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    Eclampsia

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    احمد وائل عبد الشافى ابو المعاطى Unknown
    Eclampsia is a serious complication of preeclampsia characterized by seizures in pregnant or postpartum women. It occurs in 0.2-0.3% of pregnancies affected by preeclampsia. Risk factors include primigravidity, extremes of reproductive age, family history, diabetes, chronic hypertension, multiple pregnancy, and thrombophilia. Management involves controlling blood pressure, terminating the pregnancy, preventing new seizures with magnesium sulfate, and monitoring for complications such as pulmonary edema, DIC, and intracranial hemorrhage. Recurrent seizures are treated with additional magnesium sulfate or diazepam boluses. Fluid balance must be carefully managed to prevent pulmonary edema.

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    Eclampsia

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    احمد وائل عبد الشافى ابو المعاطى Unknown
    29 views34 pages
    Eclampsia is a serious complication of preeclampsia characterized by seizures in pregnant or postpartum women. It occurs in 0.2-0.3% of pregnancies affected by preeclampsia. Risk factors include primigravidity, extremes of reproductive age, family history, diabetes, chronic hypertension, multiple pregnancy, and thrombophilia. Management involves controlling blood pressure, terminating the pregnancy, preventing new seizures with magnesium sulfate, and monitoring for complications such as pulmonary edema, DIC, and intracranial hemorrhage. Recurrent seizures are treated with additional magnesium sulfate or diazepam boluses. Fluid balance must be carefully managed to prevent pulmonary edema.

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    eclampsia lecture for medical student

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    eclampsia

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    Eclampsia is a serious complication of preeclampsia characterized by seizures in pregnant or postpartum women. It occurs in 0.2-0.3% of pregnancies affected by preeclampsia. Risk factors include primigravidity, extremes of reproductive age, family history, diabetes, chronic hypertension, multiple pregnancy, and thrombophilia. Management involves controlling blood pressure, terminating the pregnancy, preventing new seizures with magnesium sulfate, and monitoring for complications such as pulmonary edema, DIC, and intracranial hemorrhage. Recurrent seizures are treated with additional magnesium sulfate or diazepam boluses. Fluid balance must be carefully managed to prevent pulmonary edema.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    29 views34 pages

    Eclampsia

    Uploaded by

    احمد وائل عبد الشافى ابو المعاطى Unknown
    Eclampsia is a serious complication of preeclampsia characterized by seizures in pregnant or postpartum women. It occurs in 0.2-0.3% of pregnancies affected by preeclampsia. Risk factors include primigravidity, extremes of reproductive age, family history, diabetes, chronic hypertension, multiple pregnancy, and thrombophilia. Management involves controlling blood pressure, terminating the pregnancy, preventing new seizures with magnesium sulfate, and monitoring for complications such as pulmonary edema, DIC, and intracranial hemorrhage. Recurrent seizures are treated with additional magnesium sulfate or diazepam boluses. Fluid balance must be carefully managed to prevent pulmonary edema.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 34

    Ecalmpsia

    def
    • Convulsions on top of severe PE.
    • It could be considered as an advanced state of severe
    PE.
    • In high-resource countries, pre-eclampsia is currently
    reported to occur in 2–8 % of pregnancies and eclampsia
    to complicate 0.2–0.3 % of these cases, for an overall
    incidence of 0.004– 0.02 % of births.
    • In many low- and medium-resource countries, the
    reported incidences of pre-eclampsia and eclampsia are
    much higher.
    Risk factors
    • Primigravida
    • Extremes of reproductive age
    • Family history of pre-eclampsia
    • Gestational or pre-existing diabetes
    • Chronic hypertension or renal disease
    • Multiple pregnancy
    • Gestational trophoblastic disease
    • Hereditary or acquired thrombophilia
    Pathophysiology
     Endothelial lesion,
     Exaggerated microvascular permeability,
    cerebral oedema
     Pericapillary haemorrhage are common
    Complications
    • Maternal mortality occurs in about 0.07 % of eclampsia
    cases, and the main causes are intracranial haemorrhage,
    acute pulmonary oedema and multi-organ failure.
    • Maternal morbidity includes acute pulmonary oedema,
    DIC, renal insufficiency and more rarely intracranial
    haemorrhage and rupture of subcapsular hepatic
    haematoma
    • perinatal deaths : Iatrogenic prematurity
    other causes ??
    Types
    • Antepartum : 50%
    • Intrapartum : 25%
    • Postpartum :25%
    Clinical presentation
    1- premonitory stage: the eyes roll up with
    twitches of the face and hands
    2- tonic stage: generalized tonic contraction of
    the whole body muscles with opisthotonous and
    cyanosis. lasts 20 sec
    3- tonic stage: alternative contractions and
    relaxation of the body muscles. The face is
    congested, the tongue may be bitten . Blood
    stained frothy saliva appears on the mouth.
    Breathing is sterotous, urine and stool may pass
    involuntary, temp. rises due to increased muscle
    activity.60 sec
    4- coma may last few hours, other fits may occur
    again during coma
    Severity of eclampsia
    • Considered to be severe if one or more of the
    following is present (Eden,s criteria)
    1- coma of 6 h or more
    2- temp 39 or more
    3- pulse over 120bpm
    4- RR over 40 m
    5- more than 10 convulsions
    dd
    • Epilepsy
    • Intracranial haemorrhage.
    • Cerebral venous thrombosis
    • Thrombotic thrombocytopenic purpura
    • Cerebral stroke
    • Metabolic causes
    Imminent ecalmpsia
    • Ecalmpsia is an advanced stage of PE
    1- Epigastric pain : stretch of Glisson capsule of
    the liver
    2- Headache : cerebral hypoxia
    3- Visual symptoms :blurring of vision
    management
    • Control BP- CONVULSIONS
    • Terminate Pregnancy
    • Prevent new fits
    Management
    • Anticipate and Prevent the Situation
    • Ask for Help
    • Avoid Lesions During the Eclamptic Seizure
    • Left Lateral Safety Position, Inspect Airway and
    Monitor
    • Prevention of New Seizures
    • Other Non-emergent Measures
    • Decreasing Blood Pressure
    • Recurrent Seizures
    • Maintenance Dose of Magnesium Sulphate
    • Fluid Balance
    • Thromboprophylaxis
    • Evaluation of Laboratory Results and Fetal
    Evaluation
    • Programming Birth
    Anticipate and Prevent the Situation
    • In patients with pre-eclampsia, the prodromal
    symptoms of severe frontal headache, continuous
    epigastric pain and visual complaints (blind spots, fl
    ashes, double vision and blurred vision) should alert to
    impending eclampsia.
    • Intravenous magnesium sulphate should be
    started to prevent seizures and termination of
    pregnancy the key elements for preventing
    eclampsia.
    Ask for Help
    a senior obstetrician , and an anaesthetist . The
    anaesthetist will usually focus on maternal
    monitoring and maintenance of the airway, while
    the obstetrician will concentrate on starting
    magnesium sulphate and fetal monitoring.
    Avoid Lesions During the Eclamptic Seizure

    Restraining tonic-clonic movements is


    dangerous and confers no benefi t to patients,
    so the recommended attitude during the seizure
    is to remove all objects that may
    cause injury and wait until it ends, which usually
    takes less than 90 s.
    Left Lateral Safety Position, Inspect Airway
    and Monitor
    When the seizure ends, the patient should be placed in left
    lateral safety position and the airway quickly inspected for
    patency . In a second step, oropharyngeal secretions may be
    aspirated if they are abundant, a Mayo tube inserted if the
    patient remains unconscious and breathing is made diffi cult by
    the tongue and oxygen by mask .
    Monitoring maternal and fetal
    • Maternal heart rate and oxygen saturation
    should be monitored continuously and blood
    pressure evaluated every 5 min.
    • Maternal ventilation also requires frequent re-
    evaluation.
    • continuous cardiotocography should be put in
    place to evaluate fetal oxygenation.
    Prevention of New Seizures
     loading dose of magnesium sulphate
     4 g magnesium sulphate IV over 5–20 min
     Maintenance dose
     1g magnesium sulphate IV per hour
     Mechanism : NMT. VD. Diuresis
     Therapeutic level : 4-8 mEq/L
     Monitoring :Patellar Rx, RR, urine output,pulse oxymetry
     For how long
     Antidote:
    Other Non-emergent Measures
    After the acute response to eclampsia described
    above, the situation still requires continuous
    monitoring and further management. Blood should
    be drawn for haemoglobin , platelet count , liver
    and renal function and coagulation studies.
    Bladder catheterisation should be performed to
    measure urine output , important for fluid balance
    and for optimising magnesium sulphate treatment.
    Decreasing Blood Pressure
    • When maternal blood pressure rises above 160 / 110
    mmHg, it becomes necessary to reduce it, because of
    increased risks of cerebral haemorrhage, cardiac
    insufficiency, myocardial infarction and placental
    abruption.
    Labetalol
    Nifedipine
    Hydralazine
    During antihypertensive treatment, blood pressure
    should initially be monitored every 5 min, and the
    interval is then spaced according to treatment results.
    The goal is to maintain systolic blood pressure between
    140 and 150 mmHg and diastolic blood pressure
    between 80 and 100 mmHg. Lower diastolic blood
    pressures may put cerebral and uterine perfusion at risk.
    Recurrent Seizures
    intravenous bolus of 2–4 g of magnesium
    sulphate can be given over the course of
    5 min.
    If seizures persist, the diagnosis of eclampsia
    should be reconsidered and are-evaluation
    carried out with the help of a neurologist.
     Intravenous diazepam is less efficient than magnesium
    sulphate for preventing recurrent seizures and
    reducing maternal mortality, but is a possible
    alternative, given in a 5 mg bolus over the course of 5
    min and repeated if necessary to a maximum of 20
    mg.
    • Prolonged use of diazepam should be avoided, as it is
    associated with an increased risk of maternal
    death and neonatal respiratory depression.
     If seizures persist, intubation and ventilation
    remain as a last resource, in an intensive care unit
    setting.
    Fluid Balance
    The increased vascular permeability found in women with
    pre-eclampsia increases the risk of acute pulmonary
    oedema, cardiac insufficiency and cerebral oedema. For
    these reasons, total fluid volume should not exceed 83
    ml / h (2 L in 24 h) except if
    there are other sources of fl uid loss, such as haemorrhage.
    Colloids should not be administered except in life-saving
    situations. Oliguria does not usually require additional
    measures beyond fluid adjustments to the established
    limits, as it will revert spontaneously 36–48 h after delivery.
    Thromboprophylaxis
    Women with severe pre-eclampsia and
    eclampsia are at increased risk of venous
    thrombosis, so compression stockings and
    prophylactic doses of low molecular
    weight heparin need to be considered according
    to local protocols, until the patient
    is fully mobile.
    Evaluation of Laboratory Results and Fetal
    Evaluation
    The urgency of pregnancy termination and the method of
    delivery depend on the
    clinical stability of the situation; on laboratory results depicting
    the severity of preeclampsia,
    particularly the degree of thrombocytopenia and liver enzymes;
    and on
    the fetal condition. Pre-eclampsia may be associated with
    chronic placental insuffi
    ciency, so fetal ultrasound is required to evaluate fetal growth,
    amniotic fl uid volume
    and umbilical and cerebral blood fl ow.
    Programming delivery
    Management summary
    q
    • 5 uses of MgSO4
    • Antidote for MgSO4 toxicity
    • 1st sign of MSO4 toxicity
    • Imminent eclampsia
    Thank you

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