Eclampsia

Question 1

What is eclampsia

Answer 1

Is convulsion occurring in a woman with established pre-eclampsia ni the absence of any other cause of convulsion.

Question 2

What should we ask in hx of presenting complaint in eclampsia

Answer 2

• incidental finding of hypertension and proteinuria at routine ante-natal
  visit.
• Severe cases may present with nausea, vomiting, headache, double or blurred vision, flashing lights,
• Convulsion +/-los of consciousness in the presence of features of severe pre-eclampsia.

Question 3

What should we clerk in risk factors or causes of eclampsia

Answer 3

*history suggestive of.multiple pregnancy, history of predisposing systemic illnesses e.g. essential hypertension, diabetes
* primigravida, history of the disease in patient’s mother, history of recent change of husband in a multigravida with hte index pregnancy,
* Rule out other causes of
convulsion in an eclamptic patient

Question 4

Investigations for preclampsia and eclampsia

Answer 4

• Urinalysis:
• 24 hour urinary protein and creatinine clearance to asses renal
  function
• Full blood count -low platelet
• PCV, Hb level - Increases due ot haemoconcentration
• Clotting profile - Whole blood clotting time, PTTK and PT are al prolonged
• Liver Function Test -elevated liver
  enzymes due to hepatocyte necrosis
• Serum urea, electrolyte and creatinine compromise.
  shows renal function

Question 5

Definitive treatment of preclampsia

Answer 5

*definitive treatment of per-
eclampsia as wel as preventing its progression to eclampsia is delivery of baby and placenta.

Question 6

Treatment depends on:

Answer 6

1. Gestational age
2. Severity of disease

Question 7

Treatment of mild preclampsia

Answer 7

Mild
- At term, control BP and deliver
- Before term, control BP and manage conservatively till pregnancy si term (37 weeks).

Question 8

Treatment of severe preclampsia

Answer 8

Severe
At term, control BP and expedite
delivery
- Before term, control BP and expedite delivery

Question 9

Treatment of eclampsia

Answer 9

At any GA, control BP, abort seizure and deliver via the fastest and
safest route (to both mother and baby).

Question 10

Antihypertensives used:

Answer 10

*Hydralazine is most commonly used at 5-10mg Iv slowly, repeated every 30 minutes it diastolic BP = 110mmHg.

Question 11

Other hypertensive medications used in O and G

Answer 11

Oral methyldopa - drug of choice for hypertension ni pregnancy for long term use.
- Labetalol
- Nifedipine

Question 12

Abortion of seizure (anticonvulsants) which drug

Answer 12

Magnesium sulphate (MgSO4) si the drug of choice. Different protocols of use are available.

Question 13

MgSO4 toxicity manifest as;

Answer 13

• Respiratory rate < 21 cycles per minute.
• Loss of knee jerk reflex
• Oliguria -<25mls/hr
• Slurred speech and cardiac arrest.

Question 14

How is magnesium sulphate toxicity managed

Answer 14

*Toxicity is managed using 10ml of 10% Calcium Gluconate given intravenously over 10mins (rule of 10)

Question 15

Route of delivery for preclampsia,eclampsia

Answer 15

The fastest and safest route must beused
- Vaginal route is preferred as long as there are no contraindications
-Caesarean section is done when cervix is unfavourable, contraindication exists for vaginal delivery or for the extremely preterm.
LABOUR