Pre-eclampsia and Eclampsia Medical Notes

Flashcards covering definitions, risk factors, complications, pathophysiology, diagnostic signs, and management protocols for Pre-eclampsia and Eclampsia based on Dr. Muhaned Nagi's 2022 lecture.

Pre-eclampsia

A multi-systemic disorder usually occurring in the 2nd half of pregnancy after $20$ weeks (commonly after $28$ weeks), characterized by hypertension, proteinuria, and edema.

Early onset Pre-eclampsia

Pre-eclampsia occurring before $20$ weeks of gestational age, typically associated with multiple pregnancy or gestational trophoblastic disease (GTD/vesicular mole).

Eclampsia

The occurrence of convulsions (tonic-clonic) in a patient with pre-eclampsia; the term is derived from the Latin word for "Flashing Light."

HELLP Syndrome

A severe complication of pre-eclampsia characterized by Hemolysis, Elevated Liver enzymes, and Low Platelet count.

Major Risk Factors for Pre-eclampsia

Extreme age, obesity, Black African heritage ($6\%$), Chronic Renal Failure (CRF), Chronic HTN, Primigravida (especially if $> 35$ years), and new paternity (1st pregnancy with 2nd marriage).

Maternal Complications of Pre-eclampsia

Seizure and cerebral hemorrhage (most dangerous/common cause of death), Renal Failure, Hepatic Failure, DIC, Respiratory Failure (Pulmonary edema/embolism), Heart Failure, and Hypertensive Retinopathy.

Fetal Complications of Pre-eclampsia

Intrauterine Growth Restriction (IUGR), Intrauterine Fetal Death (IUFD), and Oligohydramnios.

Hypertensive Retinopathy Grades

Grade 1: Silver wiring; Grade 2: A.V nipping; Grade 3: Cotton wool appearance; Grade 4: Papilloedema.

Frontal Headache

A symptom of severe/imminent eclampsia that is not relieved by analgesics.

Epigastric Pain in Pre-eclampsia

Acute, severe, and constant pain caused by subcapsular hemorrhage of the liver.

Visual Disturbance Symptoms

Blurred vision, flashing lights, scotoma, diplopia, and transient blindness.

Severe Pre-eclampsia (Blood Pressure)

Blood pressure reading of $\ge 160/110\,\text{mmHg}$.

Severe Proteinuria

Protein in urine quantified as $\ge 5\,\text{gm/24 Hr}$ or categorized as $+3$ to $+4$ by dipstick.

Specific RFT for Pre-eclampsia

The Uric acid test is identified as specific for investigating pre-eclampsia.

Drug of Choice (D.O.C) for Mild Pre-eclampsia

$\alpha$-methyl dopa ("Aldomet") at dosages of $250\,\text{mg}$, $500\,\text{mg}$, or $1\,\text{gm}$.

D.O.C for Severe Hypertension ($160/110$)

I.V. Hydralazine.

Drug of Choice (D.O.C) for Eclampsia Convulsions

Magnesium Sulphate ($MgSO_4$), administered intravenously to prevent or treat seizures.

Therapeutic Serum Level of $MgSO_4$

$4-8\,\text{mg/dL}$.

Areflexia Level ($MgSO_4$ Toxicity)

Loss of reflexes and hypotension occurring at serum levels of $8-10\,\text{mg/dL}$.

Respiratory Failure Level ($MgSO_4$ Toxicity)

Loss of respiratory function occurring at serum levels of $13-15\,\text{mg/dL}$.

Cardiac Arrest Level ($MgSO_4$ Toxicity)

Occurs when serum magnesium levels exceed $15\,\text{mg/dL}$.

Antidote for Magnesium Toxicity

I.V. Calcium Gluconate.

Monitoring Parameters for $MgSO_4$ Administration

Presence of reflexes, Respiratory Rate ($RR > 12$), and Urine output ($> 20\,\text{mL/Hr}$).

Left Lateral Position

The recommended positioning for a patient with eclampsia to avoid aspiration and prevent supine hypotension caused by uterine pressure on the Inferior Vena Cava (I.V.C).

Imminent Eclampsia

Also known as severe pre-eclampsia; a state where the condition is likely to progress to eclampsia.

Fulminant Pre-eclampsia

Pre-eclampsia that suddenly and rapidly progresses to eclampsia.

Contraindicated Drug Post-Delivery

Ergometrine is contraindicated (C/I) after delivery in eclampsia/pre-eclampsia because it can increase blood pressure and cause retained placenta.