5.1 - Eclampsia - Exam Flashcards
Practice points
- if bp is >160/100mmHg treatment is essential
- Antihypertensive drugs threapy is an option for hypertension 140-160/90 - 100
- Anti HTN drugs confers no clear benefit to women with mild pre-eclampsia
- Women with severe hypertension or those who have received acute treatment for severe hypertension, control of blood pressure is essential to reduce the risk of cerebral events and prolonge the pregnancy for fetal beneift where possible
- Lower blood pressure carefully as inadequate placental perfusion may occur where placental circulation has adapted to a higher blood pressure
Severe hypertension - acute treatment
SBP>170 mmHg and or DBP >110mmHg
Control Blood Pressure
- admit to hospital
- commence antihypertensive treatment with a SBP >170mmHg or DBP >110mmHg
- do not allow blood pressure to fall below 140/80 mmHg
Fluid restriction
- nil by mouth
- 80 ml/ph IV crystalloid
Observations
- 15 minute BP
- 30 minutely - complete set of vital signs and assesment of response to treatment
- Continuous 02 saturation monitoroing
- continuous fetal monitoring
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Nifedipine - Ca Channel blocker
Ca channel blocker in myocardiac cells
This blockage prevents the entry of calcium ions into cells during depolarization, reducing peripheral arterial vascular resistance and dilating coronary arteries.1 These actions reduce blood pressure and increase the supply of oxygen to the heart, alleviating
- Dose -10mg tablet (max 40mg)
- Route - Oral
- Onset of action - 30 -45 minutes (repeat after 45 mins if response inadequate)
- Side effects - headache
- Contraindications: Aortic stenosis
Labetalol - B blocker with mild alpha vasodilator effect
Labetalol leads to sustained vasodilation over the long term without a significant decrease in cardiac output or stroke volume, and a minimal decrease in heart rate.3,
- Dose - 20 - 80mg max 80mg/dose
- Route - IV bolus 20mg over 2 mins. repeat every 10 min prn
- Onset of action - max effect ususally occurs within 5 minutes of each dose
- oral
- 100mg to 400mg 6-12 hourly - max 1600mg
- onset 1-2 hours half life 6-8 hours
Contraindications: Asthma; chronic airways irritation - Side effects - Bradycardia, bronchospasm, and headache, avoid with women whom have asthma
Hydralazine - Vasodilator
interfers with calcuim uptake on smooth muscles
Hydralazine is an antihypertensive agent used for the management of essential hypertension or severe hypertension associated with conditions requiring immediate action, heart failure, and pre-eclampsia or eclampsia
- Dose - 5 - 10 mg (first does 5mg if fetal compromise)
- Route - IV bolus over 5 minutes, administered by medical officer. or IM injection
- Onset of action - 20 mins may be repeated after 20 mins
Ongoing treatment of hypertension
Drugs of choice
First line drugs include
*Metholdpa -
* * labetolol and metholdopa
Second line drugs include
- hydralazine
- nifedipine (if available)
- Prazosin
Exam: Explain the principles of anatomy and pathophysiology relating to pre-eclampsia and eclampsia.
https://www.youtube.com/watch?v=RB5s85xDshA
Exam: Describe the potential causes and risk factors of eclampsia.
- primiparity,
- maternal age over 40 years,
- chronic hypertension or diabetes,
- multiple gestations,
- prior history of preeclampsia
- seizure
- hypoxia
- fetal hypoxia
- stroke
- severe htn
- gestional htn
- preeclampsia
- HELLP
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Exam: Outline the complications which may occur for both the mother and fetus in relation to
eclampsia.
Exam: Describe the role of the midwife as a member of the multi disciplinary team in the prevention,
identification and management of eclampsia.
education
regular monitoring of BP
regular calcium supplement 1.25 - 2.5 per day or educate on rich calcium diet
low dose aspirin 150mg per day
bp sbp >140 dbp >90 retake in 4-6 hours (serial BP)
identify any cerebral irrability
escalate care to the obgn
mag sulphate infusion
deep tendon reflects
identify if fetal compromise
