pqcnc : conservative management of preeclampsia (cmop) at east carolina university and vidant...
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8/9/2019 PQCNC : Conservative Management of Preeclampsia (CMOP) at East Carolina University and Vidant Medical Center
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Conservative Management ofPreeclampsia (CMOP) at East
Carolina University and VidantMedical Center“ The Balancing ct!
James E. deVente, MD/PhD
ssociate ProfessorMedical "irector of #a$or and "elivery
"epartment of O$stetrics and %ynecologyBrody &chool of Medicine
CMOP
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O'tline The Balancing Act
• Brief Histor of the Conser!ati!e Management of Preeclam"sia ato#r instit#tion $Data%
• The Preeclam"tic &Balancing Act'
Pro"er Diagnosis•
Ed#cation for MD and () $E*am"les%• CMOP "rotocol• Pre!alence of Pre+eclam"sia at Vidant Medical Center $Data%
Pro"er Management• e!ere BP treatment - hr Data $Data%• teroids - 0 1ee2s $Data%
Pro"er Discharge• Patient Ed#cation and 3ollo1+#" $e*am"le%
4esson 4earned / O""ort#nities 5denti6ed
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Balancing ctBrief istory of the Conservative Management of Preeclampsia at o'rinstit'tion
&ch i E * +r i de ma n & * & i $a i B ,C o ns e rv a t i v e ma na ge me nt o f s e v e rep re e c l a mps i a re mo te f ro m te rm, m -O $s te t %y ne co l .//0 120 3 454 6478 ,
& i $a i B , " i a gno s i s a nd Ma na ge me nt o fge s ta t i o na l hy pe r te ns i o n a ndp re e c l a mps i a , m - O $s te t %y ne co l5887 1 .85 3 .2. 6./5 ,
& i $a i B* B a r to n - 9 , E : pe c ta n tma na ge me nt o f s e v e re p re e c l a mps i are mo te f ro m te rm3 pa t i e n t s e l e c t i o n *t re a tme n t * a nd de l i v e ry i nd i ca t i o ns , m - O$ s t e t %yn e co l 5 8 8; 1 < . 0 3 . 6/ ,
588.
588/
“E:pectantmanagement
sho'ld $econsidered for=omen remote
from term =hohave mild
preeclampsia!
2008 ACOG CompendiumPractice Bulletin number 33
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8/9/2019 PQCNC : Conservative Management of Preeclampsia (CMOP) at East Carolina University and Vidant Medical Center
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8
58
08
48
28
.88
.58
P(ETE(M DE45VE(7 (ATE/ V5DA)T MED5CA4 CE)TE( 899: + 89
. 4i!e Births - ;
12s
4inear $. 4i!e
Births - ; 12s%
0. 4i!e Births - 8
12s
4inear $0. 4i!e
Births - 8 12s%
B5(TH, PE( MO)TH
22.5% decrease in infantsdelivered less than 37 weeks29.2% decrease in infantsdelivered less than 32 weeks
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8/9/2019 PQCNC : Conservative Management of Preeclampsia (CMOP) at East Carolina University and Vidant Medical Center
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8
.8
58
78
08
33
weeks & transferred to NICU
31.3% decrease in total infants
re!irin"
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8/9/2019 PQCNC : Conservative Management of Preeclampsia (CMOP) at East Carolina University and Vidant Medical Center
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8
<
.8
.<
58
5<
78
7<
085)3A)T ?5TH AP>A( - @ at 35VE M5)=TE 899: + 89
.5, P%9& 4 at < Min'tes
#inear (.5, P%9& 4 at <
Min'tes)
5)3A)T PE( MO)TH
#his re$resents a 3.&%decrease in infants with
'()'*s +, at five -in!tes
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8/9/2019 PQCNC : Conservative Management of Preeclampsia (CMOP) at East Carolina University and Vidant Medical Center
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MaternalD+etal
ssessment
Mag s'lfate forsei're
prophyla:is
"E#VE9F
BMG :5 dosesfor +#M
mmediate Protocol Vs, E:pectantProtocol
MaternalD+etalssessment
% 70 =?s =DoBMG
V mag s'lfate
&teroids +#M
Contin'o's E+M
.5 'rine TP
#a$ eval'ation
&erial e:ams
%>70 =?s
%>75 =?s =ithsteroids
%57 =?s
Hny C toe:pectant mgmt
"E#VE9F
N= 124 patients < 34 ee! N= 112 patients < 34 ee!
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8/9/2019 PQCNC : Conservative Management of Preeclampsia (CMOP) at East Carolina University and Vidant Medical Center
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t#d >est.Age
>ained$d%
Ar#"tion
Birth 1t$g%
3etaldeat
h
A"gar min
A"gar min
MatDeath
ECU 4,4/ ID62,74 nJ7 .7//,4ID6
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"o# $% do e care about & da%s'
I V H
N E C
R D S
R O P
S E P S I S
C P
ou increase gestational age … you decrease the complication of prematurity
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8/9/2019 PQCNC : Conservative Management of Preeclampsia (CMOP) at East Carolina University and Vidant Medical Center
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Preeclamptic Balancing ct
CMOP
• &tro?e• emorrhage• 9enal +ail're•
epatic +ail're• P'lmonary Edema• 9etinal detachment• EtcK
Premat'rity• 9OP• &epsis•
AEC• V• CP• 9"&• EtcK
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Proper "iagnosis
8L
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Proper "iagnosis
7/L.2L
.
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8L
.8L
58L78L
08L
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Proper Management
6.8L
8L
.8L
58L
78L
08L
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Proper Management
8L
58L
08L
48L
28L
.88L
.58L
4;L
.88L
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Proper "ischarge• ll patients =ith %TADPreeeclampsia are given a .
=ee? post6part'm BP chec? appt,
• ll patients are given ver$al ed'cation onypertension in pregnancy (and this is doc'mented
in the 9A Aotes)
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#essons and Opport'nities., Ta?ing an acc#rate BP can $e e:tremely dic'lt in some patients
8. Antih"ertensi!e dr#gs need to $e readily availa$le
7, Ma?ing a "iagnosis of #"er im"osed Preeclam"sia cansometimes $e N'ite challengingK $e patient =ith yo'r patient and
yo'r self
0. Patient Ed#cation has $een very challenging to e:ec'te in arelia$le fashion
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Eval'ation and management of severe preeclampsia $efore 70 =ee?s gestation,&M+M Clinical Opinion, m - O$stet %ynecol 588;1 ./.6./;,
addad B and &i$ai BM, E:pectant Management in Pregnancies =ith &evere pre6eclampsia, &emin Perinatol 588/1 773 .076.