Eclampsia

Management for MIDWIVES

Definition

Greek word meaning 'bolt from the blue’

• Seizure activity or coma unrelated to other

cerebral conditions in an obstetric patient with pre
eclampsia

• Eclampsia accounts for 12% of all maternal

deaths in developing countries.

• Major cause of Maternal deaths in 3rd world

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Pre Eclampsia

Affects up to 10% of pregnancies

• 99 deaths in Australia between

2006-2010 which were related to
direct or indirect causes
• 6 of these related to sequelae of
pre-eclampsia or eclampsia
• 4 due to intracranial haemorrhage
directly related to uncontrolled BP
• 1 due to hepatic rupture

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Pre Eclampsia

Can occur from 20 weeks

 Antenatal
 In labour
 Postnatal

Clinical picture varies

 May have had severe preeclampsia

(PE)
 May have been mild PE

 Eclamptic convulsions look no

different to an epileptic fit

 REMEMBER -----Significance of

Protein Creatinine Ratio

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Types of Fits

Premonitory stage

This lasts 10–20 seconds, during which:

• The eyes roll or stare

• The face and hand muscles may twitch

• Facial congestion

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 Tonic stage
This lasts up to 30 seconds, during which:

• The muscles go into violent spasm

• The fists are clenched and arms and legs are rigid

• The diaphragm (which is a muscle separating the chest

from the abdomen) is in spasm, so that breathing stops
and the colour of the skin becomes blue or dusky
(cyanosis)

• The back may be arched

• The teeth are clenched

• The eyes bulge.

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 Clonic stage
This lasts 1–2 minutes and is marked
by:

• Violent contraction and relaxation of the

muscles

• Increased saliva causes “foaming” at the

mouth and there is a risk of inhalation

• Deep, noisy breathing

• The face looks congested (filled with

blood) and swollen (mottled)

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 Coma stage
 
•This may last for minutes or hours.
•The woman is deeply unconscious and often
breathes noisily.
•The cyanosis fades but her face may still be
swollen and congested.

• Further fits may occur.

The woman may die after only one or two fits

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Complications /Risks......Neonatal /Fetal

• IUGR
• Prematurity - HMD
• Death –Still Birth
Hypoxic insults / Fetal asphyxia
• Cerebral Palsy
• Intellectual /developmental
delay/dysfunction

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 Midwifery Care
Ensure adequate equipment /drugs (crash
trolley /resus/personnel)

•A –Airway

•B- Breathing

•C- Circulation

•D - Drugs

•N- Neuro -Level of consciousness

• GCS

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Best practice
• One – one care (or two)
Convulsions
• Call for Help or code (remove bed head)
• Do not try to stop /shorten or abolish
with drugs= Respiratory depression
• Administer O2
• Left side (if possible)
• Suction if able
• Insert airway if able
• Skilled intubation if required

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• Try to protect airway
• Prevent from harm
• Get IV access x2 size 16g or 18g -ante cubical
fossa
• (MgSO4 will need an exclusive line )
• Take blood (lots of it )
• (Think CVP line)
• Urinary catheter for hourly measurements
• When you can -Observations
• RR, SaO2, MHR, BP,LOC. Reflexes, Clonus
(patella hammer)

• VE , CTG +/- FHR

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Women's & Children's Hospital
DRUGS :-

Magnesium Sulphate

• 1st line treatment

• Loading dose 2-4g IV over 5-10 mins
• Anti convulsant - reduces seizures relaxes
/stabilises membranes - does not lower BP
• If Resp rate < 16 ……..withhold
• Maintain infusion rate @ 1-2g /hr (No more than 8g
over 1hr)
• Should continue for 24hrs

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MUST have access to Calcium Gluconate
10% solution-10mls over 5 mins

If RR 10-12/min
Patellar Reflexes absent - hyporeflexic
Signs of Mg toxicity –hypotonia,arrhythmias

STOP Infusion
O2 ,Vitals
Check UEC’s, MgSO4 levels

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Magnesium sulphate observations

• Baseline Observations (HR, BP, RR, Spo2,

patellar reflexes)
• Recheck observations 10 mins after
commencement of loading dose and at the
end
• Continuous fetal monitoring from 26 + 0/40
• For maintenance-4 hourly observations
including urine output
• Magnesium sulphate is excreted by the
kidneys and therefore the risk of toxicity is
higher with oliguria

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Magnesium sulphate toxicity

• Signs of toxicity
– Loss of deep tendon reflexes
– Respiratory depression
– Respiratory arrest
– Cardiac arrest

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 Management of MgSO4 toxicity
• Follow emergency protocol
– Call for help
– Stop magnesium sulphate
– Start BLS
– Give IV calcium gluconate 1 g (10 ml of 10%)
slowly
– Intubate early and ventilate until respiration
resumes
– Check electrolytes, creatinine, magnesium
sulphate levels

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Hydrallazine :-
• 5-10mg bolus, slowly
• 5 minutely BP for 20 mins
• 100mgs in 50mls Na Cl via syringe
pump at 2-10mgs/Hr
• Monitor BP 15-30 mins or PRN
• BP not lower than 104/85mmHg
• Flushed /Headache
• Tachycardia
• N & V /dizzy / tremor

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Labetalol

•20 mg (4 mL) IV over 2 minutes. The

maximal effect usually occurs within 5
minutes of each injection
•If no change in blood pressure, repeat
labetalol 20 mg (4 mL) every 10 minutes
(titrated to blood pressure) to a maximum of
4 doses (80 mg = 16 mL)

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Sedation may be used

• Most commonly use and recommended

is Midazolam IV
• Diazepam IV but is a respiratory
depressive
• May need Steroids depending on
gestation

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• Time Line –Documentation
• Bloods
• Strict Fluid Balance Chart
• Portable Chest XRay
Personnel:-
• Senior staff
• Paediatrician
• Haematologist
• Intensive Care
• Theatre staff
• Plan +/- delivery--------- Remember cord gases
• Refer Tertiary Hospital when stable

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• Comfort /support the women- will be very
frightened & anxious

• Comfort partner /family

• Religious /spiritual advisor

• Support each other /staff

DEBRIEF

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Postnatal

• Support method of feeding

• Debrief with couple /family
• Ensure support
• Ensure follow up
• Some women experience PTSD
• Fear of it happening again

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