preeclamp - Anesthetic Management of the Patient with...

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Anesthetic Management of the Patient with Preeclampsia Dmitry Portnoy, MD Anesthesiology Department
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MATERNAL MORTALITY IN PREGNANCY IN THE UNITED STATES, 1980-1985 CAUSE RATE (%) Embolism 17.0 Indirect causes 15.6 Hypertension in pregnancy 12.3 Ectopic pregnancy complications 10.0 Hemorrhage 9.1 Stroke 8.4 Anesthesia 7.0 Complications of termination 5.2 Cardiomyopathy 4.2 Infection 3.5 Other 7.7 Adapted from the US Maternal mortality Surveillance, 1980-1985. MMWR CDC Surveillance Summary, 1988 .
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Classification of Hypertensive Disease in Pregnancy (Australian Society for the Study of Hypertension in Pregnancy, 1999) M i l d H E L L P E c l a m p s i a S e v e r e P r e e c l a m p s i a C h r o n i c H T N w i t h s u p e r i m p o s e d p r e e c l a m p s i a E s s e n t i a l H T N S e c o n d a r y H T N C h r o n i c H T N T r a n s i e n t H T N G e s t a t i o n a l H T N H y p e r t e n s i o n i n P r e g n a n c y
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Risk Factors and Mechanisms of Preeclampsia Risk of preeclampsia – up to 8% of all pregnancies Factors implicated in increased risk of developing preeclampsia Genetic determination, familial history Chronic HTN, DM, chronic renal disease, LSE, sickle cell Twin gestation, nulliparity, maternal age over 40, adolescents Pathogenesis of preeclampsia is poorly understood multisystem abnormalities - only in the presence of placental tissue generalized endothelial cell disorder excessive immunologic reaction Triad of physiological derangements Intense vasospasm endothelium, platelets, trophoblasts Local or disseminated intravascular coagulation Plasma volume contraction disruption
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FACTORS THAT DIFFERENTIATE MILD FROM SEVERE PREECLAMPSIA Mild Severe Systolic arterial pressure <160mm Hg 160 mm Hg Diastolic arterial pressure 110 mm Hg 110 mm Hg Urinary protein <5 g/24 hr 5 g/24 hrs Dipstick + or 2 + Dipstick 3+ or 4+ Urine output >500 mL24 hr ≤500 mL/24 hr Headache no yes Visual disturbances no yes Epigastric pain no yes Right upper quadrant abdominal pain no yes Pulmonary edema no yes Cyanosis no yes HELLP no yes Platelet count >100,000/mm 3 <100,000/mm 3
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Severe Preeclampsia: Diagnostic Criteria Two or more of the following signs: Systolic blood pressure of 160 mmHg or diastolic pressure of 110
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preeclamp - Anesthetic Management of the Patient with...

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