Patient history

Demographic Data
Name of patient : Masuma
Age : 20 years
Height : 5.3"
Weight : 56 kg
Religion : Islam
Marital status : Married
Number of child : 0
Address : Achim, Fulbaria, Mymensingh.
Name of Guardian: Helal Uddin (Husband)
Name of Hospital : MMCH, Ward- G/W
Date of Admission : 18/09/2023
Date of Discharge : 24/09/2023
LMP : 14/01/2023
PDD : 21/10/2023
Medical Diagnosis : Primigravida ӗ 36+ Weeks pregnancy ӗ eclampsia
Under Doctor : Dr. Jhinuk
Economic status : Low socio-economic condition
Occupation : Labour.
Chief presenting complaints
 Epigastric pain (2-3 hours).
 Pregnancy for 36+ weeks.
 Convulsion of several time.
 Blurring vision.
History of present illness
 Sudden onset of severe epigastric pain accompanied by saliva secretion,
 High blood pressure and convulsion.
Past Medical History
 No significant.
Family Medical History
 No significant of family.
Obstetric History
 Age of marriage : 18 years
 Married for : 2 years
Gravida : 1st
Para : 0
Menstrual History:
Age of period : 14 year
Duration of flow : 5-6 days
Regularity status : Regular
Length of cycle : 28 days
Dysmenorrhea : No history of dysmenorrhea
Post coital bleeding : Absent
Last month of period (LMP) : 14/01/23
Contraceptive history
Oral contraceptive pills
Vital signs
 Temperature : 99゜Ferenheit
 Respiration : 20 breath /min
 Pulse : 88/min
 Blood pressure : 150/100 mm/Hg

Physical Examination
General Appearance : Weak appearance
Nutritional status : Well
Skin : Pale & yellowish (Bilateral pedal edema present)
Head : Normal contour
Chest : No added murmur sounds
Abdomen : No tenderness over abdomen present
Genitalia : No vaginal abnormal discharge present.
Musculoskeletal: Weak muscle strength
Reflexes: Normal
Introduction:
The term eclampsia is derived from a Greek word. meaning like a flash of lightening.
It may occur. quite abruptly, without, any warning manifestations In majority (over
80%), however, the disease its Preceded by features of severe pre-eclampsia.
Eclampsia is one of the leading causes of maternal and fetal mortality rate and this
mortality is higher in Bangladesh.
Eclampsia is known complication of pre-eclampsia during pregnancy associated with
hypertensive disorder (chronic hypertension pre-eclampsia. precursor to eclampsia)

Definition :
The occurrence of convulsion in patients with pre-eclampsia with no coincident
neurological disease.
Or,
Preeclamsia when complicated with gland mal seizures ( generalized tonic clonic
convulsions) and / or coma is called eclampsia.

Incidence:
The incidence of eclampsia is extraordinarily high in Bangladesh -7.9% ( not
including pre-eclampsia) according to the results of a house to house survey . It is
more common in primigravida (75%).

Pathophysiology:
There are two proposed pathophysiologic mechanisms for eclampsia both of which
stem from the initial disease process pre-eclampsia. The pathogenesis of pre-
eclampsia is linked to abnormal placentation. Another proposed mechanism is that
elevated blood pressure from pre-eclampsia causes dysfunction of autoregulation of
the cerebral vasculature.Which causes hypo perfusion,, endothelial damage or edema.

Stages of Eclampsia:
a) Premonitory Stage : Duration 30 Seconds
b) Tonic Stage : Duration 30 Seconds.
c) Clonic Stage : Duration 1-4 Minutes
d) Stage of Coma.
Risk factors:
1. Age: Being older than 35 years or younger than 20 years.
2. Family history.
3. Obesity.
4. Gestational on chronic hypertension.
5. Multiple pregnancies.
6. Primi gravida.
7. Gestational Diabetes Mellitus.
8. Intrauterine Growth Retardation (IUGR).
9. Abruptio placenta.
10. Fetal death.
11. Low socio-economic condition.

Clinical features :
A. Patient features:
a. High blood pressure (150/100 mm/ Hg)
b. Pulse - 88/min
c. Convulsion.
d. Oedema.
e. Stool pass.
f. Anaemia.
g. Saliva present.
h. Abdominal pain.
i. Semi-convulsion.

B. Book features
 Sign:  Symptoms
a. Hypertension a. Frontal headache
b. Convulsion b. Blurring vision
c. Edema c. Breathing difficulties
d. Proteinuria d. Excessive saliva secretion
e. Oliguria e. Swelling of leg
f. Tounge bite f. Diminished urinary output
g. Haemorrhage g. Epigastic pain
h. Coma h. Nausea, vomiting
Investigation :
a. Blood pressure measurement
b. Urine R/M/E
c. Blood test
 CBC,
 RBS,
 S. Creatinine,
 S. Uric acid
d. USG

Treatment of Eclampsia:
Medical management :
A. General
a. ABCD resuscitation
b. O2 inhalation
c. A mouth gag should be given
d. left lateral position
e. IV fluid : Hartmann's solution, 5% DA, 5% DNS etc.
f. Antibiotics
g. Catheterization
h. Monitoring vital sign, Urine output, uterus etc.
B. Specific
1. Anticonvulsant therapy : MgSO4
a. Intravenous route:
 loading dose:4/6 g iv over 15/20 min
 maintainence:1/2 gm/hour
 IV infusion.
b. Intra Muscular route
 Loading dose: 4 g iv over 3/5 min followed by 10 g deep IM (5 gm in each
buttock)
 Maintenance: 5 g deep IM on alternate buttock in 4 hourly.
2. Anti Hypertensive Drug : Labetalol, Hydralazine, GTN, Nifedipine etc.
3. Furosemide.
4. Anticonvulsant: Berbit, diazepam etc.
Obstetric Management:
Immediate termination of pregnancy irrespective of gestational age.
Possible complications of eclampsia:
Maternal complications:
a. Pulmonary edema
b. Tongue bite
c. Hyperpyrexia
d. Injury due to fall from bed
e. Pneumonia
f. Cardiomyopathy
g. Renal failure
h. Cerebral hemorrhage
i. Neurological deficit
j. Post partam hemorrhage, sepsis,shock.

Fetal complications:
a. Intrauterine death(IUD)
b. Intrauterine growth retardation(IUGR)
c. Birth asphyxia
d. Prematurity
Preventive measures
 Controlling blood pressure and blood sugar.
 Maintaining regular exercise routine.
 Getting enough sleep.
 Eating healthy foods that are low in salt and avoiding caffeine.
Nursing Care plan:

Assessment Diagnosis Nursing Goal Intervention Evaluation

1. Assess blood pressure 1. Increased BP related
level and edema. hypertension.
2. Assess the level of 2. Altered state
consciousnesses consciousness related to
3. Enquire about mental status deteriorates
convulsion and coma as pre-eclampsia
4. Assess fluid volume and progresses
check weight every day 3. High risk of seizure with
5. Enquire about associated with decreased
nausea,headache, visual organ function.
disturbances or pain. 4. Excess fluid volume
6. Assess nutritional status related to salt retention.
5. Risk of mg toxicity due to
mg therapy.
6. Impaired nutritional
status related to
anxiety.
1. To stabilize blood pressure
in normal range.
of
2. To control risk of seizures.
3. Prevent maternal and
foetal injuries during seizures
occur.
4. To improve the renal
perfusion and to minimize
fluid retention.
5. To monitor signs of
magnesium toxicity like
nausea, flushing double
vision,respiratory arrest and
hypotension consult
obstetrician to minimize Mg
toxicity.
6. To maintain nourishment
either by oral or
parenteral supplements.
1. Complete bed rest & patient should be
kept in a quite & eclampsia room under 1. Control and
close supervision. stabilized blood
2. Check vital signs & consciousness pressure.
level,specially blood pressure & pulse
hourly. 2. Improve
3. Administer anti hypertensive drugs as per consciousness level.
the prescription.
4. Patient is kept in a railed cot & a tongue 3. Reduced maternal
blade is inserted between the teeth to and fetal injury during
prevent tongue bite & kept in the lateral seizures.
decubitus position to avoid aspiration.
5. Vomitus and oral secretions are removed 4. Urinary output
by frequent suctioning & oxygen is maintains no increase
maintained through face mask & in weight and no
administer anti convulsant to control
symptoms at
seizure & to prevent its recurrence.
6. Improve & minimize fluid retention & Pulmonary edema.
circulatory overload. 5. Magnesium level
7. Diuretics used to increase the urine output
& renal function.
remain within
8. Catheterize the patient with Foley's therapeutic range.
catheter & record the urinary output every
6. Nutritional needs are
hour,analysis urine for proteinuria &
maintain intake and output chart. maintained, patient
9. Magnesium excess depresses the entire doesn’t show the signs
CNS which control respiratory & cardiac of
function. Magnesium toxicity can be impaired nourishment.
reversed by slow intravenous
administration calcium gluconate.
10. Low sodium diet should be given.
11. In case of term pregnancy : immediate
termination of pregnancy is done either
by induction of labour or by
caesarian section.
12. Monitoring the patients condition timely
and aware about the prevention
of complications.
Reference :
1. Dutta, D.C., Text book of obstetrics 10th edition, Jaypee publications.
2. National Institute for Health and Care (formerly clinical : Excellence
www.nice.org.uk
3. Myles 'Text book at Midwifery',16th edition, churchill livingstone publication.
4. https;//www.slideshare.net
5. https;//www.pubmed.ncbi.nlm.nih.gov
6. https;//www.ncbi.nlm.nih.gov>articles