definition: eph-gestosis is a disease of disturbed gestation, i.e. a high risk pregnancy. if this...
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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).
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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).
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Classification & Grading:EPH-Gestosis has the following "Modified Gestosis Index"
(El-Kabarity's Formula):(El-Kabarity, 2000):0 1 2 3
Systolic BP (mmHg) Less than 140 140-159 160-179 >180
Diastolic BP (mmHg) Less than 90 90-99 100-109 >110
Edema Occult or leg Legs edema Legs & Abdomen Generalized
Proteinuria Nil or trace 0.5 gm/L+
> 0.5-1 gm/L++
> 1 gm/Litre++
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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.
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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.
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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.
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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 withliberal tendency towards Cesarean section.
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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.