ECLEMPSIA in gp clinic 21

Question 1

examination findings to ask

Answer 1

is she drowsy, with genralised edema
BP, PR, refelxes
abdominal examination : uterus enlarged to 38 cm (symphysis-fundal height), lax, and non tender. The
presentation is cephalic, fixed in the pelvic brim, with three fingerbreadths palpable above the pubic symphysis.
The fetal heart is audible and normal
CNS exam : no

Question 2

IX to ask

Answer 2

urine tets : ++++

Question 3

History

Answer 3

for how long has she had the fit,
any history of HTN, renal disease,
visual disturbance?no
edema of legs?yes

Question 4

explanation to mother

Answer 4

you are diagnosed with eclampsia, a condition occuring later in preganancy, generally in their first pregnancy.
providing it is well controlled no long term harm to mother and baby, although it can be potentially dangerous to mother and baby.
-therefore i advice her to be immediately transfered to hospital, her delivery arranged asap and get her bp under control.
-no point prolonging pregnancy at this point
-prior to transfer IV diazepam given to prevent further fitd

Question 5

what treatment to be given in hospital

Answer 5

IV mgso4 to control fits
IV hydralazine to control BP
IX :FBC, rft, lft, coagulation profe,hb platelet
CTG
monitor BP, PR UOP
room prepared for further fits to give oxygen, guedel airway padded spoon to prevent tongue bute, slightly darkened room
mode of delivery depend on her condtion
-if cervic favourable : induced, monitored closely for labour, probbaly use of epidural for pain relief
-cervix unfavourable : priming first with PG or elective CS
-If CTG abnormal : C section