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).
 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).
 Classification & Grading:
EPH-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 >180

Diastolic BP (mmHg) Less than 90 90-99 100-109 >110

Edema Occult or leg Legs edema Legs & Abdomen Generalized

Proteinuria Nil or trace 0.5 gm/L > 0.5-1 gm/L > 1 gm/Litre
+ ++ ++
 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 with liberal tendency
towards Cesarean section.
 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 "De strictly followed.
 Grading of EPH-Gestosis:
 Mild EPH-Gestosis: (Score < 4).
 Severe EPH-Gestosis: (Score 4 - 8).
 Imminent eclampsia: (score > 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.
 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 with
liberal tendency towards Cesarean section.
 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.