ECLAMPSIA

By
Mrs .Vruti patel
M.Sc(N).
Lecturer
Eclampsia

Derived from Greek word,’’

Eklampnis’’- shining forth/like a flash of
lightening

It may occur quiet abruptly with or

without warning manifestation

It is a life-threatening condition for

both a mother and her fetus. During a
seizure, the oxygen supply to the fetus is
drastically reduced.
 INCIDENCE

− 1/500 to 1/30(India)

− 75% in Primigravida

− Five times more common in twin

pregnancy
 PRE DISPOSING FACTORS

• Genetic predisposition
• Immunlogical
• Preexisting vascluar and renal
disease
• Hyperplacentosis
multiple pregnancy
diabetes
Molar pregnancy
Hydrops fetalis
 ETIOPATHOGENESIS
IMBALANCE IN PROSTAGLANDIN RATIO

PLACENTAL VASOCONSTRICTION

REDUCED PERFUSION

RELEASE OF RENIN
THROMBOPLASTIN
ANGIOTENSIN I
GENERALIZED
RENAL VASOCONSTRICTION ANGIOTENSIN II
GLOMERULAI
AFFECTED
ADRENAL HORMONES
HYPERTENSION
ALDOSTERONE
PROTEINURIA HEADACHE

SODIUM REABSORPTION
VISUAL DISTURBANCES

SEIZURES EDEMA OLIGURIA

 ONSET OF FITS

• Antepartum(50%)
• Intrapartum(30%)
• Postpartum(20%)
 SIGNS OF IMPENDING
ECLAMPSIA
• A sharp rise in blood pressure
• Diminished urinary output
• Increase proteinuria
• Frontal headache
• Drowsiness/confusion
• Visual disturbances
• Epigastric pain
• Nausea and vomiting
STAGES OF ECLAMPTIC FIT

•Premonitory stage
•Tonic stage
•Clonic stage
•Stage of coma
 EFFECTS OF ECLAMPSIA
Maternal
 Injuries –tongue bite
 Cerebral –oedema,haemorrhage
 Eyes-disturbed vision
 Cardiac –acute left ventricular failure
 pulmonary – oedema,pneumonia,adult
respiratory syndrome,embolism
 Renal –renal failure
 Hepatic - necrosis ,subcapsular
haematoma ( HELLP)
 Haematological-thrombocytopenia,DIC
 Hyperpyrexia
 Postpartum-shock,sepsis,psychosis
 Fetal Effects
o perinatal mortality rate
(30-50%)
o prematurity
o intrauterine growth
retardation
o intrauterine asphyxia
o effects of drugs
o obstetrical trauma
DIAGNOSITIC MEASURES
oUrine analysis
oBlood values
oDoppler velocimetry
oSerial ultra sound and
Non-stress test
 MANAGEMENT
Principles
1.Resuscutation
2.Oxygen administration
3.Arrest convulsions
4.Ventilatory support
5.Haemodynamic stabilization
6.Organise investigations
7.Deliver by 6-8 hours
8.Intensive postpartum care
 1. GENERAL MANAGEMENT
• Admit in dark room to avoid noxious
stumuli
• Collect detailed history
• Carryout physical examination
• Catheterization
• Monitor vital signs q1/2 hourly
• Maintain fluid balance
• Antibiotic therapy
• Management during fits
• Intensive care monitoring to treat
complications promptly
2. SPECIFIC MANAGEMENT

• Anticonvulsant and
sedative regime
• Lytic cocktail regime
• Diazepam therapy
• Phenytoin therapy
• Antihypertensives and
diuretics
 MAGNESIUM SULPHATE
(PRITCHARD REGIME)
Mechanism of Action
reduces motor endplate senstivity to
acetylcholine
blocks neuronal calcium influx
induces cerebral vasodilation,dilates
uterine arteries
increases production of endothelial
prostacylin and inhibit platelet activation
Key features
1. act as anticonvulsant,antihypertensive
and vasodilator
2. no detrimental effect to fetus
3 .maternal mortality rate of 0.4%
 DOSAGE OG MAG.SULPHATE
Loading dose;
4 gm (20% Maganesium sulphate -I.V)
10 gm(50% Maganesium sulphate -
deep I.M)

Maintenance dose; 5gm I.M q4h in

alternate buttocks ( for 24 hours) till
last seizure attack
 NURSES RESPONSIBILITY
 Monitor vital signs q1h
 Check urinary albumin q4h
 Monitor fetal heart rate q1h
 Monitor blood pressure q1h
 Report if,
urinary output (<30 ml/hour)
respiratory rate (<16/minute)
 check the deep tenden reflex (pateller
reflex) before administering each dose
Cont…

 monitor serum magnesium level to
rule out toxicity
Normal level - 1.8-2.5 mEQ/L

Therapeutic level - 4-7 mEQ/L

Hyporeflexia - 10-12 mEQ/L
respiratory distress - >12 mEQ/L
cardiac arrest - > 15 mEQ/L
 keep the emergency trolley at
bedside inculding inj.Calcium
Gluconate
 OBSTETRIC MANAGEMENT

•
PREDICTION

1. Presence of diastolic notch in

doppler velocimetry
2. Absence of end diastolic
frequency
3. Average MAP >90mmofHg
4. Angiotensin infusion test
5. Roll over test
PREVENTION

1. Regular antenatal check-up

2. Antithrombotic agent
3. Calcium supplementation
4. Antioxidants
5. Nutritional
supplementation
 RECURRENCE RISK

oPreeclampsia -25%
oEclampsia -3%
 What is new in preeclampsia
• The presence of placental growth factor in the urine (journal
of lifeline,Feb/march-2005)
• Stretching Exercises May Protect Against Preeclampsia-
(HealthDay News -June 6,2008 )
• Women who consume a high amount of dietary fiber during
early pregnancy have a reduced risk of subsequent
preeclampsia (Dr Chunfang Qiu and his colleagues report online July 17,
2008 in the American Journal of Hypertension)
• calcium supplements and low-dose aspirin offer a preventive
benefit
• primapaternity plays a larger role than primagravidity as a
risk factor for the development of preeclampsia. (e-
medicine,may7,2005)
• increased risk of cardiovascular disease in preeclampsia
survivors as compared to women with a history of
normotensive pregnancy (preeclampsia foundation,2006)
• Ongoing research on effect of antioxidants supplementation
in prevention of preeclampsia (WHO)
 CONCLUSION

• Eclampsia is a severe hypertensive

disorder in pregnancy accounts for
high maternal morbidity and
mortality
• To control eclampsia definite line of
treatment is termination of
pregnancy irrespective of
gestational age.