PRESENTATION ON

ECLAMPSIASUBJECT:

OBSTETRICSSUBMITTED BY :

KAVITHA KALESAN .M.4TH YEAR BSC NURSING

BATCH- 2011 -2015

INTRODUCTION

Hypertension is the most common medical problem

encountered during pregnancy.

Hypertensive disorders in pregnancy may cause maternal &

fetal morbidity & leading cause of maternal mortality.

Hypertensive disorders are :

1. Pre-eclampsia

2. Eclampsia

3. Gestational Hypertension

4. Chronic Hypertension

DEFINITION

Varadaeus coined the term eclampsia, is derived from

a Greek word, meaning is “ like a flash of lightening”.

The International Society for the study of

Hypertension in pregnancy (ISSHP), defines as the

“Occurrence of generalized convulsions associated

with signs of pre-eclampsia during pregnancy, labour

or within 7 days of delivery and not caused by epilepsy

or other convulsive disorders.

Contd……………………….

Pre- eclampsia when complicated with generalized

tonic- clonic convulsions and/or coma is called

eclampsia.

PATHOPHYSIOLOGY

Placental hypo perfusion

Constriction of small arteries

Reduced blood flow to multiple organs

Increased vascular permeability

Shift of extracellular fluid from the blood to the interstitial space

Contd…………………………

Reduced blood flow and edema

Hypertension, Renal ,Pulmonary and Hepatic

dysfunction and cerebral edema with cerebral

dysfunction and convulsion.

CLINICAL FEATURES

It consist of four stages, that are:-

PREMONITORY STAGE :-

The patient becomes unconscious.

There is twitching of muscles of face, tongue and

limbs.

Eye balls roll or are turned to one side and becomes

fixed.

This stage lasts for about 30 second.

Contd………………………..

TONIC STAGE :-

The whole body goes into a spasm called trunk

opisthotonus.

Limbs are flexed and hands clenched.

Respiration ceases and tongue protrudes

between the teeth.

Cyanosis appears.

Contd……………………………………

Eye balls become fixed.

This stage lasts for about 30 seconds.

CLONIC STAGE :-

All the voluntary muscles undergo alternate

contraction and relaxation.

The twitching starts in face then involve one side

of extremities and ultimately the whole body is

involved

Contd……………………

in the convulsion.

Biting of tongue occurs.

Breathing is stertorous and blood stained frothy

secretions fill the mouth.

Cyanosis gradually disappears.

This stage lasts for 1 – 4 minutes.

TONGUE BITING

Contd……………………………

STAGE OF COMA :-

Following the fit, the patient passes on the

stage of coma.

It may last for a brief period or in others deep

coma persists till another convulsion.

On occasion, the patient appears to be in a

Contd………………………………….

confused state following the fit and fail to

remember the happenings.

The fits are usually multiple, recurring at varying

intervals.

When it occurs continuously it is called status

eclampticus.

Following the convulsion, temperature rises,

pulse and

Contd…………………………..

respiration rate are increased and blood

pressure also increases.

The urinary output is markedly diminished,

proteinuria is in pronounced and blood uric acid

is raised.

OTHER CLINICAL FEATURES

Headache

Visual disturbance

Epigastric pain

Oedema

High blood pressure

Fluid retension

Fundal height less than approximate date

MANAGEMENT

Aim of management.

Prediction & prevention.

First aid treatment outside the hospital.

General management (medical & nursing).

Specific management.

Obstetric management.

1. AIM OF MANAGEMENT :-

Arrest convulsion

Maintenance of patent airway, breathing and

circulation.

Oxygen administration at the rate 8-10 L/minute.

Terminate pregnancy.

Ventilatory support.

Prevention of complication.

Contd…………………………………..

Prevention of life threatening situation.

Postpartum care.

Medicine and regular follow up.

Contd……………………………

2. PREDICTION AND PREVENTION :-

In majority of cases, eclampsia is preceded by

pre- eclampsia.

Thus prevention of eclampsia rest on early

detection and effective institutional treatment

with judicious treatment of pregnancy with

eclampsia.

Contd……………………..

Use of anti-hypertensive drugs, anti- convulsent

therapy and timely delivery are important steps.

Close monitoring during labour and 24 hours of

postpartum, are also important in prevention of

eclampsia.

Unfortunately 30 -85% of cases of eclampsia

remained unpreventable.

Contd……………………………..

Use of magnesium sulphate lowers the risk of

eclampsia.

3. FIRST AID TREATMENT OUTSIDE THE

HOSPITAL :-

The patient, either at home or in the health

center should be shifted urgently to the tertiary

referral care hospitals, because there is no place

of continuing the treatment in such place.

Contd………………………………….

Transport of an eclamptic to a teritiary care

centre is very important.

Such patient needs neonatal and obstetric

intensive care management.

IMPORATANT STEPS IN TRANSPORT ARE :-

a. All maternal records and detailed summary

should be sent with patient.

Contd…………………………….

b. Drugs should be established and convulsions

should be arrested.

c. Drugs should be give like: magnesium sulphate,

labetalol, diuretics, diazepam.

d. One medical personnel and a trained midwife

should accompany with the patient in a well

equipped ambulance to prevent injury and

complications.

Contd……………………….

4. GENERAL MANAGEMENT :-

SUPPORTIVE CARE :-

Aims to prevent serious maternal injury from

fall, to prevent aspiration, to maintain airway

and to ensure oxygenation.

Patient is kept in railed cot and a tongue

depressor is inserted between teeth.

Contd……………………

• She is kept in lateral position to avoid aspiration.

• Vomitus and oral secretion are removed by frequent

suctioning, oxygenation is maintained through face

mask to prevent respiratory acidosis.

• ABG analysis is needed when oxygen saturation falls

below 92%.

• Sodium bicarbonate is given when PH is below 7.10.

Contd……………..

HISTORY :-

Detailed history is to be taken from relatives, relevant

to diagnosis of eclampsia, duration of pregnancy,

number of fits and nature of medications administered

outside.

EXAMINATION:-

Once the patient is stabilized, abdominal and vaginal

examination are made. A self retaining catheter is

introduced and urine if tested for protein.

Contd……………………..

MONITORING :-

Half hourly pulse, respiration rate are recorded.

Hourly urine output is to be noted.

If undelivered the uterus should be palpated at

regular intervals to detect the progress of labour

and fetal heart rate is to be monitored

(bradycardia occurs).

Contd………………………

FLUID BALANCE :-

Ringer’s lactate solution.

A excess of dextrose or crystalline solutions not be

used as it will aggravate the tissue are overload

leading to pulmonary edema, circulatory overload

and ARDS.

ANTIBIOTIC:-

Ceftriaxone 1gm IV, BD.

Contd………………………..

5. SPECIFIC MANAGEMENT:-

Anti- convlsant and Sedative therapy:-

Magnesium sulfate is the drug of choice.

Other regimen are:-a) Phenytoinb) Diazepamc) Lytic cocktail(MENON 1961)

using chlorpromazine, pethadine, promethazine.

Contd…………………………

Anti – hypertensive and diuretics :-

Drugs commonly used are:-a) Hydralazineb) Labetalolc) Calcium channel blocker or nitroglycerine.

Diuretics in case of pulmonary edema. Frusimide

is given in dose of 20-40 mg IV .

Management during fits:-

Contd………………………..

Status Eclampticus:-

Thiopentone sodium 0.5gm dissolved in 20ml of

5% dextrose is given very slowly.

Treatment of complication:-

Prophylactic antibiotics.

For pulmonary edema and ARDS, frusemide

40mg IV followed by 20gm of mannitol IV.

Contd………………………..

For heart failure, dopamine infusion if given.

For psychosis, chlorpromazine or trifluoperazine

is quite effective.

6. OBSTETRIC MANAGEMENT:-

Fits controlled1) Baby mature2) Baby premature(<37 weeks)3) Baby dead

Contd……………………..

Fits not controlled:-

Termination of pregnancy.

Low rupture of the membranes is to be done to

accelerate the labour.

BIBLIOGRAPHY

DC DUTTA’S TEXTBOOK OF OBSTETRICS,

PAGE NO: 230- 236.

ESSENTIAL OBSTETRICS AND GYNACOLOGY,

E. MALCOLM SYMONDS & IAN. M. SYMONDS,

PAGE NO: 107-110.

ECLAMPSIA – SLIDE SHARE PRESENTATION

BY

V. SHARMA,4TH YEAR NSG, BANGLORE.

THANKYOU