PROGNOSIS AND COMPLICATIONS OF ECLAMPSIA

PROGNOSISIMMEDIATE: Convulsion uncertain prognosis

Factors affecting prognosis:

•Late Referral•Ante partum eclampsia with long delivery

interval•Number of fits >10•Coma in between fits•Temp >102 deg F with pulse >120/min•Systolic B.P >200 mm Hg

PROGNOSIS•Oliguria <400 ml/24 hrs with proteinuria

>5gm/24hrs•Nonresponsive to treatment•Jaundice

•MORTALITY : maternal•India 2 to 30%•If treated adequately and early, less than

2 %

CAUSES OF MATERNALDEATHS

Cardiac failure

Pulmonary Edema

Aspiration and/ or

septic pneumoni

aCerebral

Haemorrage

Acute renal

failure

Cardiopulmonary arrest

ARDS

FOETAL COMPLICATIONS•Transient foetal distress during seizure –

becomes NORMAL after seizure

•Intra Uterine Growth Retardation

•Intrauterine Foetal death

•Prematurity and its complications

FETAL MORTALITY :• Prematurity (spontaneous or Induced)• Placental insufficiency Intrauterine asphyxia • Effects of drugs used to control convulsions

• Trauma dueto operative delivery

intrauterine

asphyxia

infarction

Retro placental

haemorrhage

Spasm of uteroplacental vasculature

MATERNAL

COMPLICATIO

NS

•INJURIES :1. Tongue bite2. Injuries due to

fall from bed3. Aspiration due

to back falling of tongue

4. Bed sores if goes into coma for a long time

PULMONARY COMPLICATIONS• EDEMA: Due to

• Pneumonia: due to Aspiration – hypostatic or infective• Adult Respiratory Distress Syndrome• Embolism

Capillary

permeability

Colloidal

osmotic

pressure

Endothelial damag

e

Cardiovascular Complications• Hypertension afterload

• Preload by pathologically diminished hypervolemia of pregnancy &

• by intravenous Crystalloid or oncotic solutions

• Endothelial activation with interendothelial extravasation of intravascular fluid into the extracellular space.

• increased PR decreased C.O Acute Left ventricular failure & Cardiomyopathy.

RENAL FAILURE• Normal pregnancy GFR and RBF• Preeclampsia Renal perfusion and GFR &

• Renal afferent arteriolar resistance and glomerular endotheliosis (Endothelial cells are swollen) decreased filtration increased serum creatinine, increased urine sodium, increased plasma uric acid

• acute tubular necrosis caused by preeclampsia alone

CEREBRAL COMPLICATIONS -mechanism• Theory -1 : severe hypertension • cerebrovascular overregulation

vasospasm ischemia, cytotoxic edema, tissue infarction.

•Theory -2 : sudden elevations in systemic B.P

Lack of auto regulation forced vasodilatation and vasoconstriction vasogenic edema

CEREBRAL COMPLICATIONS -mechanism•In preeclampsia interendothelial cell

leak develops at B.P levels much lower than those usually causing vasogenic edema + a loss of autoregulation

•Manifests as Posterior Reversible Encephalopathy Syndrome—PRES.

CEREBRAL COMPLICATIONS- findings•Fibrinoid necrosis of the arterial wall and

perivascular micro infarcts and haemorrhages.

•Sub cortical oedema

•multiple non hemorrhagic areas of “softening” throughout the brain.

•hemorrhagic areas in the white matter.

NEUROLOGICAL COMPLICATIONS

•Headache relieved on MgSo4 infusion

•Scotomata, blurred vision, diplopia

•Convulsions due to glutamate release. (extended seizures brain injury & dysfunction

•Blindness – rare

•Generalized cerebral edema mental status changes confusion to coma

BLINDNESS•Blindness -- due to serous retinal

detachment or retinal infarction Purtscher retinopathy.

•Serous retinal detachment is usually unilateral and seldom causes total visual loss.

HEPATIC periportal haemorrhage in the liver periphery.

•Hepatic infarction + haemorrhage generally seen•Infarction may be worsened by obstetrical

haemorrhage Hepatic Failure ( shock liver)•Elevated liver enzymes seen. (HELLP

SYNDROME)

CLINICAL PICTURE : moderate to severe right-upper quadrant or mid epigastric pain and tenderness

•SUBCAPSULAR HAEMATOMA :hemorrhagic infarction hepatic

hematoma sub capsular hematoma rupture

HAEMATOLOGICAL COMPLICATIONS• THROMBOCYTOPENIA: frequency and intensity vary. depend on the severity and duration of the preeclampsia syndrome and the frequency with which platelet counts are

performed.

Overt thrombocytopenia—platelet count<100,000/μL severe disease

• In most cases, delivery is advisable because thrombocytopenia usually continues to worsen

OTHER COMPLICATIONS•POST PARTUM : Shock Sepsis Psychosis•HYPERPYREXIA•ABRUPTIO PLACENTA•NEUROLOGICAL DEFICITS