward facilites have MgS04.[QOC Survey 2010] Monitor fetal wellbeing-
4. SCREENING AND MANAGEMENT OF PE/E IN KENYA Effective and internationally accepted guidelines are available for screening and management of PE/E. In a countrywide QOC survey 2010/KSPA, 96% of mothers had their BP checked during ANC and 89% had BP machines available Urine testing for proteins during ANC was 59% Only 25% of health providers asked mothers about signs of PE/E in current or previous pregnancies or counselled clients to return if they experienced signs of PE/E
Screening & mgt cont’d BP measurement at initial assessment of labor was 71%, but providers recorded BP on Partograph every 4 hours in 55% of deliveries. Other screening tasks for PE/E in labor (danger signs + BP check) were completed in only 20% of all deliveries. Most of the providers (83%) indicated they knew how to diagnose severe PE/E Over ¾ (77%) of the health providers indicated had knowledge on diagnose and treatment of severe PE/E, but less than half (36%) knew how to initiate and follow up management of convulsions.
5. EFFECTS OF PRE-ECLAMPSIA ON LATE PRETERM FETAL OUTCOMES 1: Risk of fetal demise/stillbirth Severe PE/E- represents significant stillbirth rate of 21/1000 live births Mild eclampsia- the risk of fetal demise is 9/1000 live births In general obstetric population still birth rate beyond 28 weeks is 3/1000 live births. NB: The risk increases substantially after 36 weeks.
Effects of PE/E Cont’d 2: IUGR IUGR- a pathological process of reduced fetal growth with attendant increase in prenatal mortality PE/E is a significant contributor to IUGR 3: Hematological effect PE/E can result in neonatal thrombocytopenia and is apparent at birth or first two days of life and resolves by 10 days of life spontaneously 50% incidence of neutropenia which resolves after several weeks.
Effects of PE/E Cont’d 4)Bronch-pulmonary dysplasia Studies have shown that BPD occurs in infants of mothers with PE/E but only where the PE/E is severe enough to lead to fetal growth restriction. 5) Neuro-developmental outcome The outcomes are highly variable Studies still inconclusive on whether PE/E reduces cerebral palsy + intra-ventricular hemorrhage 6) Fetal origins of adult disease states Epidemiological studies show that infants exposed to PE/E are at increased risk of diabetes and cardiovascular morbidity in adulthood.
6. OPTIMIZING FETAL OUTCOMES IN PE/E Limited therapeutic options in management of PE with benefits to fetus. Antenatal steroids – decrease morbidity and improve survival rather to infants born before 34 weeks. MgS04- herein shown to have a neuro- protective effect on the preterm infant including cerebral palsy and gross motor dysfunction
7. Prevention of PE/E In a systematic review in pubmed, calcium and low dose aspirin were the interventions shown to prevent pre-eclampsia. Conclusion Better understanding of the patho-physiology of PE/E is needed since PE/E disrupts mechanisms regulating fetal growth and development with the attendant dangers of elective preterm deliveries.
MDG 4/5 - The Promise Children are our future, and their mothers are its guardians. ~ Kofi AnnanKofi Annan Millennium Development Goals promise to reduce maternal deaths by three quarters and cut child mortality by two thirds, let us rededicate ourselves to that mission."..END