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MANAGEMENTOF

ECLAMPSIA

Dr Susanta Kumar Behera

Chairperson

DR RITANJALI BEHERA

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Eclampsia is pre eclampsia with convulsion and or coma

Or

Development of Convulsions and/or unexplained coma during pregnancy or postpartum in patients with signs and symptoms of preeclampsia

What is the most common cause of seizure during Pregnancy ?

PRE EXISTING EPILEPSY

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Incidence :o 1:500 to 1: 30 & Common in Primigravida (75%) than

multigravida (25%)o In 80% cases it is proceeded by severe

preeclampsia o Commonly occurs between 36th week to term Types a) Antepartum -50%b) Intrapartum-30%c) Postpartum-20%(Early & Late)d) Intercurrent-Rare

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ABNORMAL TROPHOBLASTIC INVASION

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CAUSES OF CONVULSION Cerebral anoxia : spasm of cerebral vessel due to hypertension-increase cerebrovascular resistance-decrease oxygen consumption-convulsion Cerebral edema –irritation Cerebral dysarhythmia : increases following edema & anoxia Stages of convulsiona) Premonitory : 30 Sec• twitching of muscle• rolling of eye ball & fixing.

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b) Tonic (30 sec) :• Tonic spasm of body• Ceasing of respiration• Protruding of tongue• Fixing of Eye ball• Cyanosis

c) Clonic (1-4 min) : • Alternate contraction &

relaxation of muscle• Congested face & Cyanosed• Conjunctival Congestion• Twitching starting from face &

spreading tongue biting• Stertourous breathing with

froths• Involuntary passage of stool

& urined) Coma : -Persits for variable period & at times patient confused

-Deep coma may occurs (cerebral hemorrhage). -Labor usually starts shortly after the fit.

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SYMPTOMS• Headache • Oedema• Visual disturbance• Focal neurology, fits,

anxiety, amnesia• Abdominal Pain• Decreased urine output• None

SIGNS• Hypertension• Tachycardia and

tachypnoea• Creps or wheeze • Neurological deficit• Hyperreflexia• Petechiae, ICH• Generalised oedema• Small uterus for dates

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WITH CONVULSIONS

• Epilepsy.

• Hysteria.

• Meningitis and Encephalitis.

• Tetanus.

• Strychnine poisoning.

• Brain tumors.

• Uremic convulsions

WITH COMA

• Hypoglycemic .

• Hyperglycemic coma

• Uremic coma.

• Hepatic coma.

• Alcoholic coma.

• Cerebral coma.

D/D

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INVESTIGATION

• Hb%• DC, TLC, TPC, BT/CT• Urinalysis –R & M• Urinary Protein• LFT• RFT• Serum Uric acid• FBS• Ophthalmoscopy• BPP

• Obstetric Scan• CT –Brain & Abdomen• CTG• Coagulation Profile• USG of Abdomen &

Pelvis• Color Doppler• MRI• Electrolytes • ECG

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MANAGEMENT General 1) Maintenance of airway2) Oxygen administration3) Fluid Management4) Organization of investigation Control of Convulsions Control of BP Obstetric Management Complication Management Postpartum Care Prevention

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THE OBSTETRIC ICU PATIENT

DELIVERY ROOM

INTENSIVE CARE UNIT

HDCU

OPERATING ROOM

POST ANESTHESIA

CARE UNIT

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GENERAL

Transfer of patient to hospital

Place the patient in a railed cot in isolated room.

Detailed history taking

Vital stabilizing(Control of BP)

Continuous drainage facility

Monitoring vitals & Urine Output Antibiotics & H2 blockers

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Patent airway with tracheal and bronchial suction. Nasogastric tube may be inserted . IV glucose 25% as a Liver support, increases UO & improves hemoconcentration. Nursing Care a) Mouth gag in between teethb) Clearing of air passagec) Raising foot end of bed

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HDCU

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FLUID THERAPY

IATROGENIC FLUID OVERLOAD IS THE MAIN CAUSE OF MATERNAL DEATH IN ECLAMPSIA

Depends upon a careful balance between restriction with possible exacerbation of end organ hypoperfusion and renal dysfunction and volume overload with pulmonary edema

PRINCIPLES :• Accurate Recording of Fluid Balancea) Delivery & Postpartum Lossb) Input/Output Deficit

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• Maintenance Crystalloid infusion :1) Crystalloids is the choice of fluid-RL

2) Total daily infusion=UO+1000 ml

3) Fluid load : 80ml/hr or UO in Preceding hr+30 ml

4) No excess use of Crystalloids/Dextrose

• Selective Colloid expansion• No unnecessary fluid overload before

regional anesthesia - Severe refractory HTN - Pulmonary Edema - Oliguria unresponsive to fluid

therapy

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• Diuretics: Only in presence of PE/CCF• Pulse Oximetry• Selective monitoring of CVP if blood loss is

excessive• Intraarterial pressure monitoring indicated - Unstable eclamptic women - BP is very high - Obese women when noninvasive measurement are unreliable - Hemorrhage > 1000ml - Severe Cardiac Disease

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POSTPARTUM • Urine output recorded hrly & each four hr block summated• Each FOUR hr block should be > 80 ml• If two consecutive four hour block fails to achieve 80 ml

Total Input > 750 ml in excess of U/O in last 24 hr

Total Input < 750 ml in excess of U/O in last 24 hr

250 ml Colloid over 20 min

20 mg IV Frusemide Colloid if diuresis > 200 ml in next hr

U/O < 200 ml U/O >200 ml

Baseline Fluid + 250 ml

Gelofusine

20 mg IV Frusemide

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ANTICONVULSANTS

Magnesium Sulphate(1924)1) Continuous IV Regimen2) Pitchard Regimen3) Sibai Regimen4) Zuspan Regimen Diazepam Phenytoin Lytic Cocktail Regimena) Chlorpromazine b) Promethazinec) Pethidine

Continuous IV Regimen

4-6 gm loading dose of Mg So4 in 100 ml of

fluid IV slowly over 15-20 min

1-2gm/hr in 100 ml of IV maintenance

infusion

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PITCHARD REGIMENRoute : IM 4gm of 25% MgSO4 IV slowly over 5-10 min followed by 5 gm 50% MgSO4 IM into each buttock. 5 gm 50% MgSO4 IM 4hrly to alternate buttock.

MOA1) motor end plate sensitivity to Ach & reduces

neuromuscular irritability2) Blocking neuronal uptake of Calcium 3) Inhibits platelet aggregation.4) Increase PGI2 synthesis.

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SIBAI REGIMEN(1990)6 gm MgSo4 over 20 min followed by 2 gm MgSO4 IV infusion ZUSPAN REGIMEN(1978)4 gm MgSo4 over 5-10 min followed by 1gm/hr MgSO4 IV infusion

DIAZEPAM

10-40 mg IV slowly followed by 40 mg in 500 ml of

5%D at the rate of 30 drops/min

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MAGNESIUM SULFATE• Lazard in 1924,intern in California started mgso4.• Given IV 20-25% (most commonly) or IM (50%) or

SC(15%)• 6 gram load followed by 2 grams per hour• Total dose should not >24 gm/24hr• Supra therapeutic levels lead to CNS depression,

cardiac arrhythmias,

• Monitoring : »Patellar reflex.»RR >16/min.»U/O >100ml/4hrs.»Serum Mg++ level.

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MAGNESIUM TOXICITYClinical Manifestation Serum LevelPhysiologic 1.3-2.1 mEq/LPeripheral Vasodilatation/Flushing/Sense of warmth/Vomiting 3-5 mEq/L

Therapeutic 4-7 mEq/LDepression of deep reflex 7-8 mEq/LArrest of Deep Reflex 8-10 mEq/LRespiratory Depression 10-12 mEq/LRespiratory Arrest 12-15 mEq/LArrhythmia/Heart Block/Bradycardia 15-20 mEq/L

Cardiac Arrest 2424242424

Antidote – 10 ml of 10% Calcium

Gluconate slow IV

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LYTIC COCKTAIL REGIMEN

Menon in India has started this regimen-1961 25 mg Chlorpromazine & 100 mg Pethidine in 20 ml of 5%D IV + 50 mg Chlorpromazine & 25 mg Promethazine IM

50 mg Chlorpromazine & 25 mg Promethazine IM alternatively 4 hrly X 24 hr IV drip 10%D with 100 mg Pethidine at rate of 20-30 drop/min X 24 hr following last fit.

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PHENYTOIN 10 mg/kg slow IV followed by 5 mg/kg after 2 hr

200 mg given orally after 12 hrs X 48 hrs following delivery Side effects : hypotension/cardiac arrhythmia /phlebitis ECG monitoring required

MOD. STROGANOFF METHOD

MgSO4 6gm IV initially then 4 gm/4hours IM + 20mg Morphine IM.

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STATUS ECLAMPTICUS• Consult anaesthetist• Nasophayngeal Suction• Intubation , IPPV & Muscle relaxation• Medicationsa) Inj Thiopentone Sodium 0.5 mg in 20 ml of 5D

IV slowlyb) Inj Diazepam 10 mg Slowly IV followed by 10

mg in 5D as IV drip• General Anesthesia(PPV + Muscle Relaxants)• Evaluation of Intracranial Abnormalities

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• Investigations : CT/EEG/Cerebral Doppler Velocimetry/MRI/Cerebral Angiography

• Cerebral imaging indicated in

1) Patients with Focal Deficits/Prolonged Coma

2) Atypical presentations of Eclampsia - Onset before 20 weeks - > 48 hrs following delivery - Refractory to Magnesium Sulphate therapy

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ANTIHYPERTENSIVES Indicated if BP > 160/110 mm of Hg in spite of Anticonvulsants & Sedatives Common drugs1) IV Labetalol2) Oral Nifedipine 3) IV Hydralazine4) Diuretics in presence of Pulmonary

Edema/CCF If C/I of MgSO4 : Phenytoin: 15 mg/kg at 40 mg/min with monitoring of Cardiac function and BP x 5 min Therapeutic Range : 10-20 μg/ml.

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COMMON AGENTS

Agent MOA Side Effects

Labetalol α β-Blocker Fatigue, Bradycardia, Swelling of Feet, Depression

Nifedipine CCB Headache, Hypotension, Palpitation, Constipation

M-Dopa Direct PAV Flushing, HypotensionHeadache, Dry Mouth

Hydralazine Direct PAV Flushing, Headache,

Diarrhea, Constipation

Sod. Nitr. Direct PAV Metabolite (Cyanide)

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Agent Dose Max Dose

HydralazineOral : 25 mg 8 hrlyIV : 5-10 mg & repeat after every 10-20 min

Oral : 300 mgIV : 20 mg

LabetalolOral : 100 mg 12 hrlyIV : 20 mg & repeat 40-80 mg every 10 min

Oral : 2400 mgIV : 300 mg

Nifedipine Oral :10 mg 6-8 hrly 120 mg

Methyldopa Oral : 250 mg 8 hrly 2 gm

Sodium Nitr. IV : 5 mcg/kg/min 10 mcg/kg/min

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Eclampsia

Not in Labor Labor

LSCSARM

VentouseForcep Obstetric

Indication

Fits controlled Fits not controlled

Anticonvulsants/Antihypertensives+/-Diuretics

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FITS NOT CONTROLLED

Termination

6-8 hrs

ASSESS INDUCTION SCORE

Favourable Unfavourable

INDUCTIONLSCS

ARMOXYTOCIN

MISOPROSTOL

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ALIVE

FITS CONTROLLED

BABY

DEAD

SPONTANEOUS EXPULION

TERMINATION

INDUCTION LSCS

PGE2 GEL/ARM/OXYTOCIN/MISOPROSTOL

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INDICATION OF LSCS

Uncontrolled fits in Spite of therapy Unconscious patient and poor prospect of vaginal delivery Obstetric indicationa) Preterm (< 34 Week)b) IUGRc) Non reassuring FHRd) Oligohydramniose) Malpresentations f) Suspected AP

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CARE DURING DELIVERY

• Care full monitoring of maternal & fetal status

• Delivery : Well Planned, done on the best Day, performed in the best Place, by best Route and with best Support team

• H2 antagonists & Antibiotics

• Vaginal delivery Preferred if not indicated otherwise

• Local infiltration of anesthesia for all VD

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• No prophylactic

MethylEgrometrine/Symtometrine

• Cut Short of Second stage of labour

• Prophylactic Rectal Misoprostol

• Managing 3rd Stage : 5-10 units of IV

Syntocinon / Inj Prostaglandin

• Vigilant about PPH & Prompt Management

• Prophylaxis against thromboembolism

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POSTPARTUM CARE

• Continuing MgSo4 following 24 hr of delivery/last Seizure.

• Regular Monitoring of BP 4 hrly

• MONITORING OF VITAL X 48 HRS

• Antihypertensive till BP < 150/100 mm of Hg

• Discharged on 4th Puerperal day

• Regular intake of Iron & Calcium

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CHOICE OF ANESTHESIA

• Local Anesthesia

• Pudendal Block

• Regional Anesthesia : Spinal Or Epidural

a) Preferred for LSCS/Labor

b) Decreased Maternal Morbidity & Mortality

c) Epidural preferred over spinal due to provocation of

excessive hypotension

-Superior pain relief

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-Epidural Promotes Utero-Placental Blood Flow -Extended to Provide Regional Anesthesia for

ID/CS• General Anesthesia Indicated a) Coagulopathy / Pulmonary Edema / Impaired

Consciousnessb) Failed Spinal /Epidural blockc) Inadequate time to perform/extend a block Difficulty intubation due to laryngeal edema Risk of ICH & Aspiration Pneumonia

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COMPLICATIONSMaternal :• CVS(4%) : Cardiac failure, Hypertension• Renal (4%): Oliguria/ARF/ ATN/ Cortical Necrosis• Respiratory(5%) : ARDS(7%), Pulmonary Edema• Hepatic : HELLP Syndrome(20%) & Subcapsular

Hematoma/DIC• Cerebral(7%): Encephalopathy, Infarction, Hemorrhage, Edema• Eye (10%): Cortical Blindness, Retinal Detachment, Edema,• Reproductive : AP(10%) or PPH

Fetal :• IUGR/Premature delivery/Fetal distress/Fetal Demise

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FETAL MONITORING• Done by

a) DFMC

b) USG-GA/AFI/FW

c) BPP/CTG

d) Color Doppler of MCA/Ut A/UA/DV

• Maternal hypoxemia & hypercarbia : FHR & Uterine Changes

a) FETAL : Bradycardia/Transient Late deceleration/decreased beat to beat variability & Compensatory tachycardia

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b) MATERNAL : frequency & tone of Ut. contractions• FHR changes resolves in 3-10 min spontaneously• If not resolved in 15 min : Suspect AP/NR-FHR

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Etiology : Renal or Prerenal

Diagnosis : S Cr X 3.0, or UO < 300 mL/ for 24

hours Commonly complicated by volume overload/

hyponatremia/hyperkalemia/hypocalcemia/metabolic acidosis.

Commonly presented with thirst/hypotension/ tachycardia/reduced JVP/dry mucus membrane/ reduced axillary sweating

Sp.Inv. : Serum Urea, Creatinine, Urinary Na+,/urine Osmolality/ Urinay Cast

RENAL FAILURE

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IP/OP charting daily Input = Output/24hrs + 500ml(non febrile)+ 200

ml/ deg C of inc. in Temp No hypotonic fluid Isotonic fluid to be fluid of choice FCT :1000 ml of isotonic fluid over 1 hr

Protein intake of 0.6 g per kg per day

No UO increases, further

infusion will be guarded

by CVP/PWP

UO increases, maintain at 100 ml/hr

Hyperkalemia, should be treated by1) Decreasing intake2) Controlling intracellular Shifts Dialysisa) Hemodialysis : Hemodynamically Stable patients &

following abdominal Surgery(LSCS)b) Peritoneal Dialysis : Hemodynamically Unstable

patients Acidosis- 5% Sod. Bicarbonate if S. HCO-3 > 15

mmol/L or arterial PH < 7.2

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Indication of Dialysis. -Clinical evidence of Uremia -Intractable intravascular overload -Hyperkalemia resistant to conservative tr. -Serum Creatinine > 8 mg/dl Coagulopathy : FFP for a prolonged aPTT, Cryoprecipitate : Fibrinogen < 100 mg/dL, Platelets Transfusion : TPC < 20,000/mm3 Continuous AV hemodiafiltration(CAVH) Continous Venoveno hemodiafiltration(CVVH)

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HELLP SYNDROME

• LOUIS WEINSTEIN (1982)

• 0.3% of all Pregnancies

• 20% of Severe Preeclampsia & Eclampsia

• Delivery is the only cure

• More common in white women.

• 2/3rd : Antepartum & 1/3rd : Postpartum(48hr)

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a) Biomarkers to follow disease progression : Platelet Count & Serum LDH, HCG,Maternal AFP,Serum Haptoglobin

• Rate of recurrence in subsequent pregnancy : 2-19%

• Manifested by nausea, vomiting, epigastric pain, and biochemical and hematological changes.

• Two Clinical Types :

1) Full HELLP syndrome : Considered for delivery within 48 hours

2) Partial HELLP Syndrome : Candidates for more conservative management

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Hemolysis

1) Abnormal Peripherical Smear

2) Serum Bilirubin >1.2 mg/dl

Elevated Liver Enzymes

a) SGOT/SGPT >72 UI / L

b) LDH >600 UI / L

Low Platelets

Platelet Count < 150 × 103 /mm3

• Class 1 – TPC <50 000/mm3.

• Class 2 – TPC: 50 000 - 100 000/mm3.

• Class 3 – TPC :100 000-150 000/mm3.

TYPES & DIAGNOSIS

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HELLP Syndrome

• Microangiopathic hemolytic anemia, consumptive thrombocytopenia, liver dysfunction

• Secondary to placental abruption, sepsis or fetal death

• Complications : Eclampsia(6%), ARF(5%), ARDS,Pulmonary edema(10%), hemorrhage, placental abruption(10%), liver hematoma with rupture(1.6%)

• Maternal Mortality : upto 50%.• Perinatal Mortality : 25%

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D/D TTP/HUS DIC/ACUTE FATTY LIVER/SEPSIS SEVERA HEMORRHAGE –ABRUPTIO CONNECTIVO TISSUE DISORDERS-SLE PRIMARY RENAL DISEASE-AGN DM

• Similar to Pre-eclampsia with–RUQ/epigastric pain– Jaundice–Microangiopathic anaemia–Deranged LFT’s

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MANAGEMENT• Bed rest • Fluid : Crystalloid /Albumin-5 to 25%• Magnesium Sulphate• Antihypertensive• Volume Expansion & Electrolyte Balance• Corticosteroids: Dex/Pred/Beta(10/10/5/5)• Surveillance a) Maternal : BP/Lab Invest./Hemodynamic Monitoringb) Fetal : FHR & BPP• Transferring patient to ICU where safe delivery can be

done

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• Indication for terminationa) GA 32-34 weeksb) Bleeding/DICc) Abruptio Placentaed) Eclampsia e) Abnormal FHR pattern

• Antithrombotics : Low dose Aspirin & Heparin

• Steroid : HELLP syndrome with TPC < 100,000 per mm3

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ADMINSTRATION OF CORTICOSTEROIDS

Improves Maternal Outcome

1) Improves thrombocyte count

2) Improves Urine OutputImproves Perinatal Outcome

a) Improves Pulmonary Maturity

b) Decreases IVH

c) Decreasing Necrotising Enterocolitis

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Continue till Liver function abnormalities are resolving

and TPC > 100,000 per mm3

HELLP Syndrome : Prophylactically with magnesium

sulfate to prevent seizures

Absence of improvement of the thrombocytopenia

within 72-96 hrs Postpartum : MOF.

Patients with DIC should be given fresh frozen plasma

and packed red blood cells.

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MANAGEMENT OF LABOR

If transabdominal delivery is required, prefer :

a) Vertical Skin Incision.b) Corporeal incision of the uterus . c) SD of Placenta to avoid hemorrhageAdmisión in Obstetric ICU until: (1) Sustained of TPC and a in LDH.(2) Diuresis : UO <100ml/h X 2 hours .(3) Control BP with SBP 150 mm Hg & DBP < 100

mm Hg.

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MANAGEMENT OF LSCS

GA : Platelet count < 75000/cmm

Transfuse 6 Packs of platelet if < 40000/cmm

Insert Subfascial drain Secondary Skin Closure or

leave Observe for bleeding from

Upper abdomen before closure

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INTRACRANIAL HEMORRHAGE

• 5% presented with focal neurological deficits.

• Gross hemorrhage is due to ruptured arteries

caused by severe hypertension.

• Eclampsia : Loss of Cerebral auto-regulation ,

hyper-perfusion similar to hypertensive

encephalopathy

• Cerebral edema in 95-100% cases of Eclampsia

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Widespread edema, ischemia,thrombosis .

CT : Hypodense area in Cortex , corresponds to

Petechial hemorrhage and infarctions

Remarkable changes in area of distribution of

Posterior Cerebral A.

MRI : Hyperperfusion due to Vasogenic Edema

Eclampsia : 25% were area of infarction

Intracranial bleeding is leading cause of

mortality

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Greene M. N Engl J Med 2003;348:275-276

Autopsy Specimen from a 40-Year-Old Woman with Eclampsia and Subarachnoid Hemorrhage

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Conservative1) Low Dose Aspirin : 30-100 mg/day

2) Anticoagulant :Conventional Heparin/LMW Heparin

3) Thrombolytics : Heparin/ Stretokinase/ Alteplase/

Urokinase

4) Antihypertensives

5) Mannitol(20%) :1 g /kg 20% solution IV 8 hrly

6) Glycerol : 30 ml 6hrly orally

7) Dexamethasone : 10 mg IV followed by 4 mg 6hrlySurgical1) Bore-Hole Aspiration

2) Decompression

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DIC MANAGEMENT• 7-10 % of patients with eclampsia• DIC is defined as presence of thrombocytopenia,

low fibrinogen(<300 mg/dl) & FDP >40 mg/dl • Two forms : Acute & Chronic or Overt & Nonovert• Two Stages : Hyper & hypocoagulable • Central pathology : Progressive generation of

thrombin in blood due to TF in underlying pathology

• Common specific investigations : PT /aPT /TPC /Fibrinogen/D-Dimer or FSP/Antithrombin/ PS/ thrombelastography

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• Cardinal rule in treatment of DIC is to identify & treat underlying cause.

Nonspecific Airway management Restoration of blood volume - Fresh Plasma/Fresh Frozen Plasma - Platelet Concentration - Cryopreciptate Adequate oxygen delivery CPV monitoring Ionotropes Correction of Electrolyte imbalance

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Dose : 1 U / every 10 kg Weight.

Spontaneous Bleeding : TPC < 50.000/mm3.

In PP Period, maintain the Count

a) >50.000/mm3 LSCS b) >20.000/ mm3 VD Dexamethasone : HELLP &

Sev. thrombocytopenia . Alternatives : Plasmaphersis &

Immunoglobulins

PLATELET TRANSFUSION

Each pack is 40-50 ml raises

count by 7500-10000/cmm

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FOZEN PLASMA/FFP• Each bag=1Unit containing

100-600 ml• Contains all procoagulant

factors including labile factor • 1U FFP=2U of Frozen Plasma• Dose : 10-15ml/kg(both)• Infuse over 2-3 hr• Infuse < 4 hrs of issue• Each bag raises factors by 25%

FFP

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Specific : 1) Heparin : Conventional/LMW2) Fibrinogen Conc.3) Antifibrinolytics 4) Thrombodulin 5) Activated Factor VII 6) Antithrombin Conc.7) Activated Protein C(APC)8) Recomb. TF pathway inhibitor : Tifacogin9) Gabexate Mesylate : Syntheic inhibitor of

serine proteases such as thrombin & anticoagulant activity in absence of antithrombin

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PULMONARY EDEMA

Attributed due to1) Increased Capillary Permeability2) Low colloidal Osmotic Pressure3) Pulmonary Endothelial DamageClinically characterized by -Tachypnoea -Respiratory Distress -Crepitations -Bronchospasm -Pink frothing -Desaturation

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• Titrate Insp. Oxygen Conc. against SpO2• Head tilt/Sit up Position• 100%-Oxygen Inhalation• Restricted Fluid intake• Intubate if necessary• Mechanical Ventilation with CPAP • Evaluate for underlying etiology• Drug therapy : 1) Inj Frusemide 40 mg IV 20 mg Mannitol2) IV Aminophylline (if bronchospasm)

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• Maternal : 8-36% most frequently related to seizure activity• Fetal : 13-30% most frequently related to iatrogenic prematurity

MORTALITY&

MORBIDITY

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FOLLOW UP Postnatal follow up for 6 weeks Persistence of HTN > 12 weeks : Medical evaluation Recurrence risk 1) Onset at term : 30%2) Onset at 30-37 weeks : 40%3) Onset at < 30 weeks : 70% Permanent Neural Damage Increased risk of Essential Hypertension Contraception :a) POP or Low dose Pill

b) No Puerperal tubal ligation

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PREVENTIONPrimary : Prevention of development of preeclampsia• Folic Acid & Calcium Supplentatation• Fish oil capsules : Modify abnormal PG balance Periodic Monitoring BP & Weight gain Antioxidants • Reduced endothelial cell activation , reduction in

preeclampsiaa) Vit-C 1000 mg/day

b) Vit-E 400 mg/day

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• Periodic Screening :a) Serum Uric Acid > 6.0 mg/dlb) Doppler :Uterine Artery & Umibilical Vein in 2nd

trimester.c) Biophysical Testingd) Ultrasonography 4 Weeklye) Roll Over Test at 28-32 Weeksf) Platelet Count(High Platelet Volume)g) Urinary Calcium < 12 mg/dlh) Serum Fibronectini) Urinary Proteinj) Serum Antithrombin-IIIk) Fetal DNA in maternal Serum

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EnSuRing good

exercise during

pregnncy

To prevent one case of Eclampsia - 71 women with Preeclampsia need to be treated - 36 women with imminent eclamspia need to be treated - 129 women without symptoms(Gest.Hypertension)

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Secondary : Pharmacological agents to prevent convulsion in preeclampsia

1) Salt restriction 2) Inappropriate diuretic therapy3) Low dose aspirin (60mg)/Baby Aspirin 4) Magnesium Sulphate5) Antihypertensives Tertiary : Preventing subsequent convulsion in

established eclampsia.

With optimum Mode of management we can prevent 70% of eclampsia

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THANK Q