Pre-eclampsia

Pre-ecampsia:

Def:
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Hypertension ( sys BP > 140 and/or dia BP > 90 ) with
Proteinuria ( urinary protein > 0.3 g/ 24hr or 1+ protein on urine dipstix )
that develops after 20 wks gestational age.

Classification:
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mild to moderate:
-sys BP 140~160, and/or, dia BP 90~110

severe:
one of the following:

-sys BP > 160, and/or, dia BP > 110

-proteinuria > 5g/24hrs or >= 3+ on urine dipstix

-Oliguria <500 mL/24 hours

-Cerebral or visual disturbances

-Pulmonary oedema or cyanosis

-Epigastric or right upper quadrant pain

-Impaired liver function

-Thrombocytopenia

-Fetal growth restriction.

{간단히보면  BP, proteinuria, HELLP synrome sign, fetus 중에 하나 이상, 요렇게 보자}

Symps/signs:
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Danger signs:
-severe or persistent headache, nausea or vomiting, visual changes(blurry vision)<suggesting cerebral pathology/hemorrhage>,
-shortness of breath<suggesting pulmonary edema>,
-right upper quadrant or epigastric pain <suggesting liver hemorrhage>or
-decreased urine output <suggesting renal failure>

Dx
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do FBC, UE, AST;ALT (to pick up HELLP syndrome : HE(hemolysis - low Hb) L (deranged liver enzyme) LP (low platelete) syndrome)
fetal ultrasound

Mx
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Severe preeclampsia:
Think 4 things: hypertension, seizure, organ dysfunction, fetus

* hypertension -> IV fluid, labetalol/methyldopa
* seizure -> magnesium sulphate
* organdysfunction-> delivery
* fetus-> betamethasone and delivery


{mem tip
(피하시오) -> 피-fetus, 하-hypertension, 시-seizure, 오-organ dysfunction)

Rx 순서: seziure -> HT
씨~~~~이~~ 하!
}


1) prevent/treat seizure:
- Magnesium sulphate: 4 g in 200ml normal saline IVI over 20 mintues + 10 g IM statI
- followed by 5 g IMI every 4 hrs for 24 hrs.

#just good to know:
(MgSO4 has shown benefit in established seizures but its  role in prevention of seizures is uncertain.)
#watch out for toxicity:
(progression of clinical pictures in MgSO4 toxicity with increasing MgSO4 serum level:
loss of tendon reflex -> respiratory paralysis -> cardiac arrest )

2) IV maintenance fluid:
- 300 ml R/L IV stat
(if giving magnesium sulphate in 200 ml normal saline, give 100 ml Ringers Lactate instead of 300 ml because the two adds up to be 300 ml in total (200ml NS + 100ml R/L)
- then continue maintenance fluid: 80 mL/hour

3) Treat Hypertension:
-IV Labetalol:
(20 mg - 40 mg - 80 mg - 80 mg (at 10 minute intervals until desired response)
max dose: 220 mg in total.)
#Goal BP: <150 / 100

-Methyldopa 500 mg tds PO

4) Mature the fetal lung:
-Betamethasone 12 mg IM 12 hrly (give total of 2 doses)

5) reverse organ dysfunction
-Deliver the baby