eclampsia presentation
TRANSCRIPT
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PRESENTATION ON
ECLAMPSIASUBJECT:
OBSTETRICSSUBMITTED BY :
KAVITHA KALESAN .M.4TH YEAR BSC NURSING
BATCH- 2011 -2015
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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
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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.
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Contd……………………….
Pre- eclampsia when complicated with generalized
tonic- clonic convulsions and/or coma is called
eclampsia.
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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
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Contd…………………………
Reduced blood flow and edema
Hypertension, Renal ,Pulmonary and Hepatic
dysfunction and cerebral edema with cerebral
dysfunction and convulsion.
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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.
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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.
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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
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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.
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TONGUE BITING
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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
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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
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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.
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OTHER CLINICAL FEATURES
Headache
Visual disturbance
Epigastric pain
Oedema
High blood pressure
Fluid retension
Fundal height less than approximate date
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MANAGEMENT
Aim of management.
Prediction & prevention.
First aid treatment outside the hospital.
General management (medical & nursing).
Specific management.
Obstetric management.
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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.
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Contd…………………………………..
Prevention of life threatening situation.
Postpartum care.
Medicine and regular follow up.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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).
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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.
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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.
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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:-
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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.
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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
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Contd……………………..
Fits not controlled:-
Termination of pregnancy.
Low rupture of the membranes is to be done to
accelerate the labour.
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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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