Transcript EPH-GESTOSIS - [ O ] r g a n i s a t i o n [ G ] e s t o s i s

Definition:
EPH-Gestosis is a disease of disturbed gestation, i.e. a high risk pregnancy.
If this disturbance is demonstrated by abnormal body water retention (Edema)
and/or excretion of pathological amounts of urinary proteins (Proteinuria)
and/or elevated blood pressure (Hypertension), then it can be labeled as a
special subgroup named EPH-Gestosis.. EPH-Gestosis is not one single well
defined disease of pregnancy, yet it is a syndrome which involves many body
systems e.g., cardiovascular, renal, hepatic, respiratory and central nervous
system (El-Kabarity, 2000).
Incidence:
EPH-Gestosis is the main cause of maternal mortality and is associated
with five-fold increase in perinatal mortality in developing countries (Jaramillo
et al., 2001). EPH-Gestosis is primarily a disease of primigravida and is not
usually a recurrent condition. EPH-Gestosis occurs in around 10-15 % of first
pregnancies and 5-10 % of subsequent pregnancies. Most of the cases are
diagnosed after 34th weeks of pregnancy (Robson, 1999).
Classification & Grading:
EPH-Gestosis has the following "Modified Gestosis Index"
(El-Kabarity's Formula):
(El-Kabarity, 2000):
0
Systolic BP (mmHg)
Diastolic BP (mmHg)
Edema
Proteinuria
1
2
3
140-159
160-179
>180
Less than 90
90-99
100-109
>110
Occult or leg
Legs edema
Less than 140
Nil or trace
0.5 gm/L
+
Legs & Abdomen
> 0.5-1 gm/L
++
Generalized
> 1 gm/Litre
++
Management Guidelines of
EPH-Gestosis:
Current protocol of management of cases EPH-Gestosis
at Ain Shams University Maternity Hospital:
• Principles:
• Team approach.
Obstetric intensive care management.
Magnesium sulfate administration.
• Control of hypertension.
• Termination of pregnancy after stabilization of the
general condition of the patient with liberal tendency
towards Cesarean section.
How to reduce maternal mortality due to
EPH-Gestosis:
 By raising the standard of prenatal (antenatal) care
provided to pregnant women with early referral of
high risk cases.
 Centralization of case management in a tertiary care
hospitals.
 On admission, all the above mentioned principles and
guidelines should "De strictly followed.
Grading of EPH-Gestosis:
 Mild EPH-Gestosis: (Score < 4).
 Severe EPH-Gestosis: (Score 4 - 8).
 Imminent eclampsia: (score > 8): Severe EPH-gestosis plus
mental, visual, auditory hallucinations with cloudiness and/or
epigastric pain & vomiting.
 Fulminating EPH-Gestosis: Symptoms & signs proceeding
from normal to severe or imminent eclampsia within a period
of 12 hours or less.
 Eclampsia: EPH-Gestosis with convulsive fits. Eclampsia may
be antepartum, intrapartum or postpartum.
Management Guidelines of EPH-Gestosis:
 Current protocol of management of cases EPH-Gestosis at Ain
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Shams University Maternity Hospital:
Principles:
Team approach.
Obstetric intensive care management.
Magnesium sulfate administration
Control of hypertension.
Termination of pregnancy after stabilization of the general
condition of the patient with
liberal tendency towards Cesarean section.
How to reduce maternal mortality due to
EPH-Gestosis:
 By raising the standard of prenatal (antenatal) care provided to
pregnant women with early referral of high risk cases.
 Centralization of case management in a tertiary care hospitals.
 On admission, all the above mentioned principles and
guidelines should be strictly followed.