Eclampsia

Question 1

Definition

Answer 1

Generalised tonic clonic seizures after 20 weeks gestation or grand Mal seizures with or without hypertension

Question 2

Incidence

Answer 2

Antepartum period 38-52%, intrapartum 18-35%, postnatal 11-44%

Question 3

Risk factor

Answer 3

• Maternal age over 40
• Renal diseases
• Previous pre-eclampsia
• BMI over 30

Question 4

Symtpoms

Answer 4

• BP >140 systolic and >90 diastolic
• Persistant headaches
• Visual disturbances
• Seizures

Question 5

Help

Answer 5

Senior midwife - aware and to organise
Senior OBS - expert, create a plan and manage
Anaesthetist - In case we need to go theatre
Scribe - To document
Runner - To get equipment
Paed - If antepartum and need for urgent delivery, possibility of compromised baby

Question 6

Immediate role of midwife

Answer 6

• Emergency buzzer
• Put women in left lateral and do not leave her
• High flow O2
• ABCDE
• Control seizure with MgSO4

Question 7

ABCDE

Answer 7

Airway - Left lateral position as relieves aortocaval compression

Breathing - High flow 15l via face mask

Circulation - IV access 2x large bore cannula and bloods

Disability - Protect from injury, do not restrain

Exposure - Maintain dignity, prevent heat loss and injury

Question 8

Bloods and fluid balance

Answer 8

FBC - To ensure good iron count
G&S - In case woman requires blood transfusion
LFT - Liver function
U&E - Kidney function no build of magnesium

Indwelling catheter - Run fluid 80ml/hr to prevent pulmonary oedema, output should be 0.5ml/kg/hr

Question 9

MgSO4 Loading dose

Answer 9

4g Magnesium sulphate over 5mins

Draw 8ml of 50% MgSO4 solution followed by 12ml of 0.9% normal saline into 20ml syringe, give manually over 5 mins.

Magpie trial in 2002 concluded that MgSO4 can be used to prevent eclampsia or treat it

Question 10

MgSO4 Maintenance dose

Answer 10

1g/hr Magnesium sulphate for 24 hours

Draw 20ml of 50% MgSO4 (10g) with 30ml 0.9% normal saline. Total volume of 50mls which runs 5ml/hr in syringe driver, to start following birth or last seizure.

Question 11

Recurrent seizures

Answer 11

Loading dose 2g, 4ml of MgSO4 and 6ml of normal saline. Maintenance dose restarts.

Question 12

Immediate PN care

Answer 12

Full observations hourly - BP, Pulse, RR, Temp, Sats, Monitor level of consciousness using AVPU score.

Level 2 critical care

Debrief and treat hypertension

Question 13

Treat hypertension

Answer 13

• Aim for BP <150/100mm/Hg
• Strict fluid balance
• BP check every 15 minutes if on treatment and every 30mins if stabilised
• R/V 4hrly by Dr
• CTG continuous if not delivered
• Remain left lateral if not delivered

Question 14

Magnesium sulphate observations

Answer 14

• Hourly Urine measurements as toxicity causes oliguria.
• Hourly deep tendon reflexes
• Hourly RR and O2 as MgSO4 causes respiratory depression

Question 15

Complication of MgSO4

Answer 15

• Loss of deep tendon reflexes
• Respiratory depression
• Respiratory arrest

STOP MGSO4 IF APPLIES

Question 16

Management of MgSO4 toxicity

Answer 16

• Call for help
• Stop infusion
• BLS
• 1g (10mls of 10%) calcium gluconate IV to reverse MgSO4

Question 17

Aftercare and Documentation

Answer 17

• Debreif
• Full observations
• CTG continuous

Document

• Time of seizure
• Dose of MgSO4 and time started
• Bloods sent
• Staff present during seizure
• Incident form
• Proforma