Eclampsia ========= þ PC ratio ("pcr", protein-to-creatinine ration) - spot urine, cathed preferred (more protein in cleancatch) - ask lab for spot creatinine, spot protein - PC ratio is P/C*100. - > 300 diagnostic of preeclampsia - < 200 normal þ Pathophysiology - as with hyperemesis, seems unique to humans - diffuse vasospasm, lowered intravascular volume, and low colloid osmotic pressure. - does not reverse until after delivery, which is definitive therapy. [Tintinalli 3rd ed. p 408.] þ Diagnostic criteria for Eclampsia - coma or seizure in a patient with preeclampsia þ Diagnostic Criteria for Severe Preeclampsia - SBP > 180 or DBP > 120 on one occasion, OR - SBP 160-180 or DBP 110-120 for at least 2 hours despite bedrest OR - SBP > 140 or DBP > 90 on 2 occasions more than 6 hours apart despite bedrest PLUS one of - Proteinuria > 5 g in 24 hours or >= 3+ on rine dip on 2 occasions 2 hours apart (woman without history of renal disease) OR - Urine output < 500cc/24 hours or < 80 cc in any 4 hour period despite 250 cc IV fluid challenge OR - pulmonary edema without fluid overload OR - ALT > 11 OR - platelets < 75,000 OR - seizure without prior history of seizures [Barton JR, Conover WB, Hiett AK. The use of nifedipine during the postpartum period in patients with severe preeclampsia. Am J Ob Gyn 1990;162:788.] þ for HTN in eclampsia (or even not with eclampsia): - standard is IV hydralazine for IV management - adding nifedipine 10 mg PO Q4H after delivery increases urine output [Barton JR, Conover WB, Hiett AK. The use of nifedipine during the postpartum period in patients with severe preeclampsia. Am J Ob Gyn 1990;162:788.] - animal studies suggest nifedipine may cause fetal hypotension and hypoxia so not recommended prior to delivery. - as a generic, OK in pregnancy drug for HTN, labetalol IV or PO is the first choice of Magee OB/GYN residents þ Treatment for Pregnant/Seizing