[19] Eclampsia Flashcards
What is eclampsia?
Onset of seizures in a woman with pre-eclampsia
When can eclampsia occur?
Before, during or after delivery
What type of seizures are seen in eclampsia?
Tonic-clonic
How long do eclampsia seizures generally last?
1 minute
What are the features of the postictal period in eclampsia?
Confusion or coma
What are the main management points of eclampsia?
- Resuscitation
- Treatment and prophylaxis of seizures
- Treatment of hypertension
- Fluid therapy
- Delivery care
- After-delivery care
How should a patient with eclampsia be resuscitated?
- Place in left lateral position
- Secure airway
- Oxygen
What is the anti-convulsant drug of choice in eclampsia seizures?
Magnesium sulphate
What is the initial dose of magnesium sulphate in eclampsia?
4g bolus over 20 minutes as 20ml of a 20% solution
How are blood levels of magnesium maintained in treating eclampsia seizures?
1g/hour
When should blood levels of magnesium be measured in treating eclampsia seizures with magnesium sulphate?
Only if significant renal failure or seizures recur
Why is severe hypertension in eclampsia managed?
To reduce the risk of cerebrovascular accident
What are the most commonly used drugs to treat hypertension in eclampsia?
- Hydralazine
- IV labetalol
What are the risks of using hydralazine or IV labetalol in eclampsia?
They may cause fetal distress
What monitoring is necessary when using hydralazine or labetalol for eclampsia?
Fetal heart rate monitoring
What diastolic pressure must not be gone below during pregnancy?
90 mmHg
Why is it important to maintain a diastolic pressure of 90 mmHg in pregnancy?
To maintain perfusion of the placenta
How should fluid therapy be given in eclampsia?
- Monitor intake and output
- Input restricted to 100ml/hour
- If urine falls below 30ml/hour consider central venous pressure monitoring
What can fluid overload in women with eclampsia lead to?
- Pulmonary oedema
- ARDS
What is the definitive treatment for eclampsia?
Delivery
Should a baby be delivered of the mother is unstable?
No, even in fetal distress
When should delivery be performed in eclampsia?
After seizures, severe hypertension and hypoxia are controlled
What delivery options should be considered in eclampsia?
- Vaginal
- C-section
Which delivery method is more likely in eclampsia?
C-section
When is a c-section required in eclampsia?
- Primigravidae
- Well before term
- Unfavourable cervix
How should the patient be managed after delivery in eclampsia?
- Quiet environment under constant observation
- Appropriate levels of sedation
- Continue magnesium sulfate for 24 hours after last seizure
- Continue anti hypertensives until BP normal
How long may hypertension continue in eclampsia after delivery?
6 weeks
What are the potential complications of eclampsia?
- Aspiration
- Pneumonia
- Cerebral haemorrhage
- Kidney failure
- Cardiac arrest
