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
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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
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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
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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
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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
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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
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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
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