ECLAMPSITA IN ENGLISH

                                                 

                                          ECLAMPSITA  IN ENGLISH

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ECLAMPSIA-

Eclampsia is a neurological condition associated with preeclampsia, manifesting with tonic-clonic convulsions in pregnancy that are not ssocited with other conditions such as epilepsy

Eclampsia can develop any time from 20 weeks’ gestation up to 6 weeks postpartum. It is an medical emergency and should be dealt with a team of physician and gynecologist

 

CLINICAL MANIFESTATIONS-

•        Preceded by symptoms of severe preeclampsia:

•        Severe headache

•        Visual disturbances

•        Epigastric/RUQ pain

•        Nausea, vomiting

•        Oliguria

•        Seizures

•        Seizure chacacteristics

•        Tonic–clonic convulsions

•        Usually self-limiting (1–2 minutes)

•        It May progress to coma

•        Seizure  may recur

•         

COMPLICATIONS-

•        Complications (Maternal)

•        Cerebral hemorrhage

•        Pulmonary edema

•        HELLP syndrome

•        Renal failure

•        Disseminated Intravascular Coagulation (DIC)

•        Death

•        Complications (fetal/neonatal)

•        Intrauterine Growth Restriction (IUGR)

•        Preterm birth

•        Hypoxia/asphyxia

•        Stillbirth

•        Neonatal death

 

CAUSES AND RISK FACOTRS

Pre-eclampsia  is the precursor of eclampsia so all risk factors of preeclampsia are also risk factors for ecclampsia

 

DIAGNOSTIC INVESTIGATIONS-

• Urine examination for protein

• Blood pressures assesment

• Complete blood count

• Serum electrolytes

• Liver function test

• Serum Urea and Creatinine

• Ultrasound

• Doppler velocimetry

• Electro Encephalo Graphy   (EEG)

 

MANAGEMENT-

Immediate Management-

•        Assessment and maintenance of Airway, Breathing, Circulation (ABC)

•        Place woman in left lateral position

•        Maintain airway, suction if needed

•        Oxygen administration

•        Control seizures with Magnesium Sulphate

Magnesium Sulphate Therapy

     It is the Drug of choice for ecclampsia

•        Loading: 4 g IV slowly + 10 g IM (5 g each buttock)

•        Maintenance: 5 g IM every 4 hours

•        Monitor for toxicity (respiratory depression, reflexes, urine output)

•        Ante hypertensive drugs

Obstetric management

•        Definitive treatment = Delivery

•        Stabilize mother first

•        Assess gestational age, fetal condition

•        Induce labor or perform cesarean section if required

If the woman gives birth vaginally, syntometrine and ergometrine should be avoided to manage the third stage of labour and oxytocin

used instead.

NURSING MANAGEMENT-

•        Management during seizures

•        Stay with patient and call for help

•        Provide Position in left lateral side

•        Loosen all tight clothing

•        Maintain airway, suction secretions

•        Protect from injury (do not force objects into mouth)

•        Management after seizures

•        Monitor vital signs, fetal heart rate

•        Insert IV line for fluids/medications

•        Administer MgSO₄ & antihypertensives as prescribed

•        Monitor urine output (≥30 ml/hr)

•        Document events carefully

•        The baby is likely to be initially cared for on the neonatal unit and the woman should be taken to see her babyas soon as her condition permits.

•        Breastfeeding is to be encouraged and psychological support given by themidwife/nurse and neonatal staff.