ECLAMPSIA Flashcards
What is eclampsia
Elevated BP associated with proteinuria and convulsion
Nature of convulsion in eclampsia
Similar to epileptic fit, tonic and clonic phases followed by coma.
Fits are repetitive and last for short durations of 60-90 seconds
Obstetric complications of eclampsia
Foetal distress
Placental abruption
Symptoms
Fits
Unconsciousness
Treatment objectives in eclampsia
To protect the patient from injury
To prevent further fits
To lower the blood pressure
To monitor maternal and foetal complications
To prevent maternal mortality
To deliver the baby when the mother is stable
Investigations in eclampsia
FBC
Blood film for MPS
BUE
Urinalysis and culture
Ultrasound scan
Nonpharmacological management after the fits
Catheterise patient
Obtain IV access
Deliver foetus if mother is stable with no further fits
Initial non-pharmacological management of eclampsia
Lay patient in recovery position
Prevent patient from falling
Avoid restricting patient to prevent joint injury
Keeping patient NPO
Place patient in recovery position
Maintain airway
Artificial respiration during general anesthesia
Consider turning unconscious pospartum patients
How to maintain patient’s airway
Holding up chin if possible
or
Inserting mechanical airway to hold down the tongue
Purpose of ultrasound scan in eclampsia
to exclude multiple pregnancy
and/or molar pregnancy
Signs of eclampsia
Elevated BP
Proteinuria
Convulsions
Coma
Why do we avoid restricting patients with eclampsia
to prevent limb fractures and joint
dislocations
Why do we turn patients who are unconscious for extended periods
Prevent bed sores
Fluid replacement in eclampsia
Normal saline
Ringer’s lactae 1L/6hours max.
Maintenance dose for Mag. sulphate
IM 5g into alternating buttocks every 4 hours till 24 hours after last seizure or delivery
Protocol for pharmacological management of eclampsia
Fluid replacement
Treat convulsions
Treat recurrent convulsions and convulsions not responding to magnesium sulphate
Treat hyeprtension
Factors affecting mode of delivery
Mother’s preference
Mother’s condition
Foetal condition
Treatment of recurrent convulsions (fits>20mins after)
> 70kg: 4g of IV Mag. sulphate
<70kg: 2g of IV Mag. sulphate
Treatment of HTN in eclampsa
IV hydralazine or IV Labetalol
Monitoring parameters for mag. sulphate
Respiratory rate
Patellar reflex
Urine output
Initial management of convulsions for Magnesium sulphate
4g IV Mag. sulphate (20ml of 20%) over 5-15mins
then
M Mag. sulphate (10ml of 50%), 5g into each buttock
Management of magnesium sulphate toxicity
Assisted respiration
10ml of 10% Calcium gluconate IV inf. over 10 mins
Treatment of convulsions not responding to mag. sulphate
IV Diazepam 10mg over 2-3mins (not exceeding 2.5mg/min)
then
<60kg: 5mg 8 hourly
>60kg: 5-10mg hourly
Maximum of 500mcg/kg in a day or 30mg in 24 hours
Dosing for IV Hydralazine
5-10mg stat. over 5-10mins
then
Repeat every 20-30mins till BP is reduced
or
Hydralzine infusion 20-40mg in 500ml N/S, rate according to BP
Labetalol dosing in hypertension in eclampsia
20mg stat. over at least 1 mins
then
repeat at 10 mins interval if BP>160/110 as follows 40mg, 80mg, 80mg to a cummulative max of 220mg.
when BP<160/110mmHg,
start infusion at 40mg/hr and double at 30mins intervals till a satisfactory reponse or to a max of 160mg/h
