eclampsia presentation

1. Hypertensive disorders in pregnancy may cause maternal Hypertension is the most

common medical problem encountered during pregnancy. 1. INTRODUCTION & fetal
morbidity & Hypertensive disorders are : 1. Pre-eclampsia 2. Eclampsia 3. Gestational
Hypertension 4. Chronic Hypertensionleading cause of maternal mortality.
2. 2. 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. Varadaeus coined the term eclampsia, is derived from a Greek word, meaning is
“ like a flash of lightening”. DEFINITION
3. 3. Pre- eclampsia when complicated with generalized tonic- clonic convulsions and/or coma
is called eclampsia.Contd……………………….
4. 4. 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
5. 5. Contd………………………… Reduced blood flow and edema Hypertension, Renal
,Pulmonary and Hepatic dysfunction and cerebral edema with cerebral dysfunction and
convulsion.
6. 6. This stage lasts for about 30 second. Eye balls roll or are turned to one side and becomes
fixed.  There is twitching of muscles of face, tongue and limbs.  The patient becomes
unconscious.  PREMONITORY STAGE :- CLINICAL FEATURES It consist of four
stages, that are:-
7. 7. Cyanosis appears. Respiration ceases and tongue protrudes between the teeth.  Limbs
are flexed and hands clenched.  The whole body goes into a spasm called trunk
opisthotonus.  TONIC STAGE :- Contd………………………..
8. 8. The twitching starts in face then involve one side of extremities and ultimately the whole
body is involved All the voluntary muscles undergo alternate contraction and relaxation. 
CLONIC STAGE :-  This stage lasts for about 30 seconds.  Eye balls become fixed.
Contd……………………………………
9. 9. This stage lasts for 1 – 4 minutes. Cyanosis gradually disappears.  Breathing is
stertorous and blood stained frothy secretions fill the mouth.  Biting of tongue occurs.
Contd…………………… in the convulsion.
10. 10. On occasion, the patient appears to be in a It may last for a brief period or in others
deep coma persists till another convulsion.  Following the fit, the patient passes on the stage
of coma.  STAGE OF COMA :- Contd……………………………
11. 11. Following the convulsion, temperature rises, pulse and When it occurs continuously it
is called status eclampticus.  The fits are usually multiple, recurring at varying intervals.
Contd…………………………………. confused state following the fit and fail to remember
the happenings.
12. 12. The urinary output is markedly diminished, proteinuria is in pronounced and blood uric
acid is raised.Contd………………………….. respiration rate are increased and blood
pressure also increases.
13. 13. Fundal height less than approximate date Fluid retension  High blood pressure 
Oedema  Epigastric pain  Visual disturbance  Headache OTHER CLINICAL
FEATURES
14. 14. MANAGEMENT Aim of management. Prediction & prevention. First aid treatment
outside the hospital. General management (medical & nursing). Specific management.
Obstetric management.
15. 15. 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.
16. 16. Contd………………………………….. Prevention of life threatening situation.
Postpartum care. Medicine and regular follow up.
17. 17. 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.
18. 18. 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.
19. 19. 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.
20. 20. IMPORATANT STEPS IN TRANSPORT ARE :- a. All maternal records and detailed
summary should be sent with patient.Contd…………………………………. Transport of
an eclamptic to a teritiary care centre is very important. Such patient needs neonatal and
obstetric intensive care management.
21. 21. 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.
22. 22. Patient is kept in railed cot and a tongue depressor is inserted between teeth. Aims to
prevent serious maternal injury from fall, to prevent aspiration, to maintain airway and to
ensure oxygenation. Contd………………………. 4. GENERAL MANAGEMENT :-
SUPPORTIVE CARE :-
23. 23. 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.
24. 24. Once the patient is stabilized, abdominal and vaginal examination are made. A self
retaining catheter is introduced and urine if tested for protein. 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:-
Contd…………….. HISTORY :-
25. 25. 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). Hourly urine output is to
be noted.  Half hourly pulse, respiration rate are recorded. Contd……………………..
MONITORING :-
26. 26. Ceftriaxone 1gm IV, BD. 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:-  Ringer’s lactate solution. Contd……………………… FLUID
BALANCE :-
27. 27. Other regimen are:- a) Phenytoin b) Diazepam c) Lytic cocktail(MENON 1961) using
chlorpromazine, pethadine, promethazine. Magnesium sulfate is the drug of choice.
Contd……………………….. 5. SPECIFIC MANAGEMENT:- Anti- convlsant and
Sedative therapy:-
28. 28. Diuretics in case of pulmonary edema. Frusimide is given in dose of 20-40 mg IV .
Management during fits:- Drugs commonly used are:- a) Hydralazine b) Labetalol c)
Calcium channel blocker or nitroglycerine. Contd………………………… Anti –
hypertensive and diuretics :-
29. 29. For pulmonary edema and ARDS, frusemide 40mg IV followed by 20gm of mannitol
IV. Prophylactic antibiotics.  Thiopentone sodium 0.5gm dissolved in 20ml of 5% dextrose
is given very slowly. Treatment of complication:- Contd……………………….. Status
Eclampticus:-
30. 30. For psychosis, chlorpromazine or trifluoperazine is quite effective. 6. OBSTETRIC
MANAGEMENT:- Fits controlled 1) Baby mature 2) Baby premature( For heart failure,
dopamine infusion if given. Contd……………………….. <37 weeks) 3) Baby dead
31. 31. Low rupture of the membranes is to be done to accelerate the labour. Termination of
pregnancy. Contd…………………….. Fits not controlled:-
32. 32. 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.
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