1. EPH-GESTOSIS

2. Definition:
EPH-Gestosis is a disease of disturbed gestation, i.e. a high risk pregnancy. If this disturbance is demonstrated by abnormal body water retention (Edema) and/or excretion of pathological amounts of urinary proteins (Proteinuria) and/or elevated blood pressure (Hypertension), then it can be labeled as a special subgroup named EPH-Gestosis.. EPH-Gestosis is not one single well defined disease of pregnancy, yet it is a syndrome which involves many body systems e.g., cardiovascular, renal, hepatic, respiratory and central nervous system (El-Kabarity, 2000).

3. Incidence:
EPH-Gestosis is the main cause of maternal mortality and is associated with five-fold increase in perinatal mortality in developing countries (Jaramillo et al., 2001). EPH-Gestosis is primarily a disease of primigravida and is not usually a recurrent condition. EPH-Gestosis occurs in around % of first pregnancies and 5-10 % of subsequent pregnancies. Most of the cases are diagnosed after 34th weeks of pregnancy (Robson, 1999).

4. Classification & Grading: EPH-Gestosis has the following "Modified Gestosis Index" (El-Kabarity's Formula): (El-Kabarity, 2000): 1 2 3
Systolic BP (mmHg)
Less than 140
>180
Diastolic BP (mmHg)
Less than 90
90-99
>110
Edema
Occult or leg
Legs edema
Legs & Abdomen
Generalized
Proteinuria
Nil or trace
0.5 gm/L +
> gm/L ++
> 1 gm/Litre

5. Grading of EPH-Gestosis:
Mild EPH-Gestosis: (Score < 4).
Severe EPH-Gestosis: (Score 4 - 8).
Imminent eclampsia: (score > 8): Severe EPH-gestosis plus mental, visual, auditory hallucinations with cloudiness and/or epigastric pain & vomiting.
Fulminating EPH-Gestosis: Symptoms & signs proceeding from normal to severe or imminent eclampsia within a period of 12 hours or less.
Eclampsia: EPH-Gestosis with convulsive fits. Eclampsia may be antepartum, intrapartum or postpartum.

6. Management Guidelines of EPH-Gestosis:
Current protocol of management of cases EPH-Gestosis at Ain Shams University Maternity Hospital:
Principles:
Team approach.
Obstetric intensive care management.
Magnesium sulfate administration
Control of hypertension.
Termination of pregnancy after stabilization of the general condition of the patient with liberal tendency towards Cesarean section.

7. How to reduce maternal mortality due to EPH-Gestosis:
By raising the standard of prenatal (antenatal) care provided to pregnant women with early referral of high risk cases.
Centralization of case management in a tertiary care hospitals.
On admission, all the above mentioned principles and guidelines should be strictly followed.