Eclampsia Flashcards
Definition of eclampsia
RCOG define eclampsia as a condition which causes women to experience convulsions similar to an elliptic fit in pregnancy, labour or postnatal. Usually follows presentation of pre-eclampsia but not always.
Incidence rate
Eclampsia is rare and affects 2.7 in 10,000 pregnancies according to Baston and Hall. Less common in the UK due to good antenatal care and monitoring throughout pregnancy.
Death rate?
6/225 women who have eclampsia die
Risk factors
Primip >35 or <20 years old Multiple pregnancy Infection Diabetes Obesity Hypertension
Cause?
Unknown but thought to be due to abnormal implantation of the placenta. Shown with IUGR/ SGA.
Physiology of implantation
Trophoblast implants and spiral arteries form to allow for perfusion from placenta to baby > in eclampsia the serial arteries become fibrous and narrowed> this leads to production of proinflammatory proteins> these enter maternal blood stream causing inflammation in endothelial cells and vasoconstriction > poor perfusion
Kidneys?
Poor perfusion to kidneys damages the glomerulus > this slows the filtration rate causing proteinuria and oligouria > also leads to retained salts and therefore hypertension.
Liver?
Reduced blood flow > hypoxia > damage to tissues> causes swelling > elevated ALTs and liver capsule stretches causing epigastric pain
Retinas?
Reduced blood flow to retinas> hypoxia> Scotoma> are of vision becomes worse. Women experience blurred vision and flashing lights.
Endothelial cells
Damage> clot formation which uses platelets damage to red blood cells > haemolysis > DIC (low platelets) > vessels become more permeable and leaky causing oedema.
Oedema?
Oedema is likely to occur globally and therefore cerebral oedema will cause headaches, confusion and seizures.
What can Eclampsia evolve to?
HELLP. Haemolysis. Elevated Liver Enzymes. Low platelets. 10-20% of eclamptic women. If unrecognised/ untreated > eclamptic fit.
Signs of tonic-clonic seizures?
eye-rolling, twitching, skin cyanosed, jerking movements, facial swelling, unresponsive.
Aim of eclampsia management?
Stabilise condition. Control seizures and blood pressure. Deliver baby? eliminate fluids and oxygenate.
Initial Management
Ensure safe zone. Into left lateral to ensure patent airway and reduce aortocaval compression. Check for obstructions.
Commence 02 15l/min non rebreathe mask.
Continuous obs with dynamap, at least every 10 minutes.
CTG
Venous access (2x 16 G cannulas)
Catheterise with consent (foley indwelling with urometer) Aim for UO of previous hour + 30 mls.
Fluid restriction to avoid pulmonary oedema.
Medical Review
What bloods for eclampsia?
FBC (Hb - haemorrhage? PLT -DIC & HELLP?
Us&Es - Kidney function (increased creatinine if poor)
LFTs- Liver function (increased ALTs if damaged)
Group and Save to crossmatch for transfusion and transfer to theatre.
Clotting bloods- DIC & HELLP
Mag sulphate?
4g bolus IV over 15 minutes.
2- 4g further bolus if still convulsing over 5-15 mins
1g hourly maintenance dose
Signs of magnesium sulphate toxicity
Absent patella reflexes UO <20ml/ hour Resps< 14 SATS< 95% STOP INFUSION IF SIGNS OF TOXICITY
How to treat the hypertension?
Magnesium sulphate can reduce blood pressure so monitor closely.
Labetalol orally 200mg (not for asthmatics) OR Nifedipine 20mg orally
IV labetalol 20mg over 2 minutes can double with 10-minute intervals but not exceed 50mg hourly.
IV hydralazine (5 mg every 20 mins until 20 mg) for asthmatics.
After care
Strict fluid restriction so close monitoring of UO.
Repeat bloods at 6-24 hours and monitor Magnesium levels.
? Hypo pathway for baby due to potential compromise and IUGR/ Maternal drugs and cord gases.
PN care TWOC, VTE adjusted.
Document, DATIX, debrief.
