PQCNC : Conservative Management of Preeclampsia (CMOP) at East Carolina University and Vidant Medical Center

8/9/2019 PQCNC : Conservative Management of Preeclampsia (CMOP) at East Carolina University and Vidant Medical Center

1/20

Conservative Management ofPreeclampsia (CMOP) at East

Carolina University and VidantMedical Center“ The Balancing ct!

James E. deVente, MD/PhD

ssociate ProfessorMedical "irector of #a$or and "elivery

"epartment of O$stetrics and %ynecologyBrody &chool of Medicine

CMOP


2/20

O'tline The Balancing Act

• Brief Histor of the Conser!ati!e Management of Preeclam"sia ato#r instit#tion $Data%

• The Preeclam"tic &Balancing Act'

Pro"er Diagnosis•

Ed#cation for MD and () $E*am"les%• CMOP "rotocol• Pre!alence of Pre+eclam"sia at Vidant Medical Center $Data%

Pro"er Management• e!ere BP treatment - hr Data $Data%• teroids - 0 1ee2s $Data%

Pro"er Discharge• Patient Ed#cation and 3ollo1+#" $e*am"le%

4esson 4earned / O""ort#nities 5denti6ed


3/20

Balancing ctBrief istory of the Conservative Management of Preeclampsia at o'rinstit'tion

&ch i E * +r i de ma n & * & i $a i B ,C o ns e rv a t i v e ma na ge me nt o f s e v e rep re e c l a mps i a re mo te f ro m te rm, m -O $s te t %y ne co l .//0 120 3 454 6478 ,

& i $a i B , " i a gno s i s a nd Ma na ge me nt o fge s ta t i o na l hy pe r te ns i o n a ndp re e c l a mps i a , m - O $s te t %y ne co l5887 1 .85 3 .2. 6./5 ,

& i $a i B* B a r to n - 9 , E : pe c ta n tma na ge me nt o f s e v e re p re e c l a mps i are mo te f ro m te rm3 pa t i e n t s e l e c t i o n *t re a tme n t * a nd de l i v e ry i nd i ca t i o ns , m - O$ s t e t %yn e co l 5 8 8; 1 < . 0 3 . 6/ ,

588.

588/

“E:pectantmanagement

sho'ld $econsidered for=omen remote

from term =hohave mild

preeclampsia!

2008 ACOG CompendiumPractice Bulletin number 33


4/20

8

58

08

48

28

.88

.58

P(ETE(M DE45VE(7 (ATE/ V5DA)T MED5CA4 CE)TE( 899: + 89

. 4i!e Births - ;

12s

4inear $. 4i!e

Births - ; 12s%

0. 4i!e Births - 8

12s

4inear $0. 4i!e

Births - 8 12s%

B5(TH, PE( MO)TH

22.5% decrease in infantsdelivered less than 37 weeks29.2% decrease in infantsdelivered less than 32 weeks


5/20

8

.8

58

78

08

33

weeks & transferred to NICU

31.3% decrease in total infants

re!irin"


6/20

8

<

.8

.<

58

5<

78

7<

085)3A)T ?5TH AP>A( - @ at 35VE M5)=TE 899: + 89

.5, P%9& 4 at < Min'tes

#inear (.5, P%9& 4 at <

Min'tes)

5)3A)T PE( MO)TH

#his re$resents a 3.&%decrease in infants with

'()'*s +, at five -in!tes


7/20

MaternalD+etal

ssessment

Mag s'lfate forsei're

prophyla:is

"E#VE9F

BMG :5 dosesfor +#M

mmediate Protocol Vs, E:pectantProtocol

MaternalD+etalssessment

% 70 =?s =DoBMG

V mag s'lfate

&teroids +#M

Contin'o's E+M

.5 'rine TP

#a$ eval'ation

&erial e:ams

%>70 =?s

%>75 =?s =ithsteroids

%57 =?s

Hny C toe:pectant mgmt

"E#VE9F

N= 124 patients < 34 ee! N= 112 patients < 34 ee!


8/20

t#d >est.Age

>ained$d%

Ar#"tion

Birth 1t$g%

3etaldeat

h

A"gar min

A"gar min

MatDeath

ECU 4,4/ ID62,74 nJ7 .7//,4ID6


9/20

"o# $% do e care about & da%s'

I V H

N E C

R D S

R O P

S E P S I S

C P

ou increase gestational age … you decrease the complication of prematurity


10/20

Preeclamptic Balancing ct

CMOP

• &tro?e• emorrhage• 9enal +ail're•

epatic +ail're• P'lmonary Edema• 9etinal detachment• EtcK

Premat'rity• 9OP• &epsis•

AEC• V• CP• 9"&• EtcK


11/20


12/20

Proper "iagnosis

8L


13/20

Proper "iagnosis

7/L.2L

.


14/20

8L

.8L

58L78L

08L


15/20


16/20

Proper Management

6.8L

8L

.8L

58L

78L

08L


17/20

Proper Management

8L

58L

08L

48L

28L

.88L

.58L

4;L

.88L


18/20

Proper "ischarge• ll patients =ith %TADPreeeclampsia are given a .

=ee? post6part'm BP chec? appt,

• ll patients are given ver$al ed'cation onypertension in pregnancy (and this is doc'mented

in the 9A Aotes)


19/20

#essons and Opport'nities., Ta?ing an acc#rate BP can $e e:tremely dic'lt in some patients

8. Antih"ertensi!e dr#gs need to $e readily availa$le

7, Ma?ing a "iagnosis of #"er im"osed Preeclam"sia cansometimes $e N'ite challengingK $e patient =ith yo'r patient and

yo'r self

0. Patient Ed#cation has $een very challenging to e:ec'te in arelia$le fashion


20/20

Eval'ation and management of severe preeclampsia $efore 70 =ee?s gestation,&M+M Clinical Opinion, m - O$stet %ynecol 588;1 ./.6./;,

addad B and &i$ai BM, E:pectant Management in Pregnancies =ith &evere pre6eclampsia, &emin Perinatol 588/1 773 .076.

PQCNC : Conservative Management of Preeclampsia (CMOP) at East Carolina University and Vidant Medical Center

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