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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).
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 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++
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
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.
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.