Download - Eclampsia
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CLASIFICACION CARACTERISTICAS
Hipertension
gestacional
Aumento en la PA con cifras iguales o superiores a
140/90 o ambas. Sin ningún otro sintoma o signo
Preeclampsia HTA +albuminuria >300mg/24h y signos o sintomas de
lesión endotelial. Presencia de convulsiones hace Dx
de eclampsia
HTA Crónica HTA existente antes de la semana 20 de gestación
HTA crónica con
preeclampsia
sobreagregada
Embarazada hipertensa q hace compromiso
endotelial con exacerbación de las cifras de PA y
albuminuria
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TAS>160mmHg y/o TAD>110mmHg en reposo y q persiste por mas
de 6h
Proteinuria> 5g/24h
Trastornos cerebrales (cefalea en casco, tinitus, fosfenos)
Disfuncion hepatica o renal severa
Dolor epigastrico en barra
Hiperreflexia- clonus
Edema pulmonar o cianosis
Trombocitopenia PLT<100000
Oliguria. GU < O.5ml/Kg
Acido urico >7mg/dl
RCIU
Oligohidramnios
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Falla en la migracion
del tejido
trofoblastico (en las
arterias espirales del
miometrio
Placentacion
anormal
ISQUEMIA UTERINA
DSITRESS
OXIDATIVO
DISBALANCE
ENTRE
SUSTANCIAS
VASODILATADOR
AS Y
VASOCONSTRICI
ORAS
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HIPOPERFUSION PLACENTARIA
PLACENTACION ANORMAL
DAÑO EN
CELULA
ENDOTELIAL
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OBJETIVOS EN EL MANEJO DE LA PES
•PREVENIR LAS CONVULSIONES
•PREVENIR EL ACV- CAUSA 1 DE MUERTE EN EMBARAZADAS
CON PREECLAMPSIA
•INTERRUPCION DEL EMBARAZO
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PREVENCION DE LAS CONVULSIONES
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•PA: >140/90 con EG >20 Semanas en mujer sin
antecedentes de hipertension cronica
•Proteinuria de 2+ o mas en tira reactiva o en acido
sulfosalicilico
•Creatinina serica >1.2mg/dl
•Enzimas hepaticas aumentadas
•PLT< 100000 ml
•Cefalea en casco persistente, tinitus, vision borrosa
•Dolor abdominal en barra o epigastralgia
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PREVENCION DEL ACV
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NO DESCENSOS POR DEBAJO DE 90mmHg
Compromiso de circulacion uteroplacentaria
Hipoxia fetal
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No pasar una dosis max. De 300mg en 24h
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INTERRUPCION DEL EMBARAZO
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LESION CELULA ENDOTELIAL
Lesión BHE
CID Hemorragia
Hipoxia isquémica
Infarto
Deposito fibrina-
agregación
plaquetaria.
Edema
Trombosis
Hipertensión
Vasoespasmo
Convulsión
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Aumento de sustancias
vasoactivasVasoconstrictores
humorales
Aumento de sustancias
vasoactivas
Deposito de fibrina y PLT Injuria endotelial-necrosis
fibrinoide
Perdida de
autorregulacion
vv
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Perdida de
autorregulacion
cerebral
Isquemia
Edema citotoxico
Infarto cerebralesEdema intersticial o
vasogenico
Vasoespasmo cerebral Hipoperfusion local
cerebral
Vasodilatacion cerebral
Encefalopatia
hipertensiva-eclampsia
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Antihipertensivos y emergencia hipertensiva
en pre-eclampsia.
Medicamento Dosis Comentario
Hidralazina. Bolo inicial de 5-10 mg EV.
5-10 mg cada 15-20 min hasta
30 mg o infusión 0.5-10 mg/h.
Hipotensión de
rebote si hay
depleción de
volumen.
Labetalol. Bolo 20 mg. Dosis 20-40-80 mg
cada 15 min hasta 300 mg.Mejor resultado
con bolos que infusión continua.
Nifedipino. 10 mg VO seguidos por 10 mg
cada 15 min hasta 30 mg.
Dosis inicial de 30 mg.
Utilizar los de
acción
prolongada.
Nicardipino. Infusión 5 mg/h. 2.5 mg/h
cada 5 min hasta 10 mg/h.
No disponible en
Colombia.
Urapidil. Bolo inicial de 25 mg, segundo
bolo a misma dosis y
continuar a requerimiento.
Efecto controlado.
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