molecular mechanism of preeclampsia -...
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![Page 1: Molecular Mechanism of Preeclampsia - laoshealth.orglaoshealth.org/assets/english-preeclampsia-dr-alongkhone-cme-20154.pdf20% MgSO4 2- 6 gram IV loading dose in 10- 15 min, then. 50%](https://reader030.vdocuments.net/reader030/viewer/2022041206/5d5c3f4588c9938f078bd0dd/html5/thumbnails/1.jpg)
Clinical features
• Abnormal vasculogenesis and angiogenesis and releasing of anti-angiogenic factors results in • Vasospasm• Endothelial dysfunction
• Etiology of various clinical signs and symptoms
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So, Preeclampsia usually develops
Abnormal placentation Endothelial dysfunction
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Clinical diagnosis of Preeclampsi
aACOG Task Force on
Hypertension in Pregnancy 2013
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Classification of Preeclampsia1. Preeclampsia-eclampsia
2. Chronic hypertension
3. Chronic hypertension with superimposed preeclampsia
4. Gestational hypertension
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Preeclampsia-eclampsia 2013
HYPERTENSION
PROTEINURIA
SEVERE FEATURES
OR
**edema, IUGR, oligohydramnios, 24 hour proteinuria > 5 gms/day
NOT i l d i di ti it i
Not always necessary
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Systolic BP 140Diastolic BP 90
HYPERTENSION
(4 hours apart)
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PROTEINURIA
24 hours ≥ 300 mgUrine dipstick ≥ 1+
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SEVERE FEATURES Severe hypertension (≥ 160/110 mmHg) Low platelet count (< 100,000/cu.mm.) Abnormal liver function
(Increase AST/ALT 2 folds or RUQ pain) Abnormal renal function
(Cr > 1.1 mg/dl or 2 folds of baseline level) Pulmonary edema Symptoms of nervous system and vision
CBC with platelet, AST, ALT, LDH, Creatinine, Bilirubin, Uric acid
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Mild preeclampsiaPreeclampsia without severe features
Severe preeclampsiaPreeclampsia with severe features
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ECLAMPSIA
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during pregnan
cy38-55%
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during labor
18-36%
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11-44%POSTPARTUMMOSTLY WITHIN
48 HOURS
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Can Preeclampsia-eclampsia
be prevented?
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ASPIRIN
Low dose aspirin (60-80 mg) for high risk groupbeginning in the late first trimester
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ASPIRIN
Previous preeclampsia, diabetes, hypertension, renal disease, autoimmune disease, multiple pregnancy
High risk group
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Preeclampsia-eclampsiaPrinciple of management
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1. Controlling or prevention of
eclampsia
2. Lowering blood pressure
3. Adequate hydration
4. Termination of pregnancy
Preeclampsia-eclampsia
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MgSO41
Preeclampsia with severe features
Eclampsia
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MgSO4Dosage :
20% MgSO4 2-6 gram IV loading dose in 10-15 min, then50% MgSO4 40 gram + 5%DW 920 mL IV drip 2 gram (50 mL)/hr
Monitor : urine output, reflex,
respiratory rate, blood pressure
Antidote : 10% Calcium gluconate 10 mL (1gram) IV
Therapeutic level : 4.8-8.4 mg/dL
1
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Antihypertensive
Labetalol
Hydralazine
Nifedipine
2 BP ≥ 160/110 mmHg
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Antihypertensive2 BP ≥ 160/110 mmHg and viable fetus
Labetalol 20 mg IV over 2 minutes
Hydralazine 10 mg IV over 2 minutes
Labetalol 40 mg IV over 2 minutes
10 minutes
Labetalol 80 mg IV over 2 minutes
10 minutes
10 minutes
ACOG Committee opinion; FEB 2015
Consultor
Surveillance
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Antihypertensive2Hydralazine 5-10 mg
IV over 2 minutes
Labetelol 40 mg IV over 2 minutes
Hydralazine 10 mg IV over 2 minutes
20 minutes
Labetelol 20 mg IV over 2 minutes
20 minutes
10 minutes
BP ≥ 160/110 mmHg and viable fetus
ACOG Committee opinion; FEB 2015
Consultor
Surveillance
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Antihypertensive2Nifedipine 10 mg
PO
Labetelol 40 mg IV over 2 minutes
Nifedipine 20 mg PO
20 minutes
Nifedipine 20 mg PO
20 minutes
20 minutes
BP ≥ 160/110 mmHg and viable fetus
ACOG Committee opinion; FEB 2015
Consultor
Surveillance
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Special precaution• Do not prescribe diazepam (valium®)
in case of preeclampsia-eclampsia • Unless status epilepticus was observed
2
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Limited IV access
3
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Termination as soon as possible
Preeclampsia without severe features37 weeks gestation
4
Preeclampsia with severe featuresat least 34 weeks gestation
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Termination as soon as possible
Expectant management should be consideredIf GA >24 to < 34 weeks gestation and available NICU
Corticosteroids are recommendedif GA < 34 weeks gestation
4
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Termination as soon as possible4Delivery after completion of 4 doses of corticosteroids
- PPROM- Labour- Platelet < 100,000- Abnormal LFT- Renal dysfunction- Fetal growth restriction- Severe oligohydramnios- Abnormal doppler study
- reversed end diastolic flow (umbilical a)
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Termination as soon as possible
Prompt delivery after maternal stabilization regardless of GA if- uncontrolled BP- eclampsia- pulmonary edema- abruptio placentae- disseminated intravascular coagulation- evidence of nonreassuring fetal status- intrapartum fetal demise
4
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Postpartum surveillance- Treatment if BP ≥ 150/100 mmHg (4-6 hrs apart)- Prompt treatment if BP ≥ 160/110 mmHg
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Postpartum surveillance- BP monitoring for 72 hrs- BP follow up 7-10 days postpartum