Management and Outcome of Sever Preeclampsia and Eclampsia at Bombo Regional Hospital.
Material type:
TextPublisher number: Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania:Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tzwww.bugando.ac.tzLanguage: English Language: Kiswahili Publication details: Mwanza, Tanzania : Catholic University of Health and Allied Sciences [CUHAS - Bugando] : ©2017Description: 57 Pages; Includes ReferencesSubject(s): Summary: Introduction
Definition of terms:
Preeclampsia is a multisystem disorder after 20 weeks of gestation characterized high blood pressure above 140/90 (systolic/diastolic), protein in urine with or without edema.
Sever preelampsia is a multisystem disorder characterized by blood pressure: >160/110, proteinuria: >5gm in 24 hours, over 2+ urine dip stick, Oligurea: less than 400ml in 24 hours with features of end organ damage.
Eclampsia is the onset of seizures (convulsion) in women with preeclampsia.
Background: Preeclampsia is a relatively common pregnancy disorder that originates in the placenta and causes variable maternal and fetal problems. In the worst causes, it may threaten the survival of both mother and baby.
The word eclampsia is from the Greek term for lighting. The first known description of the condition was by Hippocrates in the 5th century BC. An outdated medical term pre-eclampsia is toxemia of pregnancy, a term that originated in the mistaken belief that the condition was caused by toxins.
Over half million women die each year from pregnancy related causes 99% in low and middle income countries. In many low income countries, complications of pregnancy and childbirth are the leading cause of death amongst women of reproductive years. Ten percent of women have high blood pressure during pregnancy, and preeclampsia complicates 2% to 8% of pregnancies. Preeclampsia can lead to problems in the liver, kidneys, brain and the clotting system. Risks for the baby include poor growth and prematurity. Although outcome is often good, preeclampsia can be devastating and life threatening. Overall, 10% to 15% of direct maternal deaths are associated with preeclampsia and eclampsia. Where maternal mortality is high, most of deaths are attributable to eclampsia, rather than preeclampsia. Perinatal mortality is high following preeclampsia, and even higher following eclampsia.
The overall perinatal mortality was 367 per 1000 and neonatal morbidity was significant. There were two maternal deaths and two patients with ruptured liver hematoma, and nine had acute renal failure. Thirty-eight percent had intravascular coagulopathy and 20% had abruptio placenta.
In women who have gestational hypertension or preeclampsia, increased rates of preterm delivery and delivery of small for gestational age infants are present only in those will severe hypertension. In these women, the presence of proteinuria does not influence perinatal outcome (Am J ObstetGynecol2002; 186: 66-71)
Treatment according to Tanzania standard treatment guidelines 2013 for mild to moderate preeclampsia general treatment are regular BP check, monitor foetal wellbeing and proteinuria, adequate rest, advise on regular use of cocoa, exclude UTI, count the patient as high risk. Medicine methyldopa 200-500mg tds, or Nifedipine 10 mg bd. For severe preeclampsia admit and give normal saline, Nifedipine 10-20 min, followed by 5mg of 50% MgSo4 in 250mls of normal saline to run for 4 hours. Maintenance dose 4mg of MgSo4 (IM in alternative buttock) E hours for 24 hours. Deliver as soon as Bp is controlled MgSo4 regimen should continue until 24 hours after last fit. Eclampsia management, general keep air ways clear, fluid and electrolyte balance. Give MgSo4 as above, antihypertensive as above, fluid management as above, deliver vaginaly unless other obstetric indication of cesarean section.
Objective of the attachment
General objective: To learn management and outcome of severe preeclampsia and eclampsia at bombo regional hospital.
Specific objective
To know the proper management of severe preeclampsia and eclampsia patients.
To determine fetal outcome associated with severe preeclampsia and eclampsia
To determine maternal outcome associated with severe preeclampsia and eclampsia
Field attachment duty plan: The period for attachment will be one month, distributed as follows
Observing the management of preeclampsia and eclampsia
Participate in the management of preeclampsia and eclampsia
Attending morning report
Participating in the service and major ward rounds
Participating in evaluation and preparing patients scheduled for operation
Assisting in major and minor operations.
| Item type | Current library | Collection | Status | Barcode | |
|---|---|---|---|---|---|
| UNDERGRADUATE DISSERTATIONS | MWALIMU NYERERE LEARNING RESOURCES CENTRE-CUHAS BUGANDO | NFIC | 1 | UD0415 |
Introduction
Definition of terms:
Preeclampsia is a multisystem disorder after 20 weeks of gestation characterized high blood pressure above 140/90 (systolic/diastolic), protein in urine with or without edema.
Sever preelampsia is a multisystem disorder characterized by blood pressure: >160/110, proteinuria: >5gm in 24 hours, over 2+ urine dip stick, Oligurea: less than 400ml in 24 hours with features of end organ damage.
Eclampsia is the onset of seizures (convulsion) in women with preeclampsia.
Background: Preeclampsia is a relatively common pregnancy disorder that originates in the placenta and causes variable maternal and fetal problems. In the worst causes, it may threaten the survival of both mother and baby.
The word eclampsia is from the Greek term for lighting. The first known description of the condition was by Hippocrates in the 5th century BC. An outdated medical term pre-eclampsia is toxemia of pregnancy, a term that originated in the mistaken belief that the condition was caused by toxins.
Over half million women die each year from pregnancy related causes 99% in low and middle income countries. In many low income countries, complications of pregnancy and childbirth are the leading cause of death amongst women of reproductive years. Ten percent of women have high blood pressure during pregnancy, and preeclampsia complicates 2% to 8% of pregnancies. Preeclampsia can lead to problems in the liver, kidneys, brain and the clotting system. Risks for the baby include poor growth and prematurity. Although outcome is often good, preeclampsia can be devastating and life threatening. Overall, 10% to 15% of direct maternal deaths are associated with preeclampsia and eclampsia. Where maternal mortality is high, most of deaths are attributable to eclampsia, rather than preeclampsia. Perinatal mortality is high following preeclampsia, and even higher following eclampsia.
The overall perinatal mortality was 367 per 1000 and neonatal morbidity was significant. There were two maternal deaths and two patients with ruptured liver hematoma, and nine had acute renal failure. Thirty-eight percent had intravascular coagulopathy and 20% had abruptio placenta.
In women who have gestational hypertension or preeclampsia, increased rates of preterm delivery and delivery of small for gestational age infants are present only in those will severe hypertension. In these women, the presence of proteinuria does not influence perinatal outcome (Am J ObstetGynecol2002; 186: 66-71)
Treatment according to Tanzania standard treatment guidelines 2013 for mild to moderate preeclampsia general treatment are regular BP check, monitor foetal wellbeing and proteinuria, adequate rest, advise on regular use of cocoa, exclude UTI, count the patient as high risk. Medicine methyldopa 200-500mg tds, or Nifedipine 10 mg bd. For severe preeclampsia admit and give normal saline, Nifedipine 10-20 min, followed by 5mg of 50% MgSo4 in 250mls of normal saline to run for 4 hours. Maintenance dose 4mg of MgSo4 (IM in alternative buttock) E hours for 24 hours. Deliver as soon as Bp is controlled MgSo4 regimen should continue until 24 hours after last fit. Eclampsia management, general keep air ways clear, fluid and electrolyte balance. Give MgSo4 as above, antihypertensive as above, fluid management as above, deliver vaginaly unless other obstetric indication of cesarean section.
Objective of the attachment
General objective: To learn management and outcome of severe preeclampsia and eclampsia at bombo regional hospital.
Specific objective
To know the proper management of severe preeclampsia and eclampsia patients.
To determine fetal outcome associated with severe preeclampsia and eclampsia
To determine maternal outcome associated with severe preeclampsia and eclampsia
Field attachment duty plan: The period for attachment will be one month, distributed as follows
Observing the management of preeclampsia and eclampsia
Participate in the management of preeclampsia and eclampsia
Attending morning report
Participating in the service and major ward rounds
Participating in evaluation and preparing patients scheduled for operation
Assisting in major and minor operations.
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