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PREECLAMPSIA & ECLAMPSIA .2022

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Presentation on theme: "PREECLAMPSIA & ECLAMPSIA .2022"— Presentation transcript:

1 PREECLEMPSIA & ECLEMPSIA

2 OUTLINE INTRODUCTION PATHOPHYSIOLOGY EPIDEMIOLOGY SIGNS & SYMPTOMS
RISK FACTORS INVESTIGATION MANAGEMENT &/TREATMENT COMPLICATIONS CONCLUSION REFERENCES

3 INTRODUCTION Pre(eclampsia) is one of the hypertensive disorders of pregnancy; Chronic hypertension (with superimposed preeclampsia) Gestational hypertension Preeclampsia-eclampsia(post partum) Preeclampsia a rapid rise in arterial blood pressure to hypertensive levels associated with proteinuria Eclampsia represents the consequence of brain injuries caused by pre-eclampsia e.g convulsions Hypertensive disorders of pregnancy Chronic hypertension; hypertension before the 20 weeks of pregnancy Chronic hypertension with superimposed preeclampsia; before week 20 and persists to post partum Gestational hypertension; diagnosed from week 20 onwards Preeclampsia; gestational hypertension associated with clinical features e.g proteinuria Eclampsia; Abrupt development of seizures or coma during the gestational period or post-partum, non-attributable to other neurologic diseases

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5 PATHOPHYSIOLOGY The pathophysiology of pre-eclampsia is still uncertain eventhough, some theories exist that try to explain it; Abnormal plancentation, placenta ischemia and oxidative stress results to maternal endothelial dysfunction responsible for the clinical presentations. NB/:Decidual natural killer cells regulate trophoblast invasion and vascular growth Genetic theory, existence of suspectibility genes for preeclampsia activated via metabolic interactions (angiotensinogen) Immunological theory, apoptosis of the extravillous cytotrophoblast by an overexpressed maternal immunity system An abnormal expression of NK cell surface antigens and a failure in the regulation of NK cell cytotoxicity and cytokines or angiogenic factors may be some of the causes of pre-eclampsia

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7 EPIDEMIOLOGY Preeclampsia is the second leading cause of maternal death, affects 3-4% of all pregnant women. All together 10% of pregnant women are affected by a hypertensive complication of pregnancy. Pre-eclampsia predominantly affects women in their first pregnancy (2-8% of first pregnancies) The incidence of preeclampsia ranging from 1.8 to 16.7% was estimated to be seven times higher in developing countries than in developed countries In Tanzania, eclampsia is associated with 11% case fatality rate and 30% mortality rate (Mooij et al., 2015).

8 SYSTEMS SIGNS/SYMPTOMS CENTRAL NERVOUS Headaches Visual disturbances
Seizures RENAL SYSTEM Proteinuria Oliguria Abnormal kidney tests Hypertension CARDIORESPIRATORY SYSTEM Chest pain Dyspnea Low oxygen saturation Pulmonary edema HEMATOLOGIC SYSTEM Intravascular disseminated coagulation Hemorrhage Coagulation impairment Shock VASCULAR SYSTEM Severe hypertension HEPATIC SYSTEM Abnormal liver function Epigastric pain Nausea

9 RISK FACTORS History of pre eclampsia(family,previous)
Diabetes mellitus (type I or II) Multiple pregnancy First pregnancy Overweight(BMI ≥ 35 Kg/m2) Maternal age (40 years old) Chronic autoimmune disease Intergestational interval ≥10 years

10 INVESTIGATIONS Hypertension (>140/90 mm Hg) and onset proteinuria (≥1+ proteinuria on reagent stick testing) Full blood count—To look for platelet consumption owing to haemoconcentration Urea and electrolytes—To look for renal dysfunction Liver enzymes—To look for transaminitis HELLP(Hemolysis Elevated Liver enzymes and Low Platelets) syndrome Urinalysis—To quantify clinically significant proteinuria Assessment of fetus—Ultrasound for fetal growth and the volume of amniotic fluid; and Doppler velocimetry of umbilical arteries.

11 MANAGEMENT & TREATMENT
Low aspirin dosage (prevention) Corticosteroid therapy (dexamethasone,betamethasone) for pulmonary maturation Antihypertensive medication (nifedipine, labetolol, or methyldopa) to lower blood pressure Magnesium sulfate (MgSO4) for the treatment of eclamptic convulsions TREATMENT Delivery at (34-37weeks) expectant management is provided for fetal maturity.

12 COMPLICATIONS Premature birth Fetal growth restriction Fetal death
Psychosis Renal failure CNS damage Intracranial hemorrhage HELLP syndrome(Hemolysis Elevated Liver enzymes and Low Platelets)

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14 DID YOU KNOW? Smoking protects pregnant women from developing pre-eclampsia. ???
ANSWER Smoking enhances the expression of ligands of the vascular endothelial growth factor (VEGF) family, which regulate the differentiation and survival of cytotrophoblasts, leading to normal uterine invasion !!!!!!Nonetheless, it is still not recommended that pregnant women smoke, since smoking is a risk factor for several complications during pregnancy, namely; Miscarriages, Placental abruption, Preterm delivery, Reduced birth weight

15 REFERENCES Nirupama R, Divyashree S, Janhavi P, Muthukumar SP, Ravindra PV. Preeclampsia: Pathophysiology and management. J Gynecol Obstet Hum Reprod Feb;50(2): doi: /j.jogoh Epub Nov 7. PMID: Jennifer & Carbonnel, Marie & Piconne, Olivier & Asmar, Roland & Ayoubi, Jean. (2011). Pre-eclampsia: Pathophysiology, diagnosis, and management. Vascular health and risk management /VHRM.S20181.ampsia_Pathophysiology_diagnosis_and_manage ment Prevalence and risk factors for preeclampsia/eclampsia in Northern Tanzania Peres, Goncalo M., Melissa Mariana, and Elisa Cairrao.2018.”Pre- eclampsia and Eclampsia: An update on the Pharmacological Treatment Applied in Portugal”Journal of Cardiovascular Development and Diseases 5


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