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Preeclampsia
Preventing Maternal Mortality and
Morbidity.
What is preeclampsia?
Hypertension
function
Haematological
SOMANZ guidelines
absolute number
15
rate/ million
deliveries
10
5
0
85-87 88-90 91-93 94-96 97-99 00-02 200305
13/18
All
HYPITAT trial
When to deliver?
>37
weeks
Uncontrolled BP
Deteriorating platelet
count, LFTs, renal
function
Neurological symptoms
or eclampsia
Pulmonary oedema
Placental abruption
Severe
IUGR
Non-reassuring fetal
status
Severe preeclampsia
Right
place/right person
of Blood Pressure
Route
Onset of
action
Labetolol
20-50mg
iv bolus over
2 min
5min, repeat
15mins
Nifedipine
5-10mg cap
Oral
10-20mg tab
Oral
10-20mins,
repeat 30mins
20-30mins,
repeat 45 mins
Hydralazine
5-10mg
iv bolus
20 mins, repeat
30mins
Diazoxide
15-45mg, max
300mg
iv rapid bolus
3-5mins, repeat
10mins
Eclampsia prevention
Combination
medication
Assessment
Obesity
Heart disease
Respiratory infection/conditions.
Renal disease
neglected
Expect the following to happen
Worsening of BP over 2-3 days
Third space fluid returning to circulation
Transient worsening of low platelets, raised
LFTs
High risk of thromboembolism
Conclusions
Avoid
Recognise disease
Right place, right person, timely management
Understand the high risks in severe
preeclampsia
Multidisciplinary team approach to care
Post natal review.
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