| ID | 337 |
|---|---|
| Name | ECLAMPSIA |
| Cause | Gestational or chronic hypertension (high blood pressure) being older than 35 years or younger than 20 years. pregnancy with twins or triplets. first-time pregnancy. diabetes or another condition that affects your blood vessels. kidney disease. |
| Signs Symptoms | Severe headaches. Difficulty breathing. Nausea or vomiting. Trouble urinating or not urinating often. Abdominal pain (especially on the upper right side). Blurred vision, seeing double or loss of vision. Swelling of the hands, face or ankles. |
| Diagnosis | Differential diagnosis: 1. Tetanus 2. Epilepsy 3. CVA 4. Hysteria. |
| Investigations | Obstetrician diagnoses eclampsia based on the presence of a seizure. They will perform an exam, blood work and regular blood pressure monitoring. They also order urine tests to look for increased protein in the urine. Blood tests: Blood tests may show abnormal factors like red blood cell count or platelet count |
| Management | Management: Prehospital phase: 1. Quick diagnosis by history from relatives about oedema, hypertension, convultion, protienuria (if previously investigated) and previous obstet-ric history and by examination of oedema, pulse, B.P. chest for pneumonia, pulmonary oedema and examination of the pt. whether the foetus is alive or not. 2. Anticonvulsant- Diazepam 10-20mg i.v or pethidine 50mg i.v and 50mg i.m to be given, and patient should be kept head placed to one side with mouth downwards to remove secretion from mouth. Pillows should be removed. Hospital phase: 1. Immediate hospitalization. 2. The patient is kept in a dark, quite room. 3. Immediate heavy sedation with diazepam is given. 4. A clear ariway must be maintained. 5. A mouth gag is placed between the jaws. 6. False teeth must be removed. 7. Oxygen inhalation started. 8. Bladder should be catheterized by an indwelling catheter. 9. Hypotensive agents are used to reduce blood pressure e.g hydralazine l0mg injected i.v. over a period of 15 minutes. 10. Frusemide 40mg. i.v to produce a diuresis. 11. Anticonvulsant- to control fit (if any)- Diazepam commonly used 10-20mg i.v given previously + 40mg in 500ml of D/A. Rate of infusion depends upon convulsion and blood presssure. Other: 1. Lytic cocktail. Chlorpromazine 100mg.+ pethidine l00mg + Chlorpromazine 50mg in 500ml of 5% D/A in i.v. At first patient is sedated and then adjusted as it ends in 4 hours. 2. Paraldehyde 5-10ml deep i.m, repeat 6 hourly, or, 15ml in normal saline or olive oil per rectally. 3. MgSO4- 20-40% soln. 10-20ml half i.m & half i.v if intracranial tension is high. If jerks are exaggerated, CaC12 to be given. If convulsion not controlled by diazepam or cocktail then thiopental-Na Igm (0.25 gm very slow i.v and 0.75 mg with fluid in drip very slowly) with careful observation of respiration (artificial aid for respiration must be ready). After controll of fit- the pregnancy should be terminated either by vaginal delivery or by C/S. Specific measures for eclampsia: A. Antepartum eclampsia.- 1. Spontaneous labour. 2. If spontaneous labour not occur, and if adequate pelvis sufficient passage for small or dead foetus then- induction of labour by ARM + Oxytocin- after 24 hours of control of convulsion. Forcep > may be needed for rapid delivery. 3. If CPD, malpresentation, uncontrolled fit (8-10) hour, unfavourable cervix or eclampsia before 36th week pregnancy then- C/S to be done. B. Intrapartum eclampsia- Urgent termination of pregnancy as fits cannot be controlled untill labour is over. 1. 1st stage-ARM, C/S. 2. 2nd stage - episiotomy, forceps, craniotomy (if dead foetus). 3. 3rd stage - no i.v ergometrine (i.m can be given), Oxtytocin if needed can be used. (Ergometrine raises B.P.) 4. Post-partum eclampsia- i.v thiopental-Na (watch respiration). |
| Introduction | Pre-eclampsia when complicated with convulsion &/or coma is called eclampsia. It is characterized by the occurence of major epileptiform convulsions in patients with signs and symptoms of- i. raising B.P ii. increasing oedema iii. heavy proteinuria iv. oliguria v. headache vi. distur-bance of vision, after 28th weeks of pregnancy. Eclampticfit consists of four stages- 1. The aura- there is visual flashes of light and spots before the eyes. 2. The cry- spasm of the respiratory muscles & larynx causes cry. 3. The tonic phase- the patient loses conscious-ness, has generalised muscular spasm and becomes cyanosed. 4. The clonic phase- Violent movements occur.the tongue may be bitten, vomiting and inhalation of vomit may occur. |
| History | |
| Etiology | see under cause |
| Clinical Features | see under sign and symptoms |
| Preventions | Prescribe medications for eclampsia during pregnancy like: Anticonvulsant medication or magnesium sulfate infusion to prevent seizures. Blood pressure medication to lower blood pressure. Corticosteroids to help develop and strengthen the fetus's lungs |
| Treatment | Magnesium sulfate should be given to control convulsions and is the first-line treatment for eclamptic seizures. A loading dose of 4 to 6 grams should be given intravenously over 15 to 20 minutes. A maintenance dose of 2 g per hour should subsequently be administered |
| Complications | Permanent neurologic damage from recurrent seizures or intracranial bleeding. Renal insufficiency and acute renal failure. Fetal changes – IUGR, abruptio placentae, oligohydramnios. Hepatic damage and rarely hepatic rupture. Hematologic compromise and DIC. |
| Prognosis | |
| Types | |
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| Observation | |
| Pathology |
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