EPH-GESTOSIS

1
EPH-GESTOSIS
2

• 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).

3

• 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).

4
Classification GradingEPH-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 gt180
Diastolic BP (mmHg) Less than 90 90-99 100-109 gt110
Edema Occult or leg Legs edema Legs Abdomen Generalized
Proteinuria Nil or trace 0.5 gm/L gt 0.5-1 gm/L gt 1 gm/Litre
5
Grading of EPH-Gestosis

• Mild EPH-Gestosis (Score lt 4).
• Severe EPH-Gestosis (Score 4 - 8).
• Imminent eclampsia (score gt 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.

6
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.

7
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.