Pre-Eclampsia and Eclampsia

Question 1

A 30-week GA woman is brought in by ambulance after a fit at home, witnessed by the husband. Assess and mange

Answer 1

Impression
Given witnessed seizure, am initially concerned about ecclampsia. However would consider a wide range of differentials including;

• First presentation of primary epilepsy
• secondary epilepsy: toxins, infection/sepsis, intracranial (malignancy, CVA, trauma), electrolyte derangements (BSL, Ca, K, Mg)

Goals
- A to E assessment, stabilise patient

Question 2

Eclampsia + seizure - Initial assessment

Answer 2

Assessment
- MET call
- position in left-lateral if still seizing
A - patent, risk of aspiration
B - RR, SP02, risk of hypoxia
C - HTN, HELLP syndrome: control HTN with hydralazine, nifedipine, labetalol, methyldopa
D - GCS: treat seizures if in Status with Mag sulphate IV and Diazepam, calcium gluconate is antidote for magnesium toxicity.
E -
F - Continuous CTG monitoring

Consider arrangements for delivery once patient is stable.

Question 3

Eclampsia - History

Answer 3

History

sx: pre-eclampsia: HT, headache, visual change, swelling, dyspnoea, LOC, jerky movements, epigastric pain, oliguria, reduced fetal movements
- Eclampsia: before, during, after seizure details
- RISK: cardiovascular disease, previous eclampsia/pre-eclampsia, fam Hx, AMA
- O&G Hx: GTPAL, yellow book, scans to date, concerns
- PMHx/PSHx
- medications + allergies
- psychosocial history

Question 4

Eclampsia - Examination

Answer 4

Examination

• general observation + vital signs (BP)
• continuous CTG monitoring
• neuro examination: clonus, brisk reflexes
• cardiorespiratory examination: APO
• peripheral oedema

Question 5

Eclampsia - Investigations

Answer 5

Investigations

• Bedside: urine ACR, GBS swabs, other serology
• Bloods: FBC (low platelets), G+H, LFTs (elevated transaminases), urate, blood film (haemolysis), UEC (kidney function)
• continuous CTG monitoring
• Imaging: abdominal ultrasound: growth restriction, amniotic fluid index, placental abnnormalities (abruption), fetal doppler flows

Question 6

Eclampsia - Management

Answer 6

Management
Delivery is the only definitive treatment for eclampsia. NVD preened unless contraindicated. Emergency delivery if concern for fetal wellbeing, uncontrolled HTN, HELLP syndrome

• consider deferring delivery 24-48 hours depending on degree of prematurity to allow administration of magnesium sulphate (neuro) and corticosteroids (resp)

Post-partum

• monitor for postpartum eclampsia
• continuous seizure prophylaxis (mag sulphate)
• VTE prophylaxis
• supportive care

Ongoing

• subsequent pregnancies start LDA at 16-20 wks gestation
• increased risk of other cardiovascular disease, require ongoing follow-up and screening.