Pre-eclampsia lecture

2021-01-31 12:00 AM

If the patient develops one of the additional complications: heart failure, pulmonary edema, shortness of breath, cyanosis, chest pain, poor fetal development in the uterus, and amniotic fluid.

General perception

Pre-eclampsia is the transition period from complicated pregnancy poisoning to eclampsia. The pre-eclampsia stage can occur about hours, days, weeks, depending on the severity of the disease; can also almost pass through this stage transient. Therefore, from the point of view of treatment, one should consider the form of severe fetal toxicity as pre-eclampsia.

Symptom learning

On the basis of patients presenting severe fetal toxicity with symptoms such as:

Hypertension: equal to or above 160/110 mmHg, measured while the patient is resting and the interval between measurements is at least 2 hours apart.

Proteinuria: protein amount over 6g / liter / 24 hours. Of course, the more proteinuria, the more severe the disease; but if less than 6g / liter / 24 hours, pre-eclampsia cannot be ruled out.

Signs of oedema or weight gain are also very important in diagnosis.

The amount of urine decreased, less than 400ml / 24 hours, and the more severe the disease.

Appears one of the following signs (referred to as neurological signs for short):

Nerve signs

The patient complains of headache, pain in the occipital region, but using anti-headache medicine does not go away. The patient's spirit is lethargic, indifferent to the environment.

Visual signs: the patient feels dizziness, dizziness, and photophobia. The patient feels blurred vision, sudden decrease, or decrease in vision.

Gastrointestinal signs: the patient feels nausea, vomiting, and pain in the epigastric region or right lower quadrant pain.

Subclinical signs of fetal toxicity are aggravated: the number of red blood cells and haemoglobin decreased. Quantification of liver enzymes (SGOT, SGPT) increased. Reduced platelet count. Creatinine, urea, and uric acid increase. Proteinuria increases.

If the patient develops one of the additional complications: heart failure, pulmonary oedema, shortness of breath, cyanosis, chest pain, poor fetal development in the uterus, and minimal amniotic fluid. Even the slightest major signs should be considered pre-eclampsia.

Clinical form

Pure pre-eclampsia, develops from fetal toxicity

Superimposed Hypertension: This form develops from a pregnant woman with chronic hypertension, now with more proteinuria. The higher the proteinuria, the more severe the disease, which can lead to eclampsia or other complications for the mother. It has a very high maternal-child morbidity and mortality rate.

HELLP syndrome. The syndrome includes hemolysis, increased liver enzymes and platelet count decreased <100,000 / mm. HELLP has a heavy prognosis for mother and child.

Prognosis

The early prognosis for mother and child depends on the severity of the disease, the earlier the disease appears in comparison with the age of gestational disease, the worse it is; the older the mother, the more serious the illness the clinical form of single pregnancy poisoning is lighter than the following two.

Diagnose

Implementing the quadrants

Diagnosis is based on history, clinical signs, and subclinical.

Got hurt by judgment

Blurred signs with eye disease.

Signs of epigastric pain with the stomach, bile disease during pregnancy.

Signs of increased liver enzymes with viral hepatitis or fetal fatty liver disease.

Signs of heart failure or pulmonary oedema associated with heart disease associated with pregnancy, ...

Solving

The goal is to prevent eclampsia. If the patient has a good response to treatment but the fetus is still preterm, it is possible to keep the pregnancy until term. If the fetus is already viable, the pregnancy should be suspended, i.e., treating the cause.

Medical therapy

Preventing eclampsia:

We need to do this as soon as a definite diagnosis.

Mixed paralytic lymphadenopathy (artificial coagulation): used for new hospital ophthalmia, with the following mixture:

Colossal 100 mg 1 dose.

Aminazin 25 mg 1 dose.

Pipolphene 50 mg 1 ampoule.

Glucose 5% 20 ml.

Mix well, inject 1/3 of the above solution into a slow vein, then every 1-2 hours, inject the remaining 2ml of solution into the muscle. Depending on the progression of the disease that one can stop or continue to add another dose, it should be remembered that the asbestos solution can be harmful to the patient's liver and kidneys, so this therapy is currently not used.

Magnesium sulfate 15% solution at a dose of 4 - 7g / 24 hours is also effective in preventing eclampsia. When using this high dose in patients with oliguria, one must be careful with Magnesium sulfate poisoning. Poisoning is manifested by a decrease or loss of knee reflex. An anti-poisoning drug is injected immediately into a tube of 5ml Gluconate Calcium 0.5g into a vein to neutralize Magnesium sulfate.

May be combined: Diazepam (valium lOmg) intravenously.

Control hypertension:

Drugs that do not control blood pressure to be safe for mothers and children are currently selected as Magnesium sulfate 15%, Alpha methyldopa and Hydralazine.

Magnesium sulfate solution 15% with a dose of 4-7g / day, intravenously or intramuscularly.

Aldomet tablets 250mg, dose not more than 3g / day, divided equally during the day. Hydralazine tablets 10mg, dose not more than 200 mg/day. Hydralazine has a vasodilator effect and reduces peripheral resistance but increases the patient's limb rate: therefore, it is recommended to use from low to high doses to limit its side effects. The above antihypertensive drugs can be used by injection to work quickly, but must be monitored closely to combat its side effects. The above drugs can be combined to increase the effectiveness of the drug.

Diuretic:

Drugs chosen are Furosemide (Lasix), Hydrochlorothiazide. We should only use diuretics when the amount of urine is below 800/24 ​​hours. When using diuretics always remember to add kalicoride to prevent potassium loss due to the side effects of Lasix, especially the dose of potassium taken before bedtime.

Adds weak t stain trace:

During treatment, we need to evaluate the results of treatment on a daily basis. If treatment lasts 3-5 days, the patient does not respond to treatment, we should suspend pregnancy immediately to save the mother.

Obstetric

Under premature pregnancy: we can have more aggressive medical treatment and daily evaluation of the results of treatment (such as severe fetal poisoning) but be very cautious because the timing of eclampsia is not known. before.

At full term (38-40 weeks old): need to evaluate the Bishop's index. If the Bishop is favorable, the central venous pressure is lower than 12 cm of water, and the oxytocin test (-), we can inject oxytocin intravenously by dilution with 5% glucose solution; If central venous pressure is normal, oxytocin can be pumped to induce labor. Therefore, the Bishop's index is less than 7 points is unfavorable, so it is advisable to proactively cesarean section to suspend pregnancy.

During labor, the fetus is in the crown: wait when the cervix is ​​open> 4cm, the amniotic fluid should be pressed to shorten the time of labor, put Foocxep for pregnancy when eligible. If not, should be cesarean section early. In general, mothers with pre-eclampsia, fetal impairment often need to prepare the means of revitalizing the newborn.