Eclampsia

Pre-eclampsia when complicated with convulsion & or coma is called eclampsia.It is more common is primigravidae.

Clinical features

- Seizures or coma: seizure may be preceeded by rolling of eyes

   to one to side with a stare.

- Can occur after intractable severe pre-eclampsia. 

- Pre-eclampsia superimposed on chronic hypertension.

- Proteinuria may present.

- Elevated creatinine level.

Complication:

1.   Hazards of convulsion

-         Injuries

-         Aspiration

-         Exhaustion due to frequent attack fits

2.   Puimonary odema

3.   Pneumonia.

4.   Cerebral haemorrhage.

5.   Postpartum shock.

6.   Pureperal sepsis.

7.   Psychosis.

8.   Pulmonary embolism.

9.   Eye complication

-The patient should b placed in a side with raised bed in an isolated room protect from noxious stimuli which might provoke further fits.

-Patient should lie on left lateral position to minimize venacaval compression.

-Administered oxygen.

-Take a detailed history from the relative for relevant diagnosis of eclampsia eg duration of pregnancy , number of fits & nature of medication administered outside.

-Periodic urine analysis and other routine blood examination should be done.

-Floeys catherter should be kept to measure urine output.

-Suction should be done to prevent aspiration.

-B.P. pulse  , respiration and fetal hearts sound should be recorded half hourly.

-Maintain nutrition by starting 10% dextrose drips.

-give antibiotic to prevent secondary infection eg inj ampicillin 500mg I/V 6 hrly.

-Labour induction or ceaserean birth.

Specific management of eclampsia:

  Ideally administered  to all women with severe pre-eclampsia as a prophylaxis and eclampsia ,currently the most widely used & successful medication is mg SO4.

 For loading dose:

Take 4 mg SO4 I/V as 20% solution:-

-Take one 20 ml syringe.

-Draw 4 amp of Mg SO4 20% , 8ml into the syringe .

-Add 12ml of distill water for infection to make it 20%.

-Give I/V slowly over 5 minutes.

For intramuscular:-

-Take two 10 ml syringe.

-draw 5 ampules of Mg SO4 50%=10 ml i.e 5gm in each syringe.

-Add 1 ml of 2% lignocaine in the syringe.

-Give deep I/M in alternate buttock every 4 hrly.

-Continue same treatment for 24 hrs after delivery or the last convulsion.

Before repeating Mg SO4:

 Always monitor for toxicity:-

-Respiratiry rate<16/min.

-Patella reflexes absent.

-Urine output<30ml/hr.

Withhold or delay if any of the above symptoms appear.