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.


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