ECLAMPSIA

ECLAMPSIA

• Definition>It is the development of

convulsions in a pre-existing pre-eclampsia.

• Incidence>About 1/1000 pregnancies.

 ECLAMPSIA>Aetiology

• The exact cause is unknown but cerebral

ischaemia and oedema were suggested.
 ECLAMPSIA>Clinical Picture
• a. Premonitory stage: the eyes are rolled up with
twitches of the face and hands. It lasts for about ½ min.
• b. Tonic stage: generalised tonic contraction of the
whole body muscles with opisthotonus and cyanosis. It
lasts for about ½ min.
• c. Clonic stage: convulsions occur where there is
alternative contraction and relaxation of the body muscles.
The face is congested, tongue may be bitten, blood-stained
frothy saliva appears on the mouth, breathing is stertorous,
urine and stool may pass involuntarily, temperature rises
due to increased muscular activity patient is unconscious.
This lasts for about 1 min.
• d. Coma: it may last for few hours.
 ECLAMPSIA>Types

1. Antepartum eclampsia 50%.

2. Intrapartum eclampsia 25%.
3. Postpartum eclampsia 25% occurs within
48 hours of delivery. It is usually the most
dangerous one.
 Severity of Eclampsia

• Eclampsia is considered severe if one or more of

the following is present (Eden’s criteria):
1. Coma of 6 or more hours.
2. Temperature 390C or more.
3. Pulse over 120/min.
4. Systolic blood pressure over 200 mmHg.
5. Respiratory rate over 40/min.
6. More than 10 convulsions.
ECLAMPSIA>Differential Diagnosis

>Epilepsy.
>Intracranial haemorrhage.
> Hysteria.
> Meningitis.
>Brain tumours.
> Strychnine poisoning.
 ECLAMPSIA
Management

• General measures
• Medical measures
• Obstetric measures
 ECLAMPSIA>Management
General measures:
• Hospitalisation
• Efficient nursing
• After sedation, a self-retained Foley’s catheter
is applied.
• Care for respiratory system
• The tongue is protected from biting by a
plastic mouth gauge.
• Observation for: Maternal vitals& FHS
 ECLAMPSIA>Management

Medical measures:
1. Sedation:
2. Antihypertensives:
3. Anticonvulsant therapy:
4. Diuretics
 Sedation:

> Morphine 10-20 mg IM or,

> Diazepam one ampule (10mg) IV over 4
min. then maintain by IV infusion 40 mg in
500 ml glucose 5% over 12-24 hours.
Diazepam is used as an anticonvulsant as
well.
 Antihypertensives

> Potent and rapidly acting drugs are

used when needed.
> Examples are:
a. Hydralazine IV.
b. Diazoxide IV.
 Anticonvulsant therapy

• Magnesium sulphate
• Phenytoin
• Sodium thiopentone (Intraval)
• Muscle relaxants
 Diuretics

a. "Loop" diuretics: > Furosemide (Lasix): 20-40

mg IV repeated at intervals of 2-4 hours
>Thiazides: better to be avoided in
pregnancy.

b.Osmotic diuretics: as mannitol or glucose

25%
 ECLAMPSIA>Management
• Obstetric measures
 The policy is that there is no conservative treatment in
eclampsia and the patient should be delivered but
convulsions should be controlled first.
 Spontaneous labour usually commences within 6
hours. If not induce labour by oxytocin as long as there
is no other indication for caesarean section and
vaginal delivery is anticipated within 8-12 hours.
Otherwise, caesarean section is indicated but never
give general anaesthesia before control of convulsions
or if the patient is in coma.