الفهرس | Only 14 pages are availabe for public view |
Abstract Pre-eclampsia and eclampsia; often referred to as toxemia of pregnancy, are among the leading causes of maternal morbidity and mortality. This syndrome occuring predominantly in young nulliparas, becomes apparent after the 20th week of gestation, characterised by hypertension, proteinuria and/or generalized edema. The aetiology is thought to be related to decreased placental perfusion, one proposed theory of the syndrome invokes immunologic rejection of fetal tissues by the mother in genetic predispos~d patients causing placental vasculitis and ischemia, with widespread arteriolar vasoconstriction, causmg hypertension, tissue hypoxia and endothelial damage. It is clear that the anesthetic management of women with Preeclampsia should be undertaken by anesthesiologist thoroughly familiar with the complex pathophysiologic changes of the disease process. In severe Pre-eclampsia and ecl’.Ullpsia, all organ systems are affected because of widespread vasospasm. Focal cerebral hypoperfusion, edema and small foci of degeneration have been occured due to hypoxia. Heart failure may occur in severe cases with left ventricular hypertrophy, and subendocardial hemorrhages. Hepatic function tests show elevated plasma level of serum enzymes with periportal fibrosis. HELLP syndrome is a particular form of severe Pre-eclampsia characterised by hemolysis, elevated liver enzymes, and thrombocytopenia. Acute renal failure with elevated serum creatinine, oliguria may develop. Airway edema is of great concern because it may lead to respiratory embarrassment and difficult intubation. Pulmonary edema also is a common feature in severe cases due to heart failure. |