Eclampsia Flashcards
1
Q
What is Eclampsia?
A
- it is defined as one or more convulsions in association with pre eclampsia
- it is estimated that 38% of seizures occur before proteinuria and hypertension have been documented
- 44% of seizures occur postpartum, 38% antepartum and 18% intrapartum
- the seizure is thought to be du to intense vasospasm of the cerebral arteries, oedema secondary to ischaemic damage of vascular endothelium and/or intravascular clot formation
2
Q
What are the three defined phases of an eclampsia fit?
A
- prodromal —> in which the imminent fit is heralded by possible reports of visual disturbances, muscular twitching, facial congestion, foaming at the mouth and/or deepening loss of consciousness
- tonic-clonic —> where initially generalised muscular contractions are present and respiration is absent, this is followed by repeated strong jerky irregular muscular activity
- abatement —> which occurs within 60-90 seconds of onset during which time respiration is re-established and there is gradual return to consciousness, but perhaps with a confused agitated state
3
Q
How should eclampsia be managed?
A
- CALL FOR HELP (SOAPS)
- SUPPORT
—> protect from injury during the tonic-clonic phase
—> maintain airway, breathing and circulation
—> move the mother into left lateral
—> administer high flow facial oxygen with a reservoir bag
—> do not attempt to restrain during her seizure, immediately following ensure the woman is maintained in the left lateral position with an open airway
—> IV access and bloods (FBC, group and save, blood glucose, U+E’s, LFTS, clotting) - CONTROL SEIZURES
—> give magnesium sulphate loading dose (4g IV over 5 mins)
—> magnesium sulphate maintenance dose (1g/hour IV for at least 24 hours after last seizure)
—> recurrent seizures (magnesium sulphate 2g bolus over 5 minutes) (consider over causes of seizures such as intracranial haemorrhage and organise urgent CT or MRI)
—> consider anti-hypertensives - fluid balance (urinary catheter)
- maternal observations
- achieve stability of maternal condition prior to making plans for birth but assess fetal wellbeing, CTG monitoring
- patellar reflexes in view of risk of magnesium toxicity
- DOCUMENT
4
Q
Why use magnesium sulphate?
A
- the results of the collaborative eclampsia trial demonstrated that women treated with magnesium sulphate have fewer recurrent seizures compared with women treated with diazepam or phenytoin
- it appears to act primarily by reducing cerebral vasospasm
- the subsequent MAGPIE trial demonstrated that magnesium sulphate can also prevent eclampsia
5
Q
What about magnesium toxicity?
A
- magnesium sulphate is excreted by the kidneys
- magnesium toxicity is unlikely with this regimen and, if the woman has a normal urine output, the measurement of levels is not necessary
- however, if the woman is oliguric (produces less than 100ml urine over 4 hours) or has renal impairment, magnesium levels are more likely to become toxic and it is therefore advisable to administer the loading dose only
- if the woman develops oliguria while receiving the maintenance dose this should be stopped blood should be taken to measure the serum magnesium level
- at toxic level there is a loss of deep tenon reflexes followed by respiratory depression, respiratory arrest and ultimately cardiac arrest
6
Q
What are some of the predisposing factors for preeclampsia?
A
- primiparous
- previous PET
- chronic hypertension
- family history of pre eclampsia
- pre-existing diabetes
- multiple pregnancy
- interval of 10 years or more between pregnancies
- obesity
- extremes of maternal age
- autoimmune disease
- renal disease
- IVF
7
Q
What are some of the signs and symptoms of preeclampsia?
A
- brisk reflexes
- papilloedema
- severe and persistent occipital or frontal headaches
- visual disturbances
- altered mental state
- oliguria
- oedema
- pulmonary oedema
- difficulty breathing
- upper epigastric pain
- vomiting