in the name of god. negin rezavand associate professor of ob &gyn kums

IN The Name of God

PREECLAMPCIANegin Rezavand

Associate Professor Of

OB &GYNKUMS

Management of preeclampcia

Severity Gestational age BP

Treatment Goal Less trauma for mother and

baby Healthy mother Well baby

Mild preeclampcia Hospitalization 2-3 day Control of BP Weekly or 3-4 days visit ↓physical activity Diet (protein-cal.) No limited use of Na ,K

Hospitalization Control of BP q4h Assess for proteinuria LFT BUN , Cr q48h PT,PTT, uric acid , LDH

Mild preeclampcia

Waiting for begining NVD or ripening Cx

Sever preeclampcia Control of BP Prophylaxis for eclampcia Delivery

Delivery Ripening Cx- Induction –C/S Delay in delivery Except : -Heelp Syn -IUGR

Glucocorticoid Befor delivery for maturation Heelp syn Thrombocytopenia

When we can’t delay in delivery

Poor sign Eclampcia Sever Hypertension ↓ o2 Saturation Oliguria < 500 cc/24h Dyspnea Pulmonary edema PLT < 100000 1μlit

Decolman Fetal distress PROM IUGR Oligohydraminous < 5 BPP≤ 4 Dopler reverse IUFD

Mgso4 Kidney clearance (Cr-serum) Control with

(RR,U/O,Reflex.p) Adequate serum level

4-7mEq/lit

Toxicology Mgso4 Serum level 10meq/lit →↓Reflex .p Serum level>10meq/lit →respiratory

depression Serum level ≥12meq/lit

→respiratory Arrest Management

MgSo4 administration protocol

Effect of Mgso4 on uterine Effect of mgso4 on

Neonate

Serum Therapy

Ringer lactate 60-125cc/h

Which Anesthesia is choice?

GA Spinal

Epidural

Long Term outcome

What happen in next pregnancy?

Late Complication

Chronic Hypertension Cardiovascular disorder CVA Thromboemboli Mortality Renal failure -Renal disease Neurologic

Prevention of Preeclampcia

Diet & Supplements A→ Low salt diet B →Calcium C →Fish oil

Drugs A →Diuretics B →Anti Hypertensives

Anti OxidantsA →Vit CB →Vit E

Anti thrombotic

A →Low dose Aspirin B →Aspirin+Dipyridamol C →Aspirin +Heparin

THANKS FOR YOUR ATTENTION