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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