Eclampsia Seizures, HELLP Syndrome, ne Awo akyi Akyirikyiri Preeclampsia kosi Adapɛn 6¶

Preeclampsia, eclampsia (ɛnanom generalized tonic-clonic convulsions), ne HELLP syndrome (Hemolysis, Elevated Liver enzymes, ne Low Platelets) yɛ nyinsɛn mu mogya mmoroso a ɛde nkwa to asiane mu a ebetumi ama mogya atɔw, mmerɛbo mu apaapae, awotwaa mu apaapae, ahurututu mu akisikuru, ne koma no agyae wɔ simma kakraa bi mu. Atosɛm a ɛyɛ hu na atrɛw ne sɛ akokoaa no a wɔwo no sa preeclampsia ntɛm ara: nokwarem no, eclampsia a ɛma obi ho kyere no ne awo akyi mogya mmoroso ho haw a emu yɛ den nyinaa mu bɛyɛ ɔha biara mu nkyem 30 kosi 50 ba BERE a wɔawo akokoaa no, na ɛtaa ba ** nnɔnhwerew 48 kosi adapɛn 6 wɔ ayaresabea akyi** bere a ɛna no wɔ fie rehwɛ ne ba a wɔawo no foforo no. Sɛ ɔbea a onyinsɛn anaa ɔwoo no nnansa yi ara (ɛkɔ adapɛn 6 wɔ awo akyi) nya mogya mmoroso a ɛyɛ 160/110 mmHg anaa nea ɛboro saa, ne ti a ɛyɛ yaw a ɛkɔ so bɔ denneennen, akanea a ɛhyerɛn a ɛhyerɛn wɔ aniwa so anaa n’anifuraefo (scotomata), yafunu a ɛyɛ yaw kɛse wɔ nifa so atifi fam anaa epigastric yafunu mu, ɔhome a ɛyɛ tiaa mpofirim, anaasɛ akisikuru a ɛyɛ den, . frɛ wo mpɔtam hɔ ntɛmpɛ nɔma denam yɛn nɔma ahorow a egye ntɛmpɛ directory ntɛm ara, efisɛ saa awo ho ntɛmpɛ yi hwehwɛ sɛ wɔde ayaresabea magnesium sulfate a wɔde fa ntini mu ne mogya mmoroso a wɔhwɛ so ntɛmntɛm na wɔasiw ano ɛnanom a ɔyare a ɛma obi hwe ase, . mogya mmoroso ho haw, anaa placental a ɛba mpofirim.

Yɛ eyi mprempren¶

1. Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma ntɛm ara na ka nyinsɛn anaa awo akyi tebea pɔtee: Trɛ 911 wɔ United States ne Canada, 112 wɔ Europa Aman Nkabom no nyinaa mu, 999 wɔ United Kingdom, 000 wɔ Australia, anaa hwɛ yɛn amanaman ntam nɔma ahorow a egye ntɛmpɛ directory a wɔde kyerɛw nsɛm. Ka kyerɛ nea ɔde kɔma no pefee sɛ: "Awo ho Ahobammɔ a Ɛho Hia Ntɛmntɛm: Onyinsɛn [anaa X nna/adapɛn wɔ awo akyi] Ɔyarefo a wosusuw sɛ ɔwɔ Eclampsia Seizure anaasɛ Severe Preeclampsia / HELLP Syndrome." Sɛ yɛbɛka sɛ ɔyarefo no awo nnansa yi ara a, ɛho hia kɛse enti adwumayɛfo a wɔhwɛ awo akyi no nhu awo akyi preeclampsia wɔ ɔkwan a ɛnteɛ so sɛ ɛyɛ atiridiinini, ehu a ɛyɛ hu, anaa gallbladder a ɛyɛ hyew.
2. Bobɔ ɔbea no wɔ ne BENKU so (Left Lateral Decubitus Position): Sɛ́ ebia ɔyarefo no reyɛ nnam wɔ ne ho popo, post-ictal (ɔda wɔ akisikuru akyi), anaasɛ wanyane a mogya mmoroso a emu yɛ den wom no, dan no kɔ ne benkum so (anaasɛ sɛ wanyin boro adapɛn 20 na ɔda baabi a ɛyɛ tratraa a, fa nsa tu n’awotwaa no kɔ benkum so anaasɛ fa pillow a ɛyɛ den si hɔ wɔ n’asen nifa ase sɛnea ɛbɛyɛ a ɔbɛma degree 15 kosi 30 benkum akyi a ɛdannan). Benkum so a wɔde si hɔ no mma awotwaa a emu yɛ duru no ntumi nbubu inferior vena cava ne abdominal aorta (supine hypotensive syndrome), ɛma mogya kɔ awotwaa ne ɛna koma mu kɛse, na ɛma nnompe, mogya, anaa ɔfe fi n’anom dwoodwoo bere a wanya akisikuru no.
3. Bɔ ne ti ho ban bere a eclamptic seizure na MMFA biribiara nhyɛ n’ano DA: Popa nneɛma a ɛyɛ den fi ne ho, fa jacket anaa pillow a wɔabobɔw hyɛ ne ti ase, na sansan ntade a ɛyɛ den wɔ ne kɔn mu. Mmɔ mmɔden da sɛ wobɛbɔ ne hwene mu anaasɛ wode nkankyee, nsateaa, anaa sika kotoku mu nneɛma bɛhyɛ n’anom, efisɛ eyi bubu sẽ na esiw mframa kwan no. Eclamptic convulsions dodow no ara ankasa gyae wɔ sekan 60 kosi 120 mu.
4. Ma ɔyarefo no sie katee Nothing by Mouth (NPO) na MMFA ne yafunu nifa so atifi: Mma ɔbea a ɔda anaasɛ wayɛ preeclamptic kɛse no nsu a wɔnom, aduan, anaa ɛyaw nnuru, efisɛ aspiration pneumonia yɛ asiane kɛse na ebia ɛho behia sɛ wɔde oprehyɛn yɛ ntɛm. Sɛ ɛyaw a emu yɛ den wɔ ne mpampam nifa ase anaa ne yafunu mfinimfini (epigastric pain), mfa wo nsa nka ne yafunu a ɛwɔ soro nifa so, nhyɛ wo ho, anaasɛ nhyɛ mu kɔ akyiri da, efisɛ wɔ HELLP syndrome mu no, mmerɛbo no mu ntini no betumi atrɛw teateaa denam subcapsular hematoma a ebetumi apaapae owuyare wɔ abɔnten nhyɛso ase.
5. Suu na kyerɛw ne mogya mmoroso sɛ ofie nsa atifi cuff wɔ hɔ a: Sɛ ɔda hɔ na ne ho adwo no a, yɛ ne nsa atifi mogya mmoroso akenkan a ɔte ase anaa ɔdan benkum na kyerɛw nɔma pɔtee ne dɔn bere a wɔde ma ayarehwɛfo. Wɔ nyinsɛn ne awo akyi bere mu no, mogya mmoroso a ɛyɛ 160 mmHg systolic anaa nea ɛboro saa, ANAA 110 mmHg diastolic anaa nea ɛboro saa yɛ aduruyɛ mu ntɛmpɛ a ɛho hia (ɛwom mpo sɛ ebia 160/110 betumi ayɛ te sɛ nea ɛba fam sen 180/120 a wɔde di dwuma wɔ mpanyimfo a wɔnyɛ nyinsɛn mu de).
6. Si so dua sɛ wɔnyɛ ayaresabea nhwehwɛmu wɔ dwumadibea a wɔhwɛ ntɛmpɛ a wotumi yɛ awo ho adwuma: Nkɔ ayaresabea a wɔhwɛ ntɛm a wɔnantew kɔ hɔ. Ɔbea a ɔwɔ preeclampsia a emu yɛ den, eclampsia, anaa HELLP syndrome hia sɛ wɔde magnesium sulfate (4 g kosi 6 g loading bolus) fa ntini mu ntɛm ara, ɛnyɛ nnuru a wɔde sa akisikuru a wɔtaa de di dwuma te sɛ diazepam anaa phenytoin, ka nnuru a ekum mogya mmoroso a ɛyɛ adwuma ntɛmntɛm (IV labetalol, IV hydralazine, anaa oral immediate-release) ho nifedipine) a wɔde di dwuma.

Gyinaesi dua: Preeclampsia a emu yɛ den, eclampsia akisikuru, ne HELLP syndrome triage¶

flowchart TD
    Start["Ɔbea a Onyinsɛn (Adapɛn 20+ Nyinsɛn) ANAA Ɔbea a Ɔwo Akyi (Nnɔnhwerew 0 kosi Adapɛn 6 Wɔ Awo Akyi) ."] --> SeizureCheck{"So ɔyarefo no wɔ akisikuru a ɛma ne ho popo, ɔnyɛ hwee, ANAA ɔreda akisikuru ho sɛnkyerɛnne adi (anim a ɛrehwe ase, ne nsa a ɛyɛ mmerɛw, ɔkasa a ɛyɛ mmerɛw)?"}

    SeizureCheck -->|"YIW: Eclamptic Seizure a Ɛyɛ Adwuma anaa Nea Ɛba Awie Nkyɛe"| EclampsiaProtocol["IMMEDIATE ECLAMPSIA PROTOCOL: 1. Frɛ 911 / 112 / 999 STAT: State Pregnant or Postpartum Eclampsia Seizure 2. Bobɔ ɔyarefo no kɔ BENKU SO (Benkum Lateral Decubitus / 15 kosi 30 deg benkum awotwaa tilt) 3. Pad ti, atwa ho ahyia pefee, MFA nneɛma nhyɛ anom da, bere a ɛtwetwe no 4. Fa O2 a ɛsen kɛse (10 kosi 15 L/simma) ma bere a mframa kwan no mu atew 5. Ayaresabea First-Line Anticonvulsant: IV Magnesium Sulfate (4g kosi 6g bolus wɔ simma 15 kosi 20, afei 1 kosi 2 g/hr) 6. Sa BP 160/110 mmHg anaa nea ɛboro saa wɔ simma 30 kosi 60 mu na asiw mogyatɔw ano ɔyare a ɛma obi hwe ase"]

    SeizureCheck -->|"DABI: Nyan, akisikuru biara nni hɔ"| RedFlagCheck{"So Preeclampsia / HELLP Red Flags a Ɛyɛ Den BI wɔ hɔ? 1. Mogya mmoroso 160 mmHg systolic anaa nea ɛboro saa, ANAA 110 mmHg diastolic anaa nea ɛboro saa 2. Tiyɛ a ɛkɔ so yɛ den (acetaminophen ntumi nnyae) 3. Visual scotomata (anifuraefo), akanea a ɛhyerɛn, aniwa a ɛyɛ kusuu anaa mmɔho abien 4. Nifa so atifi fã a ɛyɛ den (RUQ) anaasɛ epigastric ɛyaw anaasɛ akisikuru ne ɔfe 5. Ɔhome a ɛyɛ tiaa, orthopnea, anaa SpO2 a ɛba fam sen 94% (ahurututu mu edema) ."}

    RedFlagCheck -->|"YIW: Frɛko kɔkɔɔ biako biara a ɛwɔ hɔ"| SevereProtocol["SEVERE PREECLAMPSIA ANA HELLP SYNDROME EMERGENCY: 1. Frɛ 911 / 112 / 999 anaa fa kɔ Ayaresabea Adwumayɛ ne Awo / ED ntɛm ara 2. Gye w’ahome wɔ Left Lateral Tilt gyinabea; sie Nothing by Mouth (NPO) 3. MMƆ yafunu a ɛwɔ soro nifa so (asiane a ɛwɔ hɔ sɛ subcapsular liver hematoma bɛpaapae) 4. Ayaresabea STAT Labs: CBC (platelets a ɛba fam 100k), AST/ALT (2x normal), LDH, Creatinine, Urine Protein 5. Fi ase IV Labetalol, IV Hydralazine, anaa Oral Immediate-Release Nifedipine wɔ simma 30 kosi 60 mu + IV Magnesium Sulfate"]

    RedFlagCheck -->|"DABI: BP a ɛkɔ soro a ɛnyɛ den kosi nea ɛkɔ soro (140 kosi 159 / 90 kosi 109 mmHg) a sɛnkyerɛnne biara nni ho"| MildProtocol["GESTATIONAL ANAA POSTPARTUM HYPERTENSION A ƐNYƐ HIA: 1. San hwɛ mogya mmoroso wɔ simma 15 a wote ase bere a woregye w’ahome mu 2. Di Obstetrician / Maternity Triage Unit ho nkɔmmɔ DA KAR no ma lab adwuma (CBC, mmerɛbo ne asaabo panel, protein/creatinine ratio) 3. Sɛ BP yɛ kɛse a, kɔ soro kodu 911 / 112 / 999 ntɛm ara du 160/110 anaasɛ tiyɛ, anisoadehu, anaa epigastric sɛnkyerɛnne biara da adi"]

Pathophysiology: Sɛnea awotwaa mu ntini a ɛnyɛ adwuma yiye tow hyɛ ɛna no amemene, mmerɛbo, ne mogya so¶

1. Spiral Artery Remodeling a Asɛe ne Endothelial Poisoning¶

Wɔ nyinsɛn a ɛte apɔw a ɛfata mu no, awotwaa mu nkwammoaa titiriw (cytotrophoblasts) kɔhyɛ ɛna no awotwaa mu ntini spiral arteries so wɔ ɔsram abiɛsa a edi kan ne nea ɛto so abien no mu, na ɛdan no fi ntini teateaa a ɛko tia nyarewa kɛse mu kɔ akwan a ɛtrɛw a ɛko tia nyarewa pii a ɛma awotwaa no guare wɔ mogya mu.

Wɔ preeclampsia mu no, saa spiral artery remodeling yi nwie pɛyɛ. Awotwaa mu ntini teateaa a ntini wom no da so ara yɛ ketewaa, na ɛma awotwaa no ntumi nhyɛ mogya mu bere tenten na oxygen nni mu. Wɔ mmuaema mu no, awotwaa a ayɛ basaa no gyae protein ahorow a ɛko tia ntini a ɛma mogya tu, titiriw soluble fms-like tyrosine kinase-1 (sFlt-1) ne soluble endoglin (sEng), kɔ ɛna no mogya mu. Saa protein ahorow yi ma ɛna no abɔde mu ntini a ɛma onyin (VEGF ne PlGF) no nyɛ adwuma, na epira mogya ntini a ɛwɔ ne nipadua nyinaa mu a ɛyɛ mmerɛw (vascular endothelium) no: 1. Severe Systemic Vasospasm: Esiane sɛ nitric oxide ne prostacyclin nni mu nti, ntini a ɛfa ɛna no amemene, asaabo, mmerɛbo, ne awotwaa mu no twetwe denneennen, na ɛma mogya mmoroso kɔ soro ntɛmntɛm. 2. Leaky Capillaries and Intravascular Depletion: Capillary afasu a asɛe no pue protein ne nsu fi mogya no mu kɔ ntini a atwa ho ahyia no mu (ɛma anim, nsa, ahurututu [pulmonary edema], ne amemene [cerebral edema] hohoro mpofirim), bere a ɛma mogya a ɛwɔ ntini no mu no yɛ kɛse, ɛyɛ mmerɛw, na ɛtaa yɛ micro-clotting. 3. Nea Enti a Awo Nnyae Cascade no Ntɛm ara: Bere a wɔawo awotwaa no wɔ awo mu akyi mpo no, sFlt-1 a ɛkyinkyini, endothelial opira, ne systemic vasospasm gye nna kosi adapɛn pii ansa na ayɛ yiye, bere a mpofirim a wɔboaboa nsu a ɛwɔ ntam a ɛto so abiɛsa a ɛsan kɔ mogya ntini a asɛe no mu wɔ awo akyi Da 3 ne 10 ɛma mogya mmoroso kɔ soro kɔ beae a asiane wɔ hɔ sɛ ɔyare a ɛma obi hwe ase no.

2. Nea enti a 160/110 mmHg yɛ Stroke Threshold wɔ Nyinsɛn Mu (vs. 180/120 wɔ Mpanyimfo a Wɔnnye Nsɛntitiriw mu) .¶

Wɔ ɔbarima bi a wadi mfe 60 a ɔwɔ mogya mmoroso a enni sabea mfe du du pii mu no, amemene mu mogya ntini wɔ ntini afasu a ɛyɛ den a ebetumi agyina mogya mmoroso a ɛyɛ 175/105 mmHg ano a ɛrempae. Nea ɛne eyi bɔ abira no, ɔbea a onyinsɛn a wadi mfe 28 a ɔwɔ apɔwmuden taa nya nyinsɛn mu mogya mmoroso a ɛfata a ɛyɛ 95/60 mmHg kosi 110/70 mmHg.

Sɛ ne mogya mmoroso huruw mpofirim fi 100/60 mmHg kɔ 160/110 mmHg a, ne ntini mu nhyɛso a ɛkɔ soro bɛboro ɔha biara mu nkyem 60, a ɛboro amemene mu autoregulation anohyeto a ɛwɔ soro wɔ n’amemene mu ntini a ɛyɛ mmerɛw na endothelially asɛe no mu: - Mogya a nhyɛso kɛse hyɛ nsu a ɛfa mogya-amemene akwanside no mu kɔ amemene no akyi ne akyi ntini (Posterior Reversible Encephalopathy Syndrome [PRES]), na ɛde tiyɛ a ɛyɛ yaw, aniwa a ɛyɛ anifurae, cortical anifurae, ne eclamptic seizures ba. - Amemene mu ntini a ɛyɛ mmerɛw betumi apaapae koraa, na ɛde intracerebral hemorrhagic stroke aba, ade dodow a edi kan a ɛde owu ba tẽẽ wɔ mmea a wɔwɔ preeclampsia ne eclampsia mu wɔ wiase nyinaa. Eyi nti na Amerika Awo ne Mmea Ho Nnuruyɛfo Kuw (ACOG), Wiase Akwahosan Ahyehyɛde (WHO), ne UK NICE akwankyerɛ hyɛ sɛ ɛsɛ sɛ wɔde nnuru a ekum mogya mmoroso a ɛyɛ adwuma ntɛmntɛm sa ɛnanom mogya mmoroso biara a ɛkɔ so yɛ 160 mmHg systolic anaa nea ɛboro saa, anaa 110 mmHg diastolic anaa nea ɛboro saa, wɔ simma 30 kosi 60 mu.

3. HELLP Syndrome ne Subcapsular Mmerɛbo a Ɛpaapae Ho Nyarewa Ho Adesua¶

HELLP syndrome ba bɛyɛ mmea a wɔwɔ preeclampsia a emu yɛ den ɔha biara mu nkyem 10 kosi 20 (na nea ɛda nsow ne sɛ, ayarefo a wɔwɔ HELLP syndrome no mu ɔha biara mu nkyem 15 kosi 20 wɔ mogya mmoroso a ɛfata anaasɛ ɛkɔ soro kakra nkutoo na protein nni wɔn nsu mu bere a wɔde kyerɛ no, na ɛma ɛyɛ mmerɛw sɛ wɔbɛpa). Ne nkyerɛwde abiɛsa no ka ntini mu asiane ketewaa bi a ɛba mmerɛbo ne mogya mu no ho asɛm: - H (Hemolysis / Microangiopathic Hemolytic Anemia): Fibrin nhama no fa mogya ntini nketewa a asɛe no so. Bere a mogya mu nkwammoaa kɔkɔɔ piapia fibrin nhama yi ho no, wɔtwitwa no fã ma ɛyɛ asinasin a ɛte sɛ dade kyɛw (schistocytes), na ɛma hemoglobin a enni mu no fi hɔ na ɛma Lactate Dehydrogenase (LDH 600 IU/L anaa nea ɛboro saa) ne bilirubin foro a ɛnteɛ. - EL (Elevated Liver Enzymes: AST ne ALT mmɔho 2 sen anohyeto a ɛwɔ soro sen nea ɛteɛ anaa nea ɛboro saa, mpɛn pii no ɛboro 70 IU/L): Fibrin micro-clots siw hepatic sinusoids a ɛwɔ mmerɛbo no mu no ano, na ɛde periportal hepatic necrosis, ischemia, ne mogya tu wɔ mmerɛbo no mu. - LP (Low Platelets / Thrombocytopenia: Platelets under 100,000/microliter): Wɔwe mogya nkwammoaa a ɛkyinkyini ntɛmntɛm bere a ɛbata endothelial lining a asɛe no ho wɔ nipadua no nyinaa mu, na ɛde asiane kɛse ba sɛ Disseminated Intravascular Coagulation (DIC) ne awo akyi mogya a wontumi nni so.

Bere a mogya ne nsu a ɛyɛ necrotic boaboa ano wɔ mmerɛbo no nifa fã no mu no, ɛtrɛw Glisson capsule (mrɛbo no akyi honam ani nhama) a ɛyɛ den te sɛ sanku, na ɛde Right Upper Quadrant (RUQ) anaa yafunu mu yaw a ɛyɛ yaw a ɛhyerɛn kɔ mmati nifa anaa akyi mfinimfini ba. Sɛ subcapsular liver hematoma ba Glisson capsule ase a, abɔnten so ɔhwe biara, yafunu a wɔde nsa ka a emu dɔ, ɛna a ɔfe, anaasɛ eclamptic convulsion betumi apaapae mmerɛbo mu capsule no mu akɔ yafunu no mu, na ama mogya a efi mogya mu aba wɔ mu a ɛnanom ne awotwaa a wowuwu boro ɔha biara mu nkyem 50**.

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Ntotoe pon: Preeclampsia a Ɛwɔ Nneɛma a Ɛyɛ Den, Eclampsia, HELLP Syndrome, ne Late Postartum Preeclampsia¶

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Kɔkɔbɔ nsɛnkyerɛnne 5 a wobehu ansa na akisikuru anaa akisikuru aba¶

Mmea a wɔboro ɔha biara mu nkyem 80 a wonya eclamptic seizure anaa preeclamptic stroke no nya prodromal kɔkɔbɔ sɛnkyerɛnne a emu da hɔ** wɔ nnɔnhwerew anaa nna a edi kan no mu. Fa saa sɛnkyerɛnne anum yi mu biara di dwuma wɔ nyinsɛn adapɛn 20 akyi (anaasɛ wɔ awo akyi adapɛn 6 mu) sɛ ntɛmpɛ a wɔde bɔ kɔkɔ kɔkɔɔ:

1. The "Preeclampsia Headache": Tiyɛ foforo, a emu yɛ den, ɛbɔ anim anaa akyi (akyi-ti) a enkɔ wɔ simma 30 kosi 60 mu bere a woanom acetaminophen (paracetamol) na woagye w'ahome wɔ dan a emu yɛ sum mu. Ɛda amemene mu ntini a ɛyɛ mmerɛw ne Posterior Reversible Encephalopathy Syndrome (PRES) adi.
2. Scotomata a wotumi hu ne Photopsia: Sɛ wuhu kanea a ɛhyerɛn, nsensanee a ɛhyerɛn a ɛyɛ zig-zag, mmeae a ɛsensɛn nsu so a ɛyɛ sum, wohu tuntum, wohu ade abien (diplopia), anaasɛ bere tiaa mu anifurae (cortical amaurosis). Esiane sɛ occipital visual cortex a ɛwɔ amemene no akyi no ne beae a edi kan a preeclamptic breakthrough swelling ka no nti, nsakrae a ɛba aniwa mu no yɛ sɛnkyerɛnne a ɛyɛ hu a ɛkyerɛ sɛ eclamptic convulsion a ɛreba.
3. Right Upper Quadrant (RUQ) anaa Epigastric "Heartburn" Pain: Ɛyaw a emu yɛ den, a ɛkɔ so daa, nhyɛso, anaasɛ ɛhyew tẽẽ wɔ mfinimfini nufu dompe (epigastrium) ase anaa nifa mpampam ase, a ɛtaa de akisikuru ne ɔfe ka ho. Wɔfa telefon so hu mmea pii a wɔwɔ HELLP syndrome wɔ ɔkwan a ɛnteɛ so sɛ wɔwɔ nyinsɛn mu acid reflux a ɛnyɛ den, aduan a wontumi nwe, gallstones, anaa yafunu mu mmoawa: antacids mma ahotɔ biara efisɛ ɛyaw no fi mmerɛbo a ɛyɛ ischemic, a ahonhon a ɛtrɛw ne capsule mu.
4. Ɔhome a Ɛyɛ Tiaa Mpofirim Anaasɛ Ntumi Da Flat (Pulmonary Edema): Esiane sɛ preeclampsia a emu yɛ den ma ahurututu mu ntini a ɛtwetwe a ɛka bom ne benkum-ventricular afterload a ɛkɔ soro (na ɛne Peripartum Cardiomyopathy) ka bom nti, nsu betumi ayiri ntɛmntɛm wɔ ahurututu no mu mframa kotoku mu, na ɛde ɔfe, frothy sputum, . orthopnea, ne oxygen a ɛhwe ase (SpO2 a ɛba fam 94%).
5. Sudden Non-Dependent Edema (Anim, Aniwa, ne Nsa) ne Brisk Reflexes (Clonus): Bere a nansoaa a ɛho ahonhon kakra wɔ da no awiei abu so wɔ nyinsɛn a ɛfata mu no, anim, aniwa no ho, ne nsateaa a ɛhuru mpofirim (ɛhwehwɛ sɛ woyi ring ansa na nsateaa no ahonhon), anaasɛ rhythmic a ɛnyɛ nea wɔpɛ nan no a ɛwosow bere a wɔabɔ ankle no akɔ soro (ankle clonus), kyerɛ sɛ ntini a ɛwɔ ntini no mu no retu kɛse na ntini a ɛwɔ mfinimfini no abufuw.

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Mmoa a edi kan a wɔde ma anammɔn anammɔn ma eclamptic seizure a ɛba wɔ ayaresabea akyi¶

Sɛ ɔbea a onyinsɛn anaa awo akyi fi ase ho popo wɔ fie, kar mu, anaa baguam a:

1. Ma no brɛ ase kɔ fam na fa no bobɔ ne BENKU so ntɛm ara:
2. Wɔ nyinsɛn no fã a ɛto so abien mu no, sɛ obi da fam wɔ n’akyi a, ɛma awotwaa a ɔyem no tumi mia inferior vena cava a wɔato mu no, na ɛtew ɛna no koma mu ahoɔden so ɔha biara mu nkyem 25 kosi 30 wɔ sikɔne 60 mu na ɛma ɛna no amemene ne akokoaa no nyinaa kɔm de oxygen.
3. Sɛ wobobɔ no gu ne benkum so (anaasɛ wode pillow a ɛyɛ den hyɛ n’asen nifa ase ma ɛdannan n’akyi digrii 15 kosi 30 kɔ benkum) a, ɛma ntini mu mogya san kɔ ne koma mu bere a ɛma nnompe ne mogya fi ne mframa afiri mu no.
4. Bɔ ne ho ban fi impact injuries ho a worensiw ne nsa ne ne ho so:
5. Fa nneɛma a ɛyɛ den kɔ baabi a obiara ntumi nkɔ, fa ne ti to pillow anaa sweater a wɔabobɔw so, na yi aniwa ahwehwɛ. Mfa ahoɔden nkura ne nsa anaa ne nan ase da.
6. Mfa biribiara nhyɛ n'anom da:
7. Sɛ ɔka ne tɛkrɛma na mogya fi n’anom mpo a, mfa nsateaa, nkaka a wɔde siw ano, anaa nkankyee nhyɛ ne sẽ ntam. Sɛ wode benkum si hɔ a, ɛma nsu no tu kɔ fam a asiane biara nni ho.
8. Hwɛ sɛnea wohome bere a akisikuru no gyae (Post-Ictal Phase):
9. Wɔ tonic-clonic seizure a ɛyɛ sikɔne 60 kosi sikɔne 90 mu no, ɛna no taa gyae home bere tiaa bi na n’anofafa betumi ayɛ bruu. Sɛ jerking no gyae ara pɛ a, hwɛ sɛ ɔhome kɔ akyiri wɔ post-ictal home mu na ma no nkɔ benkum so wɔ baabi a ne ho bɛtɔ no a ne hwene akɔ soro brɛoo.
10. (Sɛ wannye ahome bio na onni koma a ɛbɔ bere a akisikuru no agyae a, fi ase ntɛm ara CPR a wɔde yɛ adwuma wɔ 100 kosi 120 a wɔde mia no simma biara mu bere a onipa a ɔto so abien de nsa twe ne yafunu a onyinsɛn no na ɔpia no denneennen kɔ BENKUN so [Manual Left Uterine Displacement] wɔ ne koko a wɔde mia no nyinaa mu.)
11. Nea enti a Ayaresabea Nnuruyɛfo ne Nnuruyɛfo De Magnesium Sulfate Di Dwuma (na ƐNYƐ Diazepam anaa Phenytoin):
12. Nea ɛnte sɛ akisikuru a ɛyɛ mmerɛw no, eclamptic convulsions fi amemene mu ntini a ɛyɛ mmerɛw, mogya-amemene akwanside a ɛpaapae, ne NMDA-receptor ischemia.
13. Magnesium sulfate (MgSO4) yɛ amemene mu ntini a ɛtrɛw, calcium-kwan a ɛko tia, ne NMDA-receptor blocker. Amanaman ntam sɔhwɛ ahorow a ɛyɛ nwonwa (The Collaborative Eclampsia Trial and the Magpie Trial, a mmea bɛboro 10,000 na wɔde wɔn ho hyɛɛ mu) daa no adi sɛ magnesium sulfate tew eclamptic akisikuru a ɛsan ba no so 52% kosi 67% sɛ wɔde toto diazepam anaa phenytoin ho a, na ɛtew ɛnanom a wowuwu so kɛse.

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Ayaresabea ntɛmpɛ ho nhyehyɛe: Nea ɛsɛ sɛ wohwɛ kwan bere a woadu hɔ no¶

1. Adum Abiɛsa a Ɛma Ayaresabea Gyina Agyina¶

Sɛ ɔbea bi du ayaresabea a ɔwɔ eclampsia, preeclampsia a emu yɛ den, anaa HELLP syndrome a, ayaresabea adwumayɛfo yɛ nhyehyɛe abiɛsa wɔ simma 30 a edi kan no mu:

• Odum 1: Akisikuru a Wɔde Siw Ano & Wɔde Magnesium Sulfate (MgSO4) gyae:
• Standard Intravenous Regimen (Zuspan Regimen): IV loading dose a ɛyɛ gram 4 kosi gram 6 magnesium sulfate a wɔde gu mu bɛboro simma 15 kosi 20, na ɛno akyi no wɔde IV a ɛkɔ so gram 1 kosi 2 gram dɔnhwerew biara kɔsi ** nnɔnhwerew 24 wɔ awo akyi** (anaasɛ nnɔnhwerew 24 wɔ awo a etwa to no akyi).
• Intramuscular Backup Regimen (Pritchard Regimen): IV gram 4 wɔ simma 5 kosi 15 mu PLUS gram 10 a emu dɔ wɔ ntini mu (gram 5 a wɔde gu akyi akyi akyi berɛmo biara mu), na wɔde IM gram 5 di akyi nnɔnhwerew 4 biara.
• Sɛ akisikuru a ɛtɔ so mmienu no pae: Wɔde magnesium sulfate** gram 2 foforo IV bolus gu mu wɔ simma 3 kosi 5 mu.
• Ahobammɔ sohwɛ (Aduru a wɔde ko tia ne Calcium Gluconate): Esiane sɛ magnesium nam asaabo mu fi mu nti, ayarehwɛfo hwɛ sɛnkyerɛnne abiɛsa nnɔnhwerew 1 kosi 2 biara: (1) Patellar (knee-jerk) reflexes (a edi kan yera wɔ 3.5 kosi 5.0 mmol/L, ansa na ɔhome mu adwenemhaw aba), (2) Ɔhome dodow (ahome 12 kosi 16/simma anaa nea ɛboro saa), ne (3) Nsu a ɛba (30 mL/dɔnhwerew anaa nea ɛboro saa). Wɔde 10% Calcium Gluconate (1 gram IV wɔ simma 3 kosi 10 mu) a ɛyɛ 10 mL ahina sie mpa no nkyɛn sɛ nnuru a wɔde kum ɔyare mmoawa ntɛm ara.
• Odum 2: Mogya Nhyɛso a Wɔtew So Ntɛmntɛm Wɔ Simma 30 kosi 60 Mu (Wɔ BP 160/110 mmHg anaa nea ɛboro saa):
• Target BP: Tew mogya mmoroso ase kɔ 130 kosi 150 mmHg systolic ne 80 kosi 100 mmHg diastolic (kwati sɛ ɛbɛkɔ fam mpofirim akɔ fam 120/70 mmHg, a ɛtew awotwaa mu nsu a wɔde ma no so).
• Nnuru Abiɛsa a Edi Kan a Wɔde Di Dwuma Ntɛmntɛm (ACOG / WHO / NICE):
  1. Nifedipine a Wɔnom Ntɛm ara (10 mg kɔsi 20 mg capsule a wɔmene no nyinaa, MMFA kasa ase anaasɛ wɔaka DA): Ɛyɛ adwuma wɔ simma 15 kɔsi 20 mu na wobetumi de ama ntɛm ara wɔ triage mu a wɔmfa IV line nka ho.
  2. Labetalol a wɔde fa ntini mu (20 mg IV push wɔ simma 2, ɛkɔ soro kodu 40 mg ne 80 mg simma 10 biara sɛnea ɛho hia, kosi 300 mg): Wɔkwati wɔ ayamtu a ɛyɛ nnam anaa bradycardia a emu yɛ den (a ɛba fam sen 60 bpm) mu.
  3. Hydralazine a wɔde fa ntini mu (5 mg kosi 10 mg IV push wɔ simma 2, san yɛ bio wɔ simma 20 mu sɛ ɛho hia a).
• Odum 3: Nsuo Anohyeto a Ɛyɛ Katee (80 mL/dɔnhwerew) ne Ɛnanom a Wɔma Wɔn Gyina Ansa na Wɔawo:
• Esiane sɛ mmea a wɔadi kan awo no wɔ ahurututu mu ntini a ɛtwetwe nti, nsu akɛse a wɔde IV gu mu no de ahurututu mu edema a emu yɛ den ba. Wɔabara nsu a wɔnom nyinaa bɛyɛ 80 mililita dɔnhwerew biara (nsu ounces 2.7 dɔnhwerew biara) gye sɛ mogya a ɛretu denneennen.
• Fetal Heart Rate Rule During an Eclamptic Seizure: Wɔ simma 3 kosi 10 akyi wɔ ɛna no akisikuru akyi no, akokoaa no koma bɔ taa kyerɛ bere tiaa mu bradycardia. Ayaresafoɔ MFA ahopere mfa ɛna a ne ho popo no nkɔ crash C-section mu wɔ saa simma kakraa a ɛdi kan no mu: ɛna no a wɔde benkum fam a ɛdannan, oxygen, magnesium sulfate, ne mogya mmorosoɔ a wɔde siw ano, ɛma akokoaa no koma bɔ san wɔ awotwaa no mu wɔ bɛboro ɔha mu nkyekyɛmu 90 mu.

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Mpɔtam hɔ ntɛmpɛ nɔma ne adwumakuw no nhyehyɛe ahorow¶

• United States ne Canada: Frɛ 911 ntɛm ara na bisa sɛ wɔmfa wo nkɔ ayaresabea a ɛwɔ Obstetric / Labor & Delivery Emergency Unit. American College of Obstetricians and Gynecologists (ACOG), Society for Maternal-Fetal Medicine (SMFM), ne CDC "Hear Her" Maternal Warning Signs Campaign kamfo kyerɛ sɛ ɛna biara a ɔwo akyi no nhyɛ Postpartum Alert Wristband anaasɛ ɔnka nkyerɛ adwumayɛfoɔ a wɔhwɛ ntɛmpɛ dan mu "Mewoo akokoaa wɔ 6 a atwam no mu adapɛn" enti ACOG Alliance for Innovation on Maternal Health (AIM) Severe Hypertension in Pregnancy Bundle (a ɛhyɛ sɛ wɔmfa IV labetalol/hydralazine anaa nifedipine + magnesium sulfate a wɔnom wɔ simma 30 kosi 60 mu bere a BP 160/110 mmHg anaa nea ɛboro saa) no yɛ adwuma ntɛm ara.
• United Kingdom: Frɛ 999 ma ambulance a egye ntɛmpɛ (anaasɛ di w’ayaresabea no Awo Nhwehwɛmu Dwumadibea [MAU] / Awo Nhwehwɛmu a wɔyɛ adwuma nnɔnhwerew 24 no ho nkɔmmɔ ntɛm ara). Ɔhwɛ di NICE Akwankyerɛ NG133 (Mprehyɛn a ɛkɔ soro wɔ nyinsɛn mu: nhwehwɛmu ne ne di) ne Royal College of Obstetricians and Gynecologists (RCOG) nhyehyɛe ahorow akyi.
• European Union: Frɛ 112 wɔ EU aman nyinaa mu. Ayaresabea akuw ahorow di Europa Fekuw a Ɛhwɛ Koma Ho Adesua So (ESC) ne Amanaman Ntam Fekuw a Ɛhwɛ Nyinsɛn Mu Mprehyɛn Ho Adesua So (ISSHP) ayaresabea dwumadie akwankyerɛ akyi.
• Australia ne New Zealand: Frɛ 000 wɔ Australia anaa 111 wɔ New Zealand. Awo ne ntɛmpɛ akuw di Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) Hypertension in Pregnancy Guideline (2023/2024) ne RANZCOG gyinapɛn ahorow akyi.
• India ne Asia-Pacific / Wiase Nyinaa Nhyiamu: Trɛ 112 wɔ India (anaasɛ 108 / 102 ɛnanom ambulance dwumadie), 995 wɔ Singapore, 119 wɔ Japan ne South Korea, anaa 999 wɔ Hong Kong ne Malaysia. Baabi a pɔmpɛ a wɔde fa ntini mu nni hɔ bere a wɔde rekɔ nkuraase no, Wiase Akwahosan Ahyehyɛde (WHO) ne FIGO foa Pritchard ntini mu magnesium sulfate nhyehyɛe (4 g IV + 10 g IM) so ansa na wɔde akɔma obi foforo.

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Nsɛm a wɔtaa bisa¶

Mɛyɛ dɛn atumi anya preeclampsia anaa eclampsia nnafua 5 anaa 10 AKYI a wɔawo me ba dedaw na na me nyinsɛn no ayɛ nea ɛfata koraa?¶

Mmea a wohui sɛ wɔwɔ awo akyi awo akyi awo akyi awo no mu bɛyɛ fã na na mogya mmoroso a ɛfata koraa na na protein a ɛwɔ nsu mu nni hɔ wɔ wɔn nyinsɛn ne awo nyinaa mu. Wɔ nyinsɛn mu no, nneɛma a ɛko tia awotwaa mu ntini a ɛma mogya tu no ma wo mogya ntini a ɛwɔ wo mogya mu no yɛ mmerɛw komm bere a wɔde nsu a ɛboro so lita pii sie wo nipadua mu ntini ahorow mu no. Wɔ awo akyi nnafua 3 kosi 10 na wokɔ fie no, saa ntini mu nsu a wɔakora so no nyinaa san kɔ wo mogya mu ntɛmntɛm ma w’asaabo no yi fi hɔ, na ɛhyɛ wo mogya ntini a ayɛ mmerɛw no so na ɛma mogya mmoroso a ɛyɛ hu no kɔ soro mpofirim a ebetumi ama tiyɛ, ahurututu mu akisikuru, anaasɛ eclamptic seizures akɔ adapɛn 6 wɔ awo akyi.

Dɛn nti na yafunu atifi yaw a emu yɛ den anaa "komayare" wɔ nifa mpampam ase yɛ sɛnkyerɛnne a asiane wom saa wɔ nyinsɛn mu anaa awo akyi?¶

Ɛyaw a emu yɛ den a ɛba wɔ nufu dompe a ɛwɔ mfinimfini (epigastrium) anaa nifa mpampam (nifa so atifi fã) ase, titiriw bere a akisikuru, ɔfe, anaasɛ akisikuru a ɛkɔ so wɔ baabiara ka ho no ne HELLP yare (Hemolysis, Elevated Liver enzymes, ne Low Platelets) agyiraehyɛde titiriw, na ɛba wɔ HELLP nsɛm no mu bɛyɛ ɔha biara mu nkyem 90 mu. Ɛyaw no fi mogya a ɛkɔ wo mmerɛbo mu a ɛyɛ nketenkete a esiw mogya a ɛkɔ wo mmerɛbo mu no mu na ɛtrɛw mmerɛbo no akyi aduru (Glisson aduru) no mu a ɛho ahonhon anaasɛ mogya tu no. Esiane sɛ nnuru a ekum asikre renka no na subcapsular liver hematoma betumi apaapae awu nti, yafunu atifi yaw biara a emu yɛ den biara a ɛba wɔ nyinsɛn adapɛn 20 akyi anaa awo akyi no hwehwɛ sɛ wɔyɛ mogya mu nhwehwɛmu ntɛm ara wɔ ayaresabea sɛ ebia mogya mu nkwammoaa kɔkɔɔ ne mmerɛbo mu enzymes wɔ hɔ anaa.

Dɛn nti na wɔde mogya mmoroso a ɛyɛ 160/110 mmHg di dwuma sɛ akisikuru a egye ntɛmpɛ wɔ ɔbea a onyinsɛn anaa awo akyi bere a mpanyimfo a wɔnyɛ nyinsɛn de 180/120 mmHg di dwuma no?¶

Mpɛn pii no, mmea nkumaa a wɔyem mogya mmoroso a ɛba fam na ɛyɛ mmerɛw bɛyɛ 100/60 kosi 110/70 mmHg, na preeclampsia sɛe wɔn amemene mu ntini a ɛbɔ wɔn ho ban no. Sɛ ɔbea a onyinsɛn anaa awo akyi mogya mmoroso huruw kɔ 160 mmHg systolic anaa 110 mmHg diastolic a, mpofirim a ɛkɔ soro no boro n’amemene no autoregulation threshold no so, na ɛhyɛ nsu ma fa mogya ne amemene no akwanside no so (na ɛma amemene no hohoro na ɛyɛ akisikuru) na ɛde asiane ba sɛ mogya a ɛbɛtɔ amemene no mu a edi awu. Awo ho akwankyerɛ ahorow a ɛwɔ wiase nyinaa hwehwɛ sɛ wɔtew mogya mmoroso biara a wɔagye atom sɛ ɛyɛ 160/110 mmHg anaa nea ɛboro saa so wɔ simma 30 kosi 60 mu.

Dɛn nti na ayaresabea ahorow ma Magnesium Sulfate ma eclampsia sen sɛ wɔde nnuru a wɔde sa akisikuru a wɔtaa de di dwuma te sɛ Valium (diazepam) anaa Keppra bɛma?¶

Ɛnyɛ akisikuru titiriw na ɛde eclamptic seizures ba; wɔde amemene mu ntini mu ntini a ɛyɛ den, endothelial leakage, ne amemene mu ischemia na ɛde ba. Magnesium sulfate trɛw amemene mu mogya ntini a ayɛ mmerɛw no mu tẽẽ, ɛbɔ mogya ne amemene akwanside no ho ban, na esiw NMDA agyefo a ɛkanyan adwene wɔ amemene no mu no ano. Wiase nyinaa ayaresabea sɔhwɛ ahorow a ɛyɛ nwonwa (Colaborative Eclampsia Trial ne Magpie Trial) daa no adi sɛ magnesium sulfate brɛ eclamptic akisikuru a ɛsan ba no ase bɛboro ɔha biara mu nkyem 50 kosi 65 bere a wɔde toto diazepam anaa phenytoin ho a ɛmma akokoaa a wɔawo no foforo no dwo no.

So preeclampsia, eclampsia, anaa HELLP syndrome a mewɔ no ka me koma akwahosan a ɛtra hɔ kyɛ bere a me ho atɔ me no?¶

Aane. Bere a preeclampsia ne HELLP yare no gyae wɔ adapɛn kosi asram akyi wɔ awo akyi no, preeclampsia a wonya nkwa no yɛ koma ne ntini agyiraehyɛde a ɛho hia wɔ wɔn nkwa nna nyinaa mu: mmea a wɔanya preeclampsia no kura asiane a ɛkɔ soro mpɛn 2 kosi 4 wɔ wɔn nkwa nna nyinaa mu sɛ wobenya mogya mmoroso a enni sabea, komayare, ne akisikuru akyiri yi, ne asiane a ɛyɛ ɔha biara mu nkyem 15 kosi 25 sɛ ɛbɛsan aba bio wɔ daakye nyinsɛn mu (a wobetumi atew so ɔha biara mu nkyem 50 kosi 60 denam aspirin a wɔmfa nni dwuma pii [81 mg kosi 150 mg anadwo biara] a wofi ase wɔ adapɛn 12 mu wɔ nyinsɛn a ɛbɛba daakye mu no so). Yɛ nhyehyɛe sɛ wo ne wo duruyɛfo titiriw bɛhwɛ mogya mmoroso ne koma ne ntini mu yiyedi afe biara.

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Saa akwankyerɛ yi de nkyerɛkyerɛ ho nsɛm a egye ntɛmpɛ ma na ɛnsi awo ho adwumayɛfo anaa ayaresa a egye ntɛmpɛ ananmu. Esiane sɛ ɛnanom akisikuru, akisikuru, ne awo akyi mogyatɔw betumi ayɛ kɛse wɔ simma kakraa bi mu nti, yɛhyɛ nyansa denneennen sɛ awofo a wɔrehwɛ kwan ne abusua mufo nkɔyɛ mmoa a edi kan a wɔde nsa yɛ ne CPR adesua a wɔagye atom mfi Red Cross, St John Ambulance, anaa mpɔtam hɔ nteteefo a wɔagye wɔn atom hɔ.

Akwankyerɛ ahorow a ɛfa ho¶

• Awotwaa a ɛpaapae, hama a ɛhwe ase, ne awo ho haw a ɛba wɔ ɔsram abiɛsa a ɛto so abiɛsa mu
• Awo a egye ntɛmpɛ ne awo a wɔyɛ no ntɛmntɛm
• Nsɛnnennen a ɛba bere a wɔwo awo wɔ ayaresabea akyi: McRoberts maneuver, nuchal cord, ne breech awo
• Mogya mmoroso ho haw, mogya mmoroso a ɛyɛ hu, ne mogya mmoroso a ɛboro 180/120
• Akisikuru ne akisikuru mmoa a edi kan

Fibea ne aban akwankyerɛ¶

• Amerika Awo ne Mmea Ho Nnuruyɛfo Kuw (ACOG) ne Society for Maternal-Fetal Medicine (SMFM, United States): ACOG Practice Bulletin No. 222: Nyinsɛn mu mogya mmoroso ne Preeclampsia ne Alliance for Innovation on Maternal Health (AIM) Patient Safety Bundle on Severe Hypertension in Pregnancy.
• Wiase Akwahosan Ahyehyɛde (WHO): WHO Nyansahyɛ ahorow a ɛfa Pre-eclampsia ne Eclampsia a Wɔde Siw Ano na Wɔsa: Wiase nyinaa gyinapɛn ahorow a ɛfa magnesium sulfate a wɔde fa ntini mu ne ntini mu (Pritchard) ne nnuru a wɔde ko tia mogya mmoroso ho.
• Ɔman Asoɛe a Ɛhwɛ Akwahosan ne Ɔhwɛ a Ɛyɛ Paara So (NICE, United Kingdom): Monhyɛso a ɛkɔ soro wɔ Nyinsɛn mu: Nhwehwɛmu ne ne di: NICE Akwankyerɛ NG133.
• Amanaman Ntam Fekuo a Ɛhwɛ Nyinsɛn mu Nkɔsoɔ Ho Adesua (ISSHP) ne Awoɔ Nnuruyɛ Kuo a ɛwɔ Australia ne New Zealand (SOMANZ): Nkyekyɛmu, Nhwehwɛmu, ne Nyansahyɛ a Wɔde Di Dwuma wɔ Preeclampsia, HELLP Syndrome, ne Awo Akyi Ntini Mu Ntini Mu (2023/2024).
• Centers for Disease Control and Prevention (CDC, United States): "Hear Her" Ɔsatu: Ɛnanom Kɔkɔbɔ Nsɛnkyerɛnne a Egye Ntɛmntɛm Wɔ Nyinsɛn Mu ne Awo Akyi Afe Akosi.