Eclampsia

Kartika Yulianti
1310211028

Definition
Eclampsia is defined as the
development of convulsion and/or
unexplained coma during pregnancy
or postpartum in patients with signs
and symptoms of preeclampsia.

Eclampsia occure in 10% of all pregnancy .

India account 20% of world maternal mortality rate , next to haemorrhage,
pre-eclampsia & eclampsia are direct cause .
More common in primigravida 75%.
Eclampsia is 3rd leading cause of maternal mortality after thromboembolism & non-obstetrical injury.
Maternal DBP> 110 are associated with increase risk of placental
abruption & fetal growth retardation.

Hypertensive Disorder

Criteria based on WHO

Symptoms

CLINICAL FEATURE

The eclamptic fits are epileptiform & consist of four stages , that are :

1).PREMONITORY STAGE :
*The patient becomes unconscious.
*There is twitching of muscles of face,tongue & limbs.
*Eye balls or are turned to one side & become fixed.
*This stage lasts for about 30 second.

2)TONIC STAGE :
*The whole body goes into a spam called trunk opisthotonus.
*Limbs are flexed & hands clenched.
*Respiration ceases & tongue protrudes between the teeth.
*Cyanosis appears.
*Eyes balls become fixed.
*This stage lasts for about 30 seconds.

3) CLONIC STAGE :
All the voluntary muscles undergo alternate contraction & relaxation.
The twitching starts in face then involve one side of extremities & ultimately the whole body is
involved in the convulsion.
Biting of tongue occurs.
*Breathing is stertorous & blood stained frothy secretions fill the mouth.
*Cyanosis gradually disappears.
*This stage lasts for 1-4 minutes.
4) 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 confused state following the fit & fails to remember
the happenings.
*Rarely, the coma occurs without prior convulsion.
*The fits are usually multiple , recurring at varying intervals.
*When it occurs continuously it is called status eclampticus.
*Following the convulsion ,temperature rises , pulse & respiration rates are increased & blood
pressure also increases.
*The urinary output is markedly diminished , proteinuria is is pronounced & blood uric acid is
raised.

Laboratory
A baseline laboratory
evaluation should
be performed early in
pregnancy in women
who are at high risk for
preeclampsia.
Tests should include a
hepatic enzyme level, a
platelet count, a serum
creatinine level, and a
12- to 24-hour urine
collection for total
protein measurement

Differential Diagnosis

Diagnosis
Hypertension in pregnancy should be
defined as:
a systolic blood pressure greater than or
equal to 140 mmHg
a diastolic blood pressure of greater
then or equal to 90 mmHg

Diagnosis
All

pregnant women should be

assessed for proteinuria
Urinary dipstick testing may be used for
screening fro proteinuria when the
suspicion of preeclamsia is low.

Management
The

first priority in the management of

eclampsia is prevent maternal injury
Support respiratory and cardivascular
functions A B C

Management
During or immediately after the acute
convulsive episode.
Asses and establish airway patency and
ensure maternal oxygen
Lateral decubitus
Vomitus and oral secretion are suctioned
as needed
Monitoring oxygenation

Management
Prevent

recurrent convulsions
Magnesium sulfate is drug of choice
Loading 6 gr over 15-20 minutes,
followed maintenance dose of 2gr/h as a
continuous intravenous infusion

Management
Reduce the blood preassure to safe range but at
the same time avoid significant hypotension
Keep Systol BP between 140 and 160 mmHg
Keep Dyastol BP between 90 and 110 mmHg
Bolus 5-10 mg dose of hydralazine or labetalol
10-20 mg nifedipine orally every 30 minutes,
with max dose 50 mg per one hour.

Antihypertensive drugs

Post Partum Management

After

delivery patient with eclampsia

should receive close monitoring of vital
sign, fluid intake and output, and
symptoms for at least 48 hours.
Parenteral Magnesium sulfat for 24
hours after delivery and/or last
convulsion

Pregnancy outcome and

remote prognosis
Women

with a history of eclampsia are

at increased risk of all form of
preeclampsia in subsequent
pregnancies
Chronic hypertension on follow-up was
significantly higher had eclampsia