Eclampsia khunyu, HELLP Syndrome, ndi Late Postpartum Preeclampsia mpaka 6 Weeks¶

Preeclampsia, eclampsia (maternal generalized tonic-clonic convulsions), ndi HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets) ndi matenda oopsa kwambiri a mimba omwe angayambitse sitiroko yotaya magazi, kuphulika kwa chiwindi, kuphulika kwa placenta, kumangidwa kwa pulmonary edema mkati mwa mphindi zochepa. Nthano yoopsa komanso yofala ndi yakuti kubereka khanda nthawi yomweyo kumachiritsa preeclampsia: zoona zake, mpaka 30 mpaka 50 peresenti ya eclampsia yonse ndi mavuto aakulu a pambuyo pa kubereka kwa matenda oopsa kwambiri PAMENE mwana wabadwa, zomwe zimachitika nthawi zambiri maola 48 mpaka masabata 6 atatuluka m'chipatala pamene mayi ali kunyumba. Ngati mayi woyembekezera kapena wangobadwa kumene (mpaka masabata a 6 atatha kubereka) amayamba kuthamanga kwa magazi kwa ** 160/110 mmHg kapena kupitirira apo **, kupweteka kwa mutu kosalekeza, kuwala kowoneka bwino kapena madontho akhungu (scotomata), kupweteka kwambiri kumtunda kwa quadrant kapena epigastric m'mimba, kupuma modzidzimutsa, kapena kugwedezeka kwadzidzidzi kudzera pa nambala yanu yadzidzidzi. manambala angozi chikwatu nthawi yomweyo, chifukwa chadzidzidzi cham'mimbachi chimafunikira chipatala mtsempha wamagazi magnesium sulfate ndikuwongolera kuthamanga kwa magazi kuti mupewe sitiroko ya amayi, vuto la hypertensive, kapena kuphulika kwa placenta.

Chitani izi tsopano¶

1. Imbani nambala yanu yazadzidzi zadzidzidzi nthawi yomweyo ndikufotokozereni momwe muli ndi pakati kapena pambuyo pobereka: Imbani 911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom, 000 ku Australia, kapena muwone mayiko athu apadziko lonse lapansi manambala angozi directory. Uzani dispatcher momveka bwino kuti: "Obstetric Emergency: Oyembekezera [kapena X masiku/masabata Pambuyo pa Kubadwa] Wodwala Wokayikira Eclampsia Seizure kapena Severe Preeclampsia / HELLP Syndrome." Kunena kuti wodwala posachedwapa wabereka ndi kofunika kwambiri kotero kuti ogwira ntchito m'chipinda chodzidzimutsa asazindikire molakwika postpartum amp;
2. Mutembenuzireni mzimayi kumbali yake yakumanzere (Kumanzere kwa Lateral Decubitus Position): Kaya wodwalayo akugwedezeka mwamphamvu, pambuyo pa ictal (wogona pambuyo pa kukomoka), kapena akudzuka chifukwa cha kuthamanga kwa magazi, mtembenuzireni ku kumanzere kwake (kapena ngati ali ndi pakati pa masabata 20 ndikugona chalamanzere kapena kumanzere kumanzere kwake, kumanzere kwake. chiuno kuti mupange **15-degree mpaka 30-degree kumanzere kupendekera kofananira **). Kumamanzere kumalepheretsa chiberekero cholemera kuti chisaphwanye inferior vena cava ndi abdominal aorta (supine hypotensive syndrome), kumawonjezera kutuluka kwa magazi kupita ku placenta ndi mtima wa amayi, ndikulola malovu, magazi, kapena masanzi kutuluka bwinobwino mkamwa mwake pamene akugwidwa.
3. Tetezani mutu wake pamene akugwidwa ndi khunyu ndipo MUSAMAike kalikonse mkamwa mwake: Chotsani mipando yolimba kutali ndi iye, lowetsani jekete yopindika kapena pilo pansi pamutu pake, ndipo masulani zovala zothina m'khosi mwake. **Osayesa kutsekula nsagwada zake kapena kuyika spoons, zala, kapena zinthu zachikwama mkamwa mwake **, chifukwa izi zimathyola mano ndikutchinga mpweya. Nthawi zambiri eclamptic kugwedezeka kumadzithera mkati mwa 60 mpaka 120 masekondi.
4. Ikani wodwala mosamalitsa Nothing by Mouth (NPO) ndipo OSATI kukanikizira pamimba yake yakumanja: Osapereka madzi amkamwa, chakudya, kapena mapiritsi opweteka kwa mayi yemwe ali ndi tulo kapena preclamptic kwambiri, chifukwa chibayo cholakalaka ndi chowopsa chachikulu ndipo kubereka mwadzidzidzi kungafunike. Ngati ali ndi ululu wopweteka pansi pa nthiti kumanja kapena m'mimba yapakati (kuwawa kwa epigastric), ** osagwedezeka, kutikita minofu, kapena kukanikiza kwambiri pamimba yake yakumanja **, chifukwa mu **HELLP syndrome **, kapisozi wa chiwindi akhoza kutambasulidwa woonda ndi subcapsular hematoma yomwe imatha kuphulika mwakupha chifukwa cha kupanikizika kwa kunja.
5. Yezerani ndi kulemba mbiri yake ya kuthamanga kwa magazi ngati chikhafu chakumanja chakumanja chanyumba chilipo: Ngati ali maso komanso ali phee, muwerenge kuthamanga kwa magazi komwe kumakhala pansi kapena mopendekera kumanzere ndikulemba manambala enieni komanso nthawi yowotchi ya opereka chithandizo. Pakati pa mimba ndi nthawi yobereka, kuthamanga kwa magazi kwa **160 mmHg systolic kapena kupitirira, OR 110 mmHg diastolic kapena apamwamba ** ndi **zovuta zachipatala zadzidzidzi ** (ngakhale 160/110 ingawoneke yocheperapo kusiyana ndi 180/120 yomwe imagwiritsidwa ntchito kwa akuluakulu omwe sali oyembekezera).
6. Umirirani kuunika kwa chipatala ku dipatimenti yothandiza anthu obereketsa: Osapita ku chipatala chongoyenda mwachangu. Mayi yemwe ali ndi vuto lalikulu la preeclampsia, eclampsia, kapena HELLP amafunikira nthawi yomweyo intravenous magnesium sulfate (4 g mpaka 6 g loading bolus), osati mankhwala a khunyu monga diazepam kapena phenytoin, pamodzi ndi antihypertensives (*IV labetalol, IV hydralazitedifedireral kapena oral).

Mtengo wosankha: Preeclampsia kwambiri, eclampsia khunyu, ndi HELLP syndrome triage¶

flowchart TD
    Start["Mayi Wapakati (Masabata 20+ Oyembekezera) KAPENA Mayi Oyembekezera (Maola 0 Mpaka Masabata 6 Pambuyo Pobereka)"] --> SeizureCheck{"Kodi wodwalayo akugwidwa ndi khunyu, osayankha, KAPENA kusonyeza zizindikiro za sitiroko (kugwa nkhope, kufooka kwa mkono, kulankhula mosamveka)?"}

    SeizureCheck -->|"INDE: Kugwidwa kwa Eclamptic Yogwira Kapena Yongomaliza"| EclampsiaProtocol["ZOCHITIKA ZONSE ZA ECLAMPSIA: 1. Imbani 911 / 112 / 999 STAT: State Pregnant kapena Postpartum Eclampsia Seizure 2. Pereka wodwala ku LEFT SIDE (Kumanzere Lateral Decubitus / 15 mpaka 30 deg kumanzere kwa uterine kupendekeka) 3. Pad mutu, NEVER ikani zinthu zozungulira, nthawi yozungulira. Perekani O2 othamanga kwambiri (10 mpaka 15 L / min) kamodzi paulendo wapaulendo womveka bwino 5. Chipatala Choyamba-Line Anticonvulsant: IV Magnesium Sulfate (4g mpaka 6g bolus pa 15 mpaka 20 min, ndiye 1 mpaka 2 g / hr) 6. Chitani BP 160 / 110 mmHg kuti muteteze kutayika kwa magazi mkati mwa 60 minrha"]

    SeizureCheck -->|"AYI: Galamukani, palibe kugwidwa"| RedFlagCheck{"Kodi Mbendera Zofiira za HELLP Zilipo? 1. Kuthamanga kwa magazi 160 mmHg systolic kapena kupitirira, OR 110 mmHg diastolic kapena apamwamba 2. Kupweteka kwa mutu kosalekeza (kopanda kuchotsedwa ndi acetaminophen) 3. Visual scotomata (mawanga akhungu), kuwala kowala, masomphenya osawoneka bwino kapena awiri 4. Kupweteka kwakukulu kwapang'onopang'ono kumtunda kwa QQ kapena kupweteka kwapang'onopang'ono (kupweteka kwapang'onopang'ono kumtunda kwa QQ) kapena kupweteka kwapang'onopang'ono kumtunda kwa QQ) 5. Kupuma pang'ono, orthopnea, kapena SpO2 pansi pa 94% (pulmonary edema)"}

    RedFlagCheck -->|"INDE: Mbendera yofiira iliyonse ilipo"| SevereProtocol["PREECLAMPSIA KWAMBIRI KAPENA HELLP SYNDROME EMERGENCY: 1. Itanani 911 / 112 / 999 kapena tumizani nthawi yomweyo kupita ku Chipatala Ntchito ndi Kutumiza / ED 2. Pumulani Kumanzere Lateral Kupendekera; sungani Palibe Pakamwa (NPO) 3. OSATI kukanikiza kumtunda kumtunda kwa mimba (chiopsezo cha subcapsular chiwindi hematoma rupture) 4. Chipatala STAT Labs: CBC (mapulateleti pansi pa 100k), AST / ALT (2x yachibadwa), LDH, Creatinine, Urine Protein 5. Yambani IV Rebetal-Hydraral Imlazine IV, Hydraral Imlazine, CBC Nifedipine mkati mwa mphindi 30 mpaka 60 + IV Magnesium Sulfate"]

    RedFlagCheck -->|"AYI: Kukwera pang'ono mpaka pang'ono kwa BP (140 mpaka 159 / 90 mpaka 109 mmHg) popanda zizindikiro"| MildProtocol["KUSINTHA KWA THUPI KWAMBIRI KAPENA POPHUNZITSA: 1. Yang'ananinso kuthamanga kwa magazi mu mphindi 15 mwakhala mutapumula 2. Lumikizanani ndi Obstetrician / Maternity Triage Unit TSIKU LIMENELO kuti mukagwire ntchito labu (CBC, chiwindi ndi impso, chiŵerengero cha mapuloteni / creatinine) 3. Kukwera kufika pa 921 / 9 mwamsanga ngati 911 / 9 160/110 kapena mutu, masomphenya, kapena chizindikiro cha epigastric chikuwoneka"]

Pathophysiology: Momwe kukanika kwa mitsempha ya placenta kumawonongera ubongo wa amayi, chiwindi, ndi magazi¶

1. Kuwonongeka kwa Mitsempha ya Mitsempha Yowonongeka ndi Endothelial Poisoning¶

Pa mimba yathanzi, maselo apadera a placenta (cytotrophoblasts) amalowa m'mitsempha mitsempha yozungulira ya chiberekero cha mayi m'kati mwa trimester yoyamba ndi yachiwiri, kuwasintha kuchoka ku ziwiya zopapatiza, zolimba kwambiri kukhala ngalande zazikulu, zochepa zomwe zimasambitsa thumba la magazi.

Mu preeclampsia, kukonzanso kwa mitsempha yozungulirayi sikukwanira. Mitsempha yopapatiza, yokhala ndi minofu imakhalabe yotsekeka, zomwe zimapangitsa kuti placenta ikhale yopanda mphamvu komanso hypoxic. Poyankha, thumba lopanikizika limatulutsa mapuloteni ambiri odana ndi angiogenic, makamaka soluble fms-monga tyrosine kinase-1 (sFlt-1) ndi soluble endoglin (sEng), kulowa m'magazi a mayi. Mapuloteniwa amachepetsa kukula kwa mitsempha ya mayi (VEGF ndi PlGF), kuvulaza minyewa yamkati (vascular endothelium) ya mitsempha yamagazi mthupi lonse: 1. Kuchuluka kwa Systemic Vasospasm: Kuchotsedwa kwa nitric oxide ndi prostacyclin, mitsempha yodutsa muubongo wa amayi, impso, chiwindi, ndi chiberekero imakhazikika mwamphamvu, kumapangitsa kuthamanga kwa magazi msanga. 2. ** Ma Capillaries Otayirira ndi Kuwonongeka kwa Mitsempha Yam'mitsempha **: Makoma a capillary owonongeka amatulutsa mapuloteni ndi madzimadzi kuchokera m'magazi kupita kuzinthu zozungulira (zomwe zimayambitsa kutupa kwadzidzidzi kwa nkhope, manja, mapapo [**pulmonary edema **], ndi ubongo [**cerebral edema **]), ndikusiya magazi mkati mwa mitsempha, ndi mitsempha yozungulira. 3. Chifukwa Chake Kubereka Simayimitsa Nthawi yomweyo: Ngakhale thumba latuluka litabadwa pobereka, kuzungulira sFlt-1, kuvulala kwa endothelial, ndi systemic vasospasm kumatenga masiku mpaka masabata kuti athetse, pamene kusonkhanitsa kwadzidzidzi kwa malita amadzimadzi apakati pachitatu kubwereranso m'mitsempha yamagazi yomwe yawonongeka ndi masiku 3 pakati pa mitsempha yamagazi * 3. malo owopsa a sitiroko.

2. Chifukwa Chake 160/110 mmHg Ndilo Kufikira Kwa Stroke Panthaŵi Yoyembekezera (vs. 180/120 mwa Akuluakulu Osakhala Oyembekezera)¶

Mwa bambo wazaka 60 yemwe ali ndi matenda oopsa kwambiri kwazaka zambiri, mitsempha yaubongo yakulitsa makoma amphamvu omwe amatha kupirira kuthamanga kwa magazi kwa 175/105 mmHg popanda kuphulika. Mosiyana ndi izi, mayi wapakati wathanzi wazaka 28 nthawi zambiri amakhala ndi kuthamanga kwa magazi kwa 95/60 mmHg mpaka 110/70 mmHg.

Kuthamanga kwa magazi kwake kukakwera mwadzidzidzi kuchoka ku 100/60 mmHg kufika ku 160/110 mmHg, kuthamanga kwake kwapakati kwakwera ndi kupitirira ** 60 peresenti **, kupitirira malire apamwamba a **ubongo autoregulation ** m'magawo ake osalimba, owonongeka a ubongo: - Kuthamanga kwambiri kwa magazi kumapangitsa madzimadzi kudutsa chotchinga chamagazi-muubongo kulowa mu occipital ndi parietal lobes muubongo (Posterior Reversible Encephalopathy Syndrome [PRES]), kumayambitsa kupweteka kwa mutu, madontho osawona, khungu la cortical, ndi eclamptic seizures. - Mitsempha ya muubongo yosalimba imatha kusweka, zomwe zimayambitsa intracerebral hemorrhagic stroke, chiwerengero chimodzi chomwe chimayambitsa imfa mwa amayi omwe ali ndi preeclampsia ndi eclampsia padziko lonse lapansi. Ichi ndi chifukwa chake American College of Obstetricians and Gynecologists (ACOG), World Health Organization (WHO), ndi malangizo a UK NICE amalamula kuti **kuthamanga kwa magazi kwa amayi apakati pa 160 mmHg systolic kapena kupitirira, kapena 110 mmHg diastolic kapena kupitirira apo, ayenera kuthandizidwa ndi mankhwala oletsa kuthamanga kwa magazi mkati mwa mphindi 60 * 30.

3. The Pathophysiology of HELLP Syndrome ndi Subcapsular Liver Rupture¶

Matenda a HELLP amapezeka pafupifupi ** 10 mpaka 20 peresenti ya amayi omwe ali ndi preeclampsia yoopsa ** (ndipo makamaka, ** 15 mpaka 20 peresenti ya odwala omwe ali ndi matenda a HELLP amakhala ndi kuthamanga kwa magazi kwachibadwa kapena pang'onopang'ono ndi zero mapuloteni mu mkodzo wawo ** powonetsera, zomwe zimapangitsa kuti zikhale zosavuta kuphonya). Zilembo zake zitatu zimalongosola tsoka laling'ono la mitsempha mkati mwa chiwindi ndi magazi: - H (Hemolysis / Microangiopathic Hemolytic Anemia): Zingwe za Fibrin zimadutsa mumitsempha yaing'ono yowonongeka. Maselo ofiira akamadutsa ma fibrin mesheswa, amametedwa pakati kukhala zidutswa zooneka ngati chisoti (schistocytes), kutulutsa himoglobini yaulere ndi kutumiza Lactate Dehydrogenase (LDH 600 IU/L kapena kupitilira apo) ndi kukwera kwa bilirubin mosalunjika. - EL (Ma Enzymes a Chiwindi Okwezeka: AST ndi ALT 2 kuchulukitsa kwanthawi yayitali kapena kupitilira apo, nthawi zambiri kuposa 70 IU/L): Fibrin micro-clots imamanga sinusoid yachiwindi m'chiwindi, kumayambitsa periportal hepatic necrosis, ischemia, ndi magazi mkati mwa chiwindi. - LP (Low Platelets / Thrombocytopenia: Mapulateleti osakwana 100,000/microliter): Mapulateleti ozungulira amadyedwa mwachangu pamene amamatira ku chiwopsezo cha endothelial chowonongeka m'thupi lonse, kupanga chiopsezo chachikulu cha Disseminated Intravascular Coagulation (DIC) ndi kusalamulirika kwa postpartum hemorrhage.

Pamene magazi ndi necrotic madzimadzi amadziunjikira mkati mwa lobe yakumanja kwa chiwindi, amatambasula Glisson's capsule (khungu lakunja la chiwindi) limakhala ngati ng'oma, zomwe zimapangitsa kupweteka Right Upper Quadrant (RUQ) kapena kupweteka kwapakati pa epigastric m'mimba komwe kumatuluka kumanja kwa phewa lakumanja kapena kumbuyo kwapakati. Ngati subcapsular liver hematoma ipangika pansi pa Glisson's capsule, kugunda kulikonse kwakunja, kugunda kwakuya m'mimba, kusanza kwa amayi, kapena kukomoka kwachiwindi kungathe kuphwanya kapisozi wachiwindi m'mimba, kuchititsa kutuluka kwa magazi mkati ndi kufa kwa amayi ndi mwana wosabadwayo kupitirira 50 peresenti*.

Gome lofananitsa: Preeclampsia yokhala ndi Zovuta Kwambiri, Eclampsia, HELLP Syndrome, ndi Late Postpartum Preeclampsia¶

Kuzindikira zizindikiro 5 zochenjeza musanayambe kugwidwa kapena sitiroko¶

Kufikira ** 80 peresenti ya amayi omwe amadwala eclamptic khunyu kapena preeclamptic stroke amakhala ndi zizindikiro zomveka bwino za prodromal ** m'maola kapena masiku asanafike. Chitani chilichonse mwa zizindikiro zisanu izi pambuyo pa milungu 20 ya mimba (kapena mkati mwa masabata 6 mutabereka) ngati mwadzidzidzi:

1. "Preeclampsia Headache": Mutu watsopano, wovuta, wopweteka wakutsogolo kapena wa occipital (kumbuyo kwa mutu) womwe **simatha mkati mwa mphindi 30 mpaka 60 mutamwa acetaminophen (paracetamol) ndikupumula m'chipinda chamdima **. Imawonetsa cerebral vasospasm ndi Posterior Reversible Encephalopathy Syndrome (PRES).
2. Visual Scotomata ndi Photopsia: Kuwona kuwala kuthwanima nyali, mizere yonyezimira ya zig-zag, mawanga oyandama, mawonedwe a ngalande, kuwona kawiri (diplopia), kapena khungu kwakanthawi (cortical amaurosis). Chifukwa occipital visual cortex kumbuyo kwa ubongo ndi malo oyamba omwe amakhudzidwa ndi kutupa kwa preeclamptic, kusintha kwa mawonekedwe ndi chizindikiro chowopsa cha kugwedezeka kwa eclamptic.
3. Right Upper Quadrant (RUQ) kapena Epigastric "Heartburn" Ululu: Kupweteka kwambiri, kupweteka kosalekeza, kupanikizika, kapena kutentha mwachindunji pansi pa fupa lapakati pa chifuwa (epigastrium) kapena pansi pa nthiti yakumanja, nthawi zambiri zimatsagana ndi nseru ndi kusanza. Amayi ambiri omwe ali ndi matenda a HELLP amawazindikiritsa molakwika pafoni kuti ali ndi mimba ya acid reflux, kusanza, ndulu, kapena kachilombo ka m'mimba: Maantacids amapereka mpumulo chifukwa ululu umachokera ku ischemic, kutupa kwachiwindi komwe kumatambasula kapisozi.
4. Kupuma Mwadzidzidzi kapena Kulephera Kugona Pathyathyathya (Pulmonary Edema): Chifukwa preeclampsia yoopsa imayambitsa kutayikira kwa ma capillaries pamodzi ndi kuchulukira kwamphamvu kwa ventricular yamanzere (ndi kuphatikizika ndi Peripartum Cardiomyopathy), madzimadzi amatha kusefukira m'matumba a mpweya m'mapapo, kupangitsa chifuwa, kupuma pang'ono, kupuma pang'ono kapena mpweya wa okosijeni. (SpO2 pansi pa 94%).
5. Edema Yopanda Kudalira Mwadzidzidzi (Nkhope, Zikope, ndi Manja) ndi Brisk Reflexes (Clonus): Ngakhale kutupa pang'onopang'ono kumapeto kwa tsiku kumakhala kofala pamimba yachibadwa, kudzikuza mwadzidzidzi kwa nkhope, m'maso, ndi zala (zomwe zimafuna kuchotsedwa kwa mphete zala zisanayambe kutupa), kapena phokoso la phazi likamatuluka. kupindikira m'mwamba (ankle clonus), kumawonetsa kuchucha kwambiri kwa capillary komanso kukwiya kwapakati pamitsempha.

Thandizo loyamba la pang'onopang'ono la kutuluka kwa chipatala eclamptic khunyu¶

Ngati mayi woyembekezera kapena woyembekezera ayamba kukomoka kunyumba, mgalimoto, kapena pagulu:

1. Muchepetseni pansi ndikumugwetsera kumanzere kwake nthawi yomweyo:
2. Mu theka lachiwiri la mimba, kugona cham'mbuyo kumapangitsa kuti chiberekero cha gravid chikanikize **inferior vena cava ** kutsekedwa, kudula kutulutsa kwa mtima wa amayi ndi **25 mpaka 30 peresenti ** mkati mwa masekondi 60 ndi njala yonse ya ubongo wa mayi ndi mwana wa oxygen.
3. Kumugudubuza kukumanzere (kapena kukulunga pilo pansi pa ntchafu yake yakumanja kuti apendekere chiuno chake madigiri 15 mpaka 30 kumanzere) kumabwezeretsa magazi a venous kumtima kwake kwinaku akutulutsa malovu ndi magazi kuchoka pamphuno yake.
4. Mutetezeni kuti asavulale popanda kumuletsa manja ake:
5. Chotsani mipando yolimba kuti isamufikire, ikani mutu wake pa pilo kapena juzi lopindika, ndi kuchotsa magalasi a maso. Osamugwira manja kapena miyendo yake pansi mwamphamvu.
6. Musamuike kalikonse mkamwa mwake:
7. Ngakhale ataluma lilime ndi kutulutsa magazi m’kamwa, musaike zala, zitsulo zoluma, kapena spoons pakati pa mano ake. Kuyika kumanzere kumapangitsa kuti madzi azitsikira pansi mosavulaza.
8. Yang'anirani kupuma pamene kugwedeza kumayima (Post-Ictal Phase):
9. Pakati pa masekondi 60 mpaka 90, mayi nthawi zambiri amasiya kupuma pang'onopang'ono ndipo milomo yake imatha kusanduka buluu. Kugwedezekako kukangosiya, onetsetsani kuti akupuma mozama pambuyo pa ictal ndikumusunga kumanzere kumanzere ndi chibwano chake chopendekeka bwino.
10. (Ngati sayambiranso kupuma ndipo alibe kugunda kwa mtima atasiya kukomoka, yambani nthawi yomweyo CPR pa 100 mpaka 120 kukakamiza pa mphindi imodzi pamene munthu wachiwiri ** amakoka pamanja ndikukankhira mimba yake yoyembekezera mwamphamvu ku mbali ya KU LEFT [Manual Left Uterine Displacement]* panthawi yonse ya kukanikizana pachifuwa.)*
11. Chifukwa Chake Othandizira Zachipatala ndi Madokotala Amagwiritsa Ntchito Magnesium Sulfate (OSATI Diazepam kapena Phenytoin):
12. Mosiyana ndi khunyu wamba, kukomoka kwa eclamptic kumachitika ndi cerebral vasospasm, kusweka kwa chotchinga chamagazi ndi ubongo, ndi NMDA-receptor ischemia.
13. Magnesium sulfate (MgSO4) ndi cerebral vasodilator, calcium-channel antagonist, ndi NMDA-receptor blocker. Mayesero odziwika padziko lonse lapansi (The Collaborative Eclampsia Trial and the Magpie Trial, okhudza amayi opitilira 10,000) adatsimikizira kuti magnesium sulfate imachepetsa kukomoka kwa eclamptic ndi 52% mpaka 67% poyerekeza ndi diazepam kapena phenytoin, ndipo amachepetsa kufa kwa amayi oyembekezera.

Kusamalira mwadzidzidzi kuchipatala: Zomwe mungayembekezere mukafika¶

1. Mizati Itatu Yokhazikika Pachipatala¶

Mayi akafika kuchipatala ali ndi eclampsia, preeclampsia kwambiri, kapena HELLP syndrome, madokotala amapereka njira zitatu mphindi 30 zoyambirira:

• Mzati 1: Kupewa Kukhudzika & Kuthetsa ndi Magnesium Sulfate (MgSO4):
• Standard Intravenous Regimen (Zuspan Regimen): Mlingo wa IV wokweza wa 4 magalamu mpaka 6 magalamu a magnesium sulfate amalowetsedwa kwa mphindi 15 mpaka 20, kutsatiridwa ndi kulowetsedwa kwa IV kosalekeza kwa 1 gramu mpaka 2 magalamu pa ola mpaka maola 24 mutatha kubereka (kapena maola 24 omaliza atatha).
• Intramuscular Backup Regimen (Pritchard Regimen): 4 magalamu IV kupitirira mphindi 5 mpaka 15 KUPONGA 10 magalamu akuya mu muscularly (5 magalamu obayidwa kumtunda uliwonse wakunja matako), kutsatiridwa ndi 5 magalamu IM maola 4 aliwonse.
• **Ngati kukomoka kachiwiri kukadutsa **: Zowonjezera 2 magalamu IV bolus a magnesium sulfate amalowetsedwa kwa mphindi zitatu mpaka 5.
• Kuwunika Chitetezo (The Antidote ndi Calcium Gluconate): Chifukwa magnesium imatulutsidwa ndi impso, anamwino amayang'ana zizindikiro zitatu maola 1 mpaka 2 aliwonse: (1) Patellar (knee-jerk) reflexes (omwe amazimiririka poyamba pa 3.5 mpaka 5.0 mmol/L, asanapume kupuma kwa kupuma), 2 mpaka 2) kupuma kwa Re kupuma, 2 mpaka 2) apamwamba), ndi (3) Kutulutsa mkodzo (30 mL/ola kapena kupitirira apo). Botolo la 10 ml la 10% Calcium Gluconate (1 gram IV kupitilira mphindi 3 mpaka 10) imasungidwa pambali pa bedi ngati mankhwala apompopompo.
• Nsanamira 2: Kutsika Kwadzidzidzi Kuthamanga kwa Magazi Pakati pa Mphindi 30 mpaka 60 (Pa BP 160/110 mmHg kapena kupitirira apo):
• BP BP: Kutsika kwa magazi kufika ku 130 mpaka 150 mmHg systolic ndi 80 mpaka 100 mmHg diastolic (kupewa kutsika mwadzidzidzi pansi pa 120/70 mmHg, zomwe zimachepetsa kutulutsa kwa placenta).
• Mankhwala Atatu Azadzidzi Zadzidzidzi (ACOG / WHO / NICE):
  1. Oral Immediate-Release Nifedipine (10 mg mpaka 20 mg kapisozi yomezedwa lonse, OSATI m'zinenero kapena kulumidwa): Imagwira ntchito mu 15 mpaka maminiti a 20 ndipo ingaperekedwe mwamsanga pa triage popanda mzere wa IV.
  2. Intravenous Labetalol (20 mg IV kukankhira pa mphindi ziwiri, ikukwera mpaka 40 mg ndi 80 mg mphindi 10 zilizonse ngati pakufunika, mpaka 300 mg): Imapewedwa mu chifuwa cha mphumu kapena bradycardia yoopsa (pansi pa 60 bpm).
  3. **Mtsempha wa Hydralazine (5 mg mpaka 10 mg IV kukankhira kwa mphindi 2, kubwerezedwa mu maminiti a 20 ngati kuli kofunikira) **.
• Nsanamira Yachitatu: Kuletsa Kwambiri Madzimadzimadzi (80 mL/ola) ndi Kukhazikika kwa Amayi Asanabereke:
• Chifukwa amayi omwe ali ndi preeclamptic amakhala ndi ma capillary a m'mapapo otuluka, ma boluses akuluakulu a IV amadzimadzi amachititsa acute pulmonary edema. Kuchuluka kwa madzimadzi kumangotsala pafupifupi 80 milliliters pa ola (2.7 ounces madzimadzi pa ola) pokhapokha ngati kukha mwazi kukuchitika.
• Kugunda kwa Mtima wa Mwana Wakhanda Panthawi ya Eclamptic Seizure: Panthawi ndi 3 mpaka mphindi 10 pambuyo mayi atakomoka, kugunda kwa mtima wa khanda nthawi zambiri kumasonyeza kuchepa kwa bradycardia. Madokotala SAMAthamangitsa mayi amene akugwedezeka pagawo la C m'mphindi zochepa zoyambirirazo: kukhazikika kwa mayi ndi kupendekeka kumanzere, okosijeni, magnesium sulfate, ndi kuwongolera kuthamanga kwa magazi kumathandizira kugunda kwa mtima wa mwanayo m'mimba mwa 90 peresenti ya milandu.

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

• United States ndi Canada: Imbani 911 nthawi yomweyo ndikupempha zoyendera kupita kuchipatala chokhala ndi Obstetric / Labor & Delivery Emergency Unit. ** American College of Obstetricians and Gynecologists (ACOG)**, Society for Maternal-Fetal Medicine (SMFM), ndi *CDC "Mumvereni Iye" Machenjezo Ochenjeza Amayi ** amalimbikitsa kuti mayi aliyense amene akubereka azivala Postpartum Alert Wristband kapena auze chipatala cha 6 * G" mkati mwa masabata asanu ndi limodzi Alliance for Innovation on Maternal Health (AIM) Kuthamanga Kwambiri Kwambiri pa Mimba ** (kulamula IV labetalol / hydralazine kapena oral nifedipine + magnesium sulfate mkati mwa 30 mpaka 60 maminiti a BP 160 / 110 mmHg kapena apamwamba) imatsegulidwa mwamsanga.
• United Kingdom: Imbani 999 kuti mupeze ambulansi yadzidzidzi (kapena funsani chipatala chanu cha maola 24 Maternity Assessment Unit [MAU] / Maternity Triage nthawi yomweyo). Chisamaliro chimatsatira NICE Guideline NG133 ( Hypertension in pregnancy: diagnosis and management)** ndi ** Royal College of Obstetricians and Gynecologists (RCOG) ** ndondomeko.
• European Union: Imbani 112 m'maiko onse omwe ali membala wa EU. Magulu a chipatala amatsatira European Society of Cardiology (ESC) ndi International Society for the Study of Hypertension in Pregnancy (ISSHP) malangizo achipatala.
• Australia ndi New Zealand: Imbani 000 ku Australia kapena 111 ku New Zealand. Magawo oyembekezera ndi odzidzimutsa amatsatira Society of Obstetric Medicine of Australia ndi New Zealand (SOMANZ) Hypertension in Pregnancy Guideline (2023/2024) ndi RANZCOG miyezo.
• ** India ndi Asia-Pacific / Global Protocols **: Imbani ** 112 ** ku India (kapena ** 108 / 102 ** ntchito za ambulansi ya amayi), ** 995 ** ku Singapore, ** 119 ** ku Japan ndi South Korea, kapena ** 999 ** ku Hong Kong ndi Malaysia. Kumene mapampu olowetsera m'mitsempha sakupezeka pamayendedwe akumidzi, World Health Organisation (WHO) ndi FIGO amavomereza Pritchard intramuscular magnesium sulfate regimen (4 g IV + 10 g IM) asanasamutsidwe.

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi ndingakhale bwanji ndi preeclampsia kapena eclampsia patatha masiku asanu kapena 10 mwana wanga atabadwa kale komanso kuti mimba yanga inali yachibadwa?¶

Pafupifupi theka la amayi omwe adapezeka ndi preeclampsia mochedwa postpartum preeclampsia anali ndi kuthamanga kwa magazi kwabwinobwino komanso opanda mapuloteni amkodzo pa nthawi yonse yomwe anali ndi pakati komanso pobereka. Pa nthawi ya mimba, zinthu za placenta anti-angiogenic zimathandizira mwakachetechete mitsempha yanu yamagazi pamene malita amadzimadzi owonjezera amasungidwa m'thupi lanu. Pakati pa 3 ndi 10 masiku mutabereka ndi kupita kunyumba, zonse zomwe zimasungidwa zamadzimadzi zimasuntha mofulumira kubwerera m'magazi anu kuti ziyeretsedwe ndi impso zanu, kugonjetsa mitsempha yanu yamagazi ndikuyambitsa kuthamanga kwadzidzidzi kwa kuthamanga kwa magazi komwe kungayambitse mutu, pulmonary edema, kapena eclamptic eclamptic mpaka masabata a 6 pambuyo pobereka.

Chifukwa chiyani ululu wam'mimba kwambiri kapena "kutentha pamtima" pansi pa nthiti zakumanja ndi chizindikiro chowopsa pamimba kapena pambuyo pobadwa?¶

Kupweteka koopsa pansi pa chifuwa chapakati (epigastrium) kapena nthiti kumanja (kumanja kumtunda kwa quadrant), makamaka pamene akutsatiridwa ndi nseru, kusanza, kapena malaise ambiri, ndi chizindikiro cha matenda a HELLP (Hemolysis, Elevated Liver enzymes, ndi Low Platelets), omwe amapezeka mpaka 90 peresenti ya milandu ya HELLP. Ululuwu umayamba chifukwa cha kutsekeka kwa magazi komwe kumatsekereza kutuluka kwa magazi m'chiwindi chanu ndikutambasula kapisozi wakunja kwachiwindi (kapisozi wa Glisson) ndikutupa kapena kutuluka magazi. Chifukwa maantacids sangakhudze ndipo subcapsular hematoma ya chiwindi imatha kuphulika kwambiri, ululu uliwonse wam'mimba wam'mimba pambuyo pa milungu 20 ya mimba kapena pambuyo pobereka kumafuna kuyezetsa magazi m'chipatala mwamsanga kwa mapulateleti ndi michere ya chiwindi.

Chifukwa chiyani kuthamanga kwa magazi kwa 160/110 mmHg kumachitidwa ngati vuto la sitiroko kwa mayi wapakati kapena wobereka pamene akuluakulu omwe sali oyembekezera amagwiritsa ntchito 180/120 mmHg?¶

Amayi oyembekezera achichepere nthawi zambiri amakhala ndi kutsika, kumasuka kwa magazi mozungulira 100/60 mpaka 110/70 mmHg, ndipo preeclampsia imawononga minyewa yoteteza endothelial ya ma capillaries awo. Pamene kuthamanga kwa magazi kwa mayi wapakati kapena pambuyo pobereka kutsika kufika pa 160 mmHg systolic kapena 110 mmHg diastolic, kuthamanga kwadzidzidzi kumapitirira malire a ubongo wake, kukakamiza madzi kudutsa chotchinga cha magazi ndi ubongo (kuyambitsa kutupa kwa ubongo ndi kukomoka) ndikuika pangozi yoopsa yotaya magazi. Malangizo okhudza zakulera padziko lonse lapansi amafunikira kutsitsa kuthamanga kwa magazi kwa 160/110 mmHg kapena kupitilira apo mkati mwa mphindi 30 mpaka 60.

Chifukwa chiyani zipatala zimapatsa Magnesium Sulfate ya eclampsia m'malo mwamankhwala okhazikika a khunyu monga Valium (diazepam) kapena Keppra?¶

Eclamptic khunyu sichimayambitsidwa ndi khunyu; Matendawa amayamba chifukwa cha kuchepa kwa magazi m'mitsempha yamagazi, kuchepa kwa magazi m'mitsempha yamagazi, kuchepa kwa magazi m'mitsempha yamagazi ndi ubongo. Magnesium sulphate mwachindunji dilates constrict mitsempha ya muubongo, amateteza magazi-ubongo chotchinga, ndi midadada excitatory NMDA zolandilira mu ubongo. Mayesero achipatala odziwika padziko lonse lapansi (Collaborative Eclampsia Trial and Magpie Trial) atsimikizira kuti magnesium sulfate imachepetsa kukomoka kobwerezabwereza ndi 50 mpaka 65 peresenti poyerekeza ndi diazepam kapena phenytoin popanda kusangalatsa mwana wakhanda.

Kodi kukhala ndi preeclampsia, eclampsia, kapena HELLP syndrome kumakhudza thanzi langa lokhalitsa mtima ndikachira?¶

Inde. Ngakhale preeclampsia ndi matenda a HELLP amatha pakatha milungu ingapo atabadwa, kupulumuka kwa preeclampsia ndikofunikira kwa moyo wonse wamtima: Amayi omwe ali ndi preeclampsia amakhala ndi chiopsezo chambiri chambiri chokhala ndi kuthamanga kwa magazi, matenda amtima, ndi sitiroko m'tsogolomu, komanso 15 mpaka 25% pachiwopsezo chokhala ndi pakati pazaka 25 mtsogolo. 60 peresenti pomwa aspirin ya mlingo wochepa [81 mg mpaka 150 mg usiku] kuyambira pa masabata 12 apakati amtsogolo). Konzani zoyezetsa zapachaka za kuthamanga kwa magazi komanso moyo wabwino wamtima ndi dokotala wanu wamkulu.

*Bukhuli limapereka chidziwitso chadzidzidzi ndipo sililowa m'malo mwa akatswiri azachipatala kapena azachipatala. Chifukwa kukomoka kwa amayi, sitiroko, ndi kutuluka kwa magazi pambuyo pobereka kumatha kuchuluka pakangopita mphindi zochepa, timalimbikitsa kwambiri kuti makolo oyembekezera ndi achibale atenge maphunziro ovomerezeka a chithandizo choyamba ndi CPR kuchokera ku Red Cross, St John Ambulance, kapena wovomerezeka wamaphunziro akuderalo.

Maupangiri ogwirizana¶

• Kuphulika kwa placenta, cord prolapse, ndi trimester obstetric crisis
• Kubereka mwadzidzi komanso ntchito yowopsa
• Mavuto obadwa kunja kwa chipatala: Kuwongolera kwa McRoberts, nuchal cord, ndi kubereka breech
• Hypertensive crisis, malignant hypertension, and blood pressure over 180/120
• Kukomoka ndi kukomoka thandizo loyamba

Magwero ndi malangizo ovomerezeka¶

• American College of Obstetricians and Gynecologists (ACOG) ndi Society for Maternal-Fetal Medicine (SMFM, United States): ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia ndi *Alliance for Innovation on Maternal Health (AIM) Patient Safety Bundle pa Pregnancy Hypertension.
• World Health Organization (WHO): Zomwe WHO Recommendations for Prevention and Treatment of Pre-eclampsia and Eclampsia: Miyezo yapadziko lonse ya intravenous and intramuscular (Pritchard) magnesium sulfate regimens ndi antihypertensive therapy.
• National Institute for Health and Care Excellence (NICE, United Kingdom): Hypertension in Pregnancy: Diagnosis and Management: NICE Guideline NG133.
• International Society for the Study of Hypertension in Pregnancy (ISSHP) ndi Society of Obstetric Medicine ya Australia ndi New Zealand (SOMANZ): Magulu, Kuzindikira, ndi Kuwongolera Malangizo a Preeclampsia, HELLP Syndrome, ndi Postpartum Hypertension (2023/2024).
• Centers for Disease Control and Prevention (CDC, United States): Kampeni ya "Mumveni Iye": Zizindikiro Zachangu Zochenjeza Amayi Panthawi Yoyembekezera Ndi Kufikira Chaka Chimodzi Pambuyo Pobereka.