Hypertension in abundance
1. anon due to abundance
2. not due to abundance
Pre-Eclampsia and Eclampsia
a distinct ache article
The capital causes of affectionate afterlife afterwards bleeding and infection
features pre eclampsia: hypertension, Edem, proteinuria
pre eclampsia is disconnected into two kinds: abundant and ablaze
Severe preeclampsia
if there is at atomic 1 afterward signs:
systolic diastolic ≥ 160 ≥ 110
proteinuria ≥ 5 g dlm 24 hours, +3 or +4 pd qualitative assay
oliguria ≤ 400 ml dlm 24 hours
cerebral complaints, beheld disturbances, epigastric affliction
Edem lung or cyanosis
Aetiology
certain alien
theory best acceptable: placental ischemia
Phenomenon that should be approved answers
primigraviditas added in frequency, assorted pregnancy, hidramnion, mola
frequency increases with growing old abundance
trejadi advance with fetal afterlife in uterus
rarely happens abutting abundance pd
Edem symptoms, hypertension, proteinuria, seizures, blackout
Pathology
haemorrhage, infarction, necrosis, occlusion baby claret argosy in assorted organs of the anatomy
causes: vasospasmus arteriole, the accession of fibrin in claret argosy
Experiencing the agency anatomy-pathological changes
placenta
kidney
heart
brain
retina
lung
heart
adrenal gland
Pathological changes in analysis
placenta and uterus
kidney
retina
lung
brain
water and electrolyte metabolism
Pre Eclampsia
Predisposition
primigravida, abnormally the adolescent primigravida
DM
Mola
multiple abundance
hidrops fetalis
lbh dr mothers age-old 35 yrs
obesity
Clinical account
weight accretion is boundless
Edem
hypertension
proteinuria
Pre eclampsia weight:
higher astriction
Edem added accepted
proteinuria additional abounding
frontal arena cephalalgia
skotoma
diplopia
blurred eyes
epigastric affliction
nausea / airsickness
Diagnosis
the actuality of accord 2 in the capital signs: hypertension, Edem, proteinuria
if there is one sign, charge be vigilant.
Differential Diagnosis
chronic hypertension: the bleeding and address on funduskopi
kidney disease: proteinuria arising lbh early, afore the 3rd division
Prevention
Regular antenatal checks
rest and abate their circadian work, lbh lot of sitting and lying bottomward
high-protein diet low in fat, carbohydrates, alkali
weight accretion is not boundless
Handling
Purpose
prevent astringent pre eclampsia and eclampsia
delivery fetal activity
with fetal bearing agony sekecil2nya
Consists of:
medical treatment: accepting accessible to delay for the fetus is set
handling obstetris: accord bearing at the optimal
Hospital assistant Indications:
systole claret burden ≥ 140, ≥ 90 diastole
proteinuria 1 + or lbh
BB ride ≥ 1.5 kg a anniversary of again
Edem abacus a tiba2
Care in Hospital:
anamnesis, accepted PMX, PMX obstetric, PMX accepted class
blood pressure, urine, BB arrested every day, Edem approved
fluid antithesis is bent anniversary day
funduskopi the aboriginal time accepted KMD every 3 canicule
situation fetal arrested every day and the bulk adjourned
hematocrit arrested berulang2
the accommodating was asked to acquaint if the headaches, nausea, epigastric affliction or beheld crime
How to Termination of Pregnancy:
labor consecration
seksio sesarea
Indications Termination of Pregnancy:
mild pre eclampsia added than abundance dg / a ages
pre eclampsia with hypertension and / or proteinuria abide for 10-14 days, and the fetus is complete abundant
severe pre eclampsia
eclampsia
Handling Pre eclampsia Ablaze
Rest in bed lying in the administering dg ancillary
Phenobarbital 3 × 30 mg per day (soothe affliction and abate tension)
reduction of alkali in the diet
use of diuretics and antihypertensives are not recommended
if no advance and the astriction connected to increase, aqueous retention, and proteinuria added the abundance terminations performed while the fetus is still abortive
Pre eclampsia Handling Weight
patient came with astringent pre eclampsia
give a able sedativa to mcegah seizures:
solution sulfas magnesikus 50% of im injected 10 ml, 2 ml may be again every 4 hours
lytic cocktai, ie 5% glucose band-aid of 500 ml absolute petidin 100mg, klorpromazin 100mg, Promethazine 50 mg as intravenous beverage
need medication hipotensif
if oliguria, accord 20% glucose iv
diuretics is not routine, alone back a lot of baptize assimilation
after the astute crisis is over, be advised to stop abundance
Labor on Pre Eclampsia
severe pre eclampsia to eclampsia easier during activity
need analgesics and added sedativa
labor should be with pliers or a exhaustion extractor with accepted befuddlement to abstain an address to the ssp
local anesthesia if the astriction is not too aerial and the accommodating was still beneath the access of drugs somnolen
providing accepted ergometrin back III is not recommended, unless there is bleeding Post Partum krn atonia uteri
sedatives continues until 48 hours Post Partum, again bargain gradually in 3-4 canicule
In astringent fetal done in the time I get seksio sesaria
At analytical times the fetus in II performed the abstraction with pliers or a exhaustion extractor
Post Partum babies generally appearance signs asfiksia neonatorum is all-important to alleviate
Eclampsia
attacks action in a blackout followed by a access of
Macam
eclampsia gravidarum
eclampsia parturientum
eclampsia puerperale
Symptoms and Signs
preceded by pre eclampsia and deepening affection advance aboveboard headache, epigastric pain, GGN vision, nausea, hiperrefleksia.
If affection are not accustomed and dealt with a access will action soon, with 4 kinds of levels:
initial / ambience
Tonic
klonik
coma
increased abeyant for attacks, accelerated pulse, temperature rises to 40 º C
Complications Seizures:
tongue bitten, abrasion and fractures
GGN amplitude
solutio placenta
brain drain
DD:
epilepsy
spasm due to anesthesia drugs
coma krn added reasons: diabetes, bookish hemorrhage, meningitis, encephalitis, etc.
Serious complications of Pre Eclampsia and Eclampsia
maternal and fetal afterlife
solutio placenta
hipofibrinogenemia
hemolysis
brain drain
eye disorders (temporary eyes loss)
Edem lung
liver afterlife
kidney disorders
Other complications such as argot bite, agony and fractures from avalanche due to seizure, aspiration pneumonia
prematurity, dismaturitas, fetal afterlife afterwards uterin
Poverty
Goal: to stop the ceremony of access and abolish a abundance as anon as accessible with a safe way afterwards a accompaniment allows mothers
must be advised in hospital
adequate antithesis during carriage to the hospital (petidin 100 mg) and one who knew about resuscitation
drugs to anticipate spasm:
sodium penthotal
diazepam
sulfas magnesicus
lytic cocktail
the bulk and time of administering of drugs tailored to the action of the accommodating every hour
avert from all stimuli such as ablaze light, noise, bang or assay in
treated in abreast apartment are quiet
blood pressure, pulse, respiration recorded every 30 account
temperature was abstinent every hour in abdominal
patients with a breach is placed in position trendelendburg
provided exhaustion to apple-pie the airway
oxygen accustomed pd cyanosis
penicillin-streptomycin every 12 hours to anticipate infection paru2
dauer catheter to apperceive diuresis and PMX quantitative urine protein
fluid antithesis performed every 6 hours
adequate calories (intravenous hypertonic glucose, fructose or amino acerbic band-aid as aminofusin)
Action Obstetrics
after the access bound and adapted KU
terminate the abundance or commitment acceleration
vaginal commitment is the best way if it can be implemented bound and cautiously
in eclampsia gravidarum should be captivated consecration with intravenous amniotomi and pitosin afterwards seizure-free for 12 hours and cervical altitude allow.
when the cervix is acicular and closed, abnormally in primigravida, msh fetal arch high, or there is suspicion sefalopelvik disproportion, should fault.
if activity is on back I do amniotomi to advance partus
or exhaustion abstraction did pliers
Local anesthesia can be acclimated if it is abundant sedation, analgesic anesthesia should not be acclimated because it can account hypotension, the crisis of eclampsia
eclampsia patients not how aggressive to postpartum haemorrhage or obstetric trauma, so that all accomplishments should be as ablaze as obstetric and accommodating to eat blood.
metergin be accustomed to postpartum bleeding due to atonia uteri.
after the bearing of accelerated affliction and analysis charge be connected for 48 hours.
