Hypertensive disorders of pregnancy complications & chronic Hypertension

Complication of severe pre-eclampsia are:
• Eclampsia
• HELLP syndrome
• DIC
• ARDS
• Pulmonary oedema
• Acute renal failure
• Placental abruption
• Intrauterine growth restriction (IUGR)
• Intrauterine fetal death

Eclampsia:
defined as new-onset tonic-clonic seizure in an otherwise healthy woman with hypertensive disorder of pregnancy, is a significant complication of preeclampsia and is associated with high maternal and neonatal morbidity and mortality.
Of seizures 44% occur postnatally, 38% antepartum & 18% intrapartum. The pathophysiology is thought to involve cerebral vasospasm leading to ischaemia & cerebral oedema.

Diagnosis:
Eclamptic seizures classically occur in the second half of pregnancy & up to 10 days postpartum. They are tonic-clonic followed by a brief period of coma. Many women manifest excitability or hyper-reflexia prior to the onset of seizure. The diagnosis of eclampsia is straight forward if the woman had PE, some have not established proteinuria & hypertension before the first fit.

Management:
• General measures:
? Do not leave the patient alone
? Call for help
? Inform consultant
? Prevent maternal injury during convulsion
• Air way: assess, maintain patency, protect air way, apply oxygen.
• Breathing: assess & ventilate as required.
• Circulation: evaluate pulse rate & BP, if absent initiate cardiopulmonary resuscitation (CPR) & call for help.
• Secure intravenous access as soon as possible
• Urinary catheter to assess urinary out put
• Fluid input/output chart