A case study about

Cesarean Section: Eclampsia

Presented By

Bangeles, Pearl Joy

Benauro, Seth Michael
Bengcang, Mary Ruth
Benito, Allaina
Beronggoy, Christian Jay

RLE 219-39B
I. Introduction
Caesarian section is done due to some complications during pregnancy Cesarean section

(CS) is part of the standard of care in modern obstetrics. During the last 50 years,

institutionalization of delivery pretended to make childbirth a safer event. The wide

availability of cesarean section has been intended to favor maternal and neonatal outcomes

in certain clinical situations in which vaginal delivery is not a safe alternative. Today, CS is

an active part of obstetrical practice with aims to improve clinical performance and perinatal

indicators. The indications for a caesarean section as an alternative to vaginal delivery have

evolved over the centuries. From remote anecdotal references in the history of medicine, the

worldwide reported CS rate seems to draw back from the World Health Organization

recommendation. Significant variations are apparent between first-and third-world

economies, health models, the standard of obstetrical care, reimbursement, obstetrical risk

factors, and cultural influences. Other factors related to the type of practice in modern

obstetrics have contributed to the popularization of cesarean section: liberalization of the use

of a relatively safe procedure under a pragmatic point of view, limited training in

instrumented vaginal delivery among the younger generations of obstetricians, optimization

of time, minimizing possible legal medical complications, and evident improvements in

surgical and anesthetic safety. Finally, new phenomena like acceptance of CS upon

maternal request without any medical indications as a valid indication and the loss of

medical autonomy in the modern practice of obstetrics will be addressed in this chapter as

contributors to changes in CS rates.

Over the last decades, obstetrics has evidenced a notorious increase in the rate of cesarean

sections. The progressive institutionalization of birth has resulted in evident improvements

not only in fetal and neonatal care but also in a growing number of cesarean sections.

Trends in rates have evolved in the United States from one digit numbers, 5% in 1970, and

into 32.7% for 2014. Unfortunately, this growing trend has not always corresponded to a

warrant of quality improvement in perinatal outcome indicators. This worldwide concerning

phenomenon of a growing cesarean rate has been reported and analyzed not only from the
perspective of reproductive medicine but also as a neonatal, financial, public health, legal,

and ethical issue.

The indications for a cesarean section as an alternative to vaginal delivery have evolved

over the centuries. From remote anecdotal references in the history of obstetrics, CS is

reported in many clinical scenarios as the most common way to be born.

Objective of the study

the goal of our study is to ensure the patient's fast recovery whom undergo caesarian

section because of pregnancy-induced hypertension (eclampsia).

II. History

A. History of present illness

The patient has experienced Eclampsia due to pregnancy stress which is accompanied with

Edema on the extremities.

B. History of past illness

During the childhood of the patient, the patient have experienced convulsions due to

infection in urinary tract and high fevers.

Convulsions - Most women who have a seizure disorder that is well-controlled by anti-

seizure drugs are able to safely give birth to a healthy baby. If these women get enough

sleep and take anti-seizure drugs in appropriate doses, the number of seizures usually does

not increase during pregnancy, and pregnancy outcomes are usually good. However, these

women are slightly more likely to

 ● Develop preeclampsia (a type of high blood pressure that develops during

pregnancy)

● Have a stillbirth

● Have a fetus who does not grow as much as expected (small for gestational

age)

On the other hand, taking antiseizure drugs increases the risk of birth defects (see table

Some Drugs That Can Cause Problems During Pregnancy) and may slightly reduce

intelligence in the baby. However, these risks may be increased by the seizure disorder as

well as by the use of antiseizure drugs.

Taking certain anti-seizure drugs (such as phenytoin, carbamazepine, or phenobarbital)

during pregnancy increases the risk of hemorrhagic disease of the newborn (which causes a

tendency to bleed easily). However, if women take prenatal vitamins with vitamin D and if

vitamin K is given to the newborn, hemorrhagic disease rarely occurs.

Thus, women who have a seizure disorder should talk to an expert in the field about how to

balance the risks of taking antiseizure drugs with the risks of having seizures, preferably

before they become pregnant. Some women may be able to safely stop taking antiseizure

drugs during pregnancy, but most women should continue to take the drugs. The risk

resulting from not taking the drugs—more frequent seizures, which can harm the fetus and

the woman—usually outweighs the risks resulting from taking antiseizure drugs during

pregnancy.

Doctors prescribe the lowest effective dose of the antiseizure drugs and use as few different

antiseizure drugs as possible. Women who take anti seizure drugs need to take a high dose

of folic acid supplement daily. Ideally, it is started before they become pregnant. Taking folic

acid supplements helps reduce the risk of having a baby with a birth defect.
Vaginal delivery is usually possible. Cesarean delivery is done only if women have repeated

seizures during labor or other problems develop and require it.

High Fever - A fever is a high body temperature. A temperature of up to 38.9°C (102°F) can

be helpful because it helps the body fight infection. Most healthy children and adults can

tolerate a fever as high as 39.4°C (103°F) to 40°C (104°F) for short periods of time without

problems. Children tend to have higher fevers than adults.The degree of fever may not show

how serious the illness is. With a minor illness, such as a cold, you may have a temperature,

while a very serious infection may cause little or no fever. It is important to look for and

evaluate other symptoms along with the fever.If you are not able to measure your

temperature with a thermometer, you need to look for other symptoms of illness. A fever

without other symptoms that lasts 3 to 4 days, comes and goes, and gradually reduces over

time is usually not a cause for concern. When you have a fever, you may feel tired, lack

energy, and not eat as much as usual. High fevers are not comfortable, but they rarely cause

serious problems. Oral temperature taken after smoking or drinking a hot fluid may give you

a false high temperature reading. After drinking or eating cold foods or fluids, an oral

temperature may be falsely low.

Causes of fever

Viral infections, such as colds and influenza (flu), and bacterial infections, such as a urinary

tract infection or pneumonia, often cause a fever.

C. Family history of illness

According to the patient they have a family history of Hypertension. High blood pressure is a

common condition in which the long-term force of the blood against your artery walls is high

enough that it may eventually cause health problems, such as heart disease.

Blood pressure is determined both by the amount of blood your heart pumps and the amount

of resistance to blood flow in your arteries. The more blood your heart pumps and the
narrower your arteries, the higher your blood pressure. You can have high blood pressure

(hypertension) for years without any symptoms. Even without symptoms, damage to blood

vessels and your heart continues and can be detected. Uncontrolled high blood pressure

increases your risk of serious health problems, including heart attack and stroke. High blood

pressure generally develops over many years, and it affects nearly everyone eventually.

Fortunately, high blood pressure can be easily detected. And once you know you have high

blood pressure, you can work with your doctor to control it.

D. Obstetric history

The patient's only record was on September 13, 2019 the patient was diagnosed with pre-

ecalmpsia and before the Delivery of the child, dated on November 10, 2019 the patient is

diagnosed of eclampsia.

III. Anatomy and Physiology

The included organ system is the Female Reproductive System.

Uterus - is a hollow, thick-walled, pear-shaped organ, located in the pelvic cavity between

the bladder and the rectum.

-nurturing the fertilized ovum that develops into the fetus and holding it till the baby is mature

enough for birth.

Outer layer of uterus/serosa/perimetrium - is a thin layer of tissue made of epithelial cells

that envelop the uterus

Middle layer/myometrium - makes up most of the uterine volume and is the muscular layer,

composed primarily of smooth muscle cells

Inner layer/endometrium - is the most active layer and responds to cyclic ovarian hormone

changes, the endometrium is highly specialized and is essential to menstrual and

reproductive function.

Uterine wall - from innermost to outermost layer.

Fallopian tube - oviduct or uterine tube, is responsible for carrying the egg to the uterus.

The fallopian tube has finger-like branches, called fimbriae, which reach out into the pelvic

cavity and pick up the released egg.

Ovarian ligament -The ovarian ligament is attached to the ovary inferiorly. It connects the

ovary to the side of the uterus. Structurally, it is a fibrous band of tissue that lies within the

broad ligament. It joins the uterus just below the origin of the fallopian tubes.

Ovary -the ovaries have two main reproductive functions in the body. They produce oocytes

(eggs) for fertilization and they produce the reproductive hormones estrogen and

progesterone.

Round ligament -The round ligaments are two ropelike cords of connective tissues that

support the uterus on each side. These ligaments connect the uterus to the groin and pubic

region. As the uterus grows during pregnancy, the round ligaments can stretch.

Broad ligament -The broad ligament is a peritoneal fold that attaches the uterus, fallopian

tubes, and ovaries to the pelvis

Cervix -The cervix is a cylinder-shaped neck of tissue that connects the vagina and uterus.

... An opening in the center of the ectocervix, known as the external os, opens to allow

passage between the uterus and vagina.

Vagina - The vagina is a muscular canal lined with nerves and mucus membranes. It

connects the uterus and cervix to the outside of the body, allowing for menstruation,

intercourse, and childbirth.

IV. Physical Assessment

The Physical Assessment technique that was been use is from Head to Toe

(Cephalocaudal)

Head/Eyes/Face/Neck Lethargic (Face Grimace), Neck pain (nape

part)
 Ear No Deviations

Nose No Deviations

Mouth Slightly Dehydrated

Skin, Hair, Nails Edematic skin

Chest No Deviations

Abdomen Surgical Incision Due to Caesarian Section

Extremities Ankle Edema occurs

Back Area No Deviations

Tubes, drains, dressings, and IVs:Tubes, Protein is present in urinary catheter

drains, dressings, and IVs:

Mobility Resticted Movements due to previous

operation.

The patient has been physically assess, there is no certain deviation except for the Skin,

Abdomen, and Mobility. The patient shows some signs of eclampsia and another sign is the

surgical incision on the abdomen which pertains to Caesarian Section. According to Lee

Macon (2018), the following sign and symptoms are swelling of extremities, loss of

conciousness, protenuria and etc. Eclampsia is one of the major factors to undergo C-

Section Delivery.

V. Laboratory Test Examination

*No latest Lab Test

VI. Pathophysiology

Ceasarian Section

In a C-section, the birth doctor, or obstetrician, makes a cut across the abdomen and womb

while the mother is under an epidural or spinal anesthetic. General anesthesia is not

common during a C-section.

The cut is normally between 10 and 20 centimeters (cm) in length.

With the epidural or spinal anesthesia, the lower body will remain pain-free despite the

mother not being fully unconscious. They may experience a tugging or pulling sensation.

The obstetrician sometimes sets up a drape to block the view of the operation for the

mother, as this could cause distress despite not being painful.

Some hospitals allow the use of a transparent drape. The obstetrician and midwives will

keep the mother informed about progress as they operate.

Women who have undergone a C-section with previous babies may be candidates for

vaginal birth after C-section. However, medical professionals do not recommend this option

for all women. Discuss the risks with a healthcare provider.

A C-section may be planned or unplanned for a multitude of reasons.

Eclampsia

The mechanism(s) responsible for the development eclampsia remain(s) unclear. Genetic

predisposition, immunology, endocrinology, nutrition, abnormal trophoblastic invasion,

coagulation abnormalities, vascular endothelial damage, cardiovascular maladaptation,

dietary deficiencies or excess, and infection have been proposed as etiologic factors for

preeclampsia/eclampsia. Imbalanced prostanoid production and increased plasma

antiphospholipids have also been implicated in eclampsia. In murine models, placental

ischemia appears to be associated with an increased susceptibility to seizures and

cerebrospinal fluid (CSF) inflammation.

VII. Gordon's 11 Functional Patterns

This is some the patients data according to the Nursing-Patient Interaction

● Health Perception and Management

The patient’s health management was said to be fine, the patient maintains proper hygiene

but lazy to listen for other health teachings.

● Nutritional metabolic

The patient seldom eats due to the current operation.

● Elimination

The patient has undergone C-section. The patient’s elimination by flatulence and stool will

be hard and needs to undergo treatments.

● Activity exercise

No data available

● Sleep rest

The patient’s sleeping patterns is disturbed since the delivery of the baby, the patient is

currently sleeping for only 4 hours.

● Cognitive
No data available

● Self perception/self concept

The patient tells about her being a teenage mom, the patient is confident to face the

challenges although it is hard.

● Role relationship

The patient accepts the role of being a mother despite of young age.

● Sexuality reproductive

No data Available

● Coping-stress tolerance

No data available

● Value-Belief Pattern

No data available

VIII. Discharge Plans

A. Medication

Continue medications as prescribed by the doctors. Strictly follow what the doctors advice

in taking the medications

B. Exercise

Exercise is advisable after surgical is healed and the patient is relieved from pain.

Example: Walking, Going in and out of bed, Cleaning or house chores (Avoid lifting heavy

things). Etc.
C, Treatment

● Take it easy. A C-section is a major surgery. Be cautious specially if the wound is

not yet fully healed.

● Support your stomach. Hold your belly when you sneeze, cough, or laugh to keep it

still.

● Ease your pain. A heating pad (set on low) or a warm washcloth can help with pain

around your belly.

● Drink fluids.

D. Hygiene

● Incision Care

● Minimal Activity

● Daily Bath and Shower

E. OPD/ Follow ups

Schedule a follow up check up for Postpartal Period.

F. Diet

Foods high in protein are meats, fish, chicken, eggs, dairy foods, nuts, dried beans, and

peas. Foods high in vitamin C are oranges, grapefruits, strawberries, melons, and papayas.

Foods high in iron are red meat, liver, dried beans, dried fruits, and iron enriched cereals. It

is important to drink plenty of fluids

G. Spirituality/Sex/Socialization

Ensure a good health for the family. Use a family Planning method.
IX. References

https://www.msdmanuals.com/home/women-s-health-issues/pregnancy-complicated-by-

disease/seizure-disorders-during-pregnancy

https://www.healthlinkbc.ca/health-topics/fevr4

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-

20373410

https://www.healthpages.org/health-a-z/nutrition-diet-after-cesarean-birth/

https://www.webmd.com/baby/recovery-after-c-section#1

https://www.intechopen.com/books/caesarean-section/trends-in-cesarean-section

https://www.medicalnewstoday.com/articles/299502.php#procedure