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.