OBSTETRIC EMERGENCIES

OBSTERIC EMERGENCIES

• These are obstetric conditions that when they

occur are life threatening to mothers and or
their babies.
• The ability of the Midwife to recognize these
conditions will influence how fast she will
instigate emergency measures.
 OBSTERIC EMERGENCIES

• The immediate management of obstetric

emergencies whiles awaiting medical aid will
depend on the timely intervention of the
midwife.
• The speed of intervention will determine
whether the outcomes for mother and baby
will be positive or negative.
 OBSTERIC EMERGENCIES

• The following are some of the obstetric

emergencies;
A. Vasa praevia
B. Presentation and prolapse of the umbilical cord
C. Shoulder dystocia
D. Ruptured uterus
E. Amniotic fluid embolism
F. Acute inversion of the uterus
G. Eclamptic fits
 A. VASA PRAEVIA
• Vasa praevia is said to have occurred when a
foetal blood vessel lies over the cervical os, in
front of the presenting part.
• This occur as a result of foetal vessels from a
valementous insertion of the cord crossing in
front of the internal os to the placenta.
• The foetus is at the risk of exsanguination if
the blood vessel ruptures
 DIAGNOSIS OF VASA PRAEVIA
• Feeling pulsations on vaginal examination
through the intact membranes.
• Ultrasound scan
 MANAGEMENT OF VASA PRAEVIA
• Once membranes are intact and vessels not
ruptured;
1. Explain condition to client and relatives
2. Seek consent
3. Prepare client for caesarian section
 RUPTURED VASA PRAEVIA
• Vasa praevia will rupture if membranes
rupture.
• This will lead to exsanguination of foetus
unless birth occurs within minutes
 DIAGNOSIS
1. Slight vaginal bleeding occurring at the same
time as rupture of membranes.
2. Foetal distress disproportionate to amount of
blood loss.
 MANAGEMENT
1. Call for help from colleagues
2. Call for the Doctor
3. Monitor foetal heart rate
4. If mother is in first of labour and foetus is still
alive, prepare for emergency c/s
5. If mother is in second stage, expedite vaginal
birth
6. In the second stage, c/s can be done depending
on the following; parity, foetal condition
 MANAGEMENT
7. A Paediatrician should be present at the birth
to help with resuscitation and care of the
neonate
8. If baby is alive, HB estimation is done after
resuscitation
9. Transfuse blood as prescribed
 PROGNOSIS
• Usually poor since most of the babies die as a
result of this condition.
 B. PRESENTATION AND PROLAPSE OF THE
UMBILICAL CORD
• CORD PRESENTATION is when the umbilical
cord is felt in the intact bag of membranes
and in front of the presenting part.
 CORD PROLAPSE
• Feeling of the cord in the vagina or seeing the
cord lying in the vulva after rupturing of
membranes.
 CORD COMPRESSION OR OCCULT PROLAPSE

• In this situation, the cord lies alongside the

presenting part but not in front of it.
 CAUSES
1. Multiparity
2. Multiple pregnancy
3. Contracted pelvis
4. Fetal malpresentation (face presentation)
5. Polyhydraminious
6. OPP
7. High head
8. Prematurity
9. Artificial rupture of membranes
 WHEN TO SUSPECTS CORD PROLAPSE OR PRESENTATION

• When there is fetal distress without any

apparant cause
• When membranes spontaneously ruptures
• Artificial rupture of membranes
 MANAGEMENT OF CORD PRESENTATION

• Seek agent medical aid.

• Do not artificially rupture membranes
• Encourage the women to assume the knee chest
position with the thighs straight to ease pressure on the
cord.
• The woman may assume the exaggerated sims position;
buttocks raise with pillows or
• Raise foot end of the bed.
• If foetus is alive caesarean section is done.
• If foetus is dead delivery is as safest for the mother
 DANGERS OF CORD PRESENTATION/PROLAPSE

• If the membranes are intact the risk is not so

great as the liquor prevents pressure on the
umbilical cord.
• However, if membranes ruptures there may be
compression between the cord and presenting
part and maternal pelvis cutting circulation
and foetus may die of anoxia.
 MANAGEMENT OF CORD PROLAPSE

1ST STAGE:
• If foetus is alive seek medical aid immediately
• Wrap any cord at the vulva with moistured
sterile guaze in warm normal saline and gently
return the cord into the vagina.
• Avoid handling the cord to prevent spasm.
 MANAGEMENT OF CORD PROLAPSE

1ST STAGE
• Allow woman to lie on the exaggerated sim’s position, left
lateral, knee chest position or raise foot end of the bed. OR
• Inflate the bladder using normal saline by passing a catheter.
• The midwife must keep her fingers in the vagina and hold
presenting part off the cord especially during uterine
contraction.
• If foetus is alive give oxygen to the mother and prepare for
caesarean section
• If baby is dead delivery is as safest for mother
 COMPLICATIONS OF CORD PRESENSTATION
CORD PROLAPSE
FOETUS
• Fetal anoxia
• Death due to spasm of the cord
• Prematurity
• Hypoxia
• Meconium aspiration
• Fetal death if delayed or undiagnosed
 COMPLICATIONS OF CORD PRESENSTATION
CORD PROLAPSE
MOTHER
• Infection
• Risk of instrumental or operative delivery
• Risk for hemorrhage from emergency delivery
• Risk for increased perineal trauma from
emergency vaginal forceps delivery
• Uterine atony related to anesthesia effect
 C. SHOULDER DYSTOCIA

• Shoulder dystocia is a rare complication

occurring after delivery of the foetal head, in
which the shoulders fail to rotate, descend
and be deliver.
• The anterior shoulder becomes trapped
behind or on the symphysis pubis whilst the
posterior shoulder may be in the hollow of the
sacrum or above the sacral promontory.
SHOULDER DYSTOCIA
 SHOULDER DYSTOCIA cont.

• Predisposing factors (Risk factors)

• Large baby (foetal macosomia) Birth weight over 4kg
• Post term pregnancy
• High parity
• Maternal age over 35 years
• Maternal obesity (weight over 90kg at delivery)
• Maternal diabetes
• Gestational diabetes
• Note: In diabetic women a previous delivery complicated
by shoulder dystocia increase the risk of recurrence to 9.8%.
 SHOULDER DYSTOCIA cont.

SUSPECTS:
• Prolonged 2nd stage of labour
• Arrest of descent
• Retraction of head after crowning
 SHOULDER DYSTOCIA cont.

Warning Signs/ clinical manifestation

1.Initial uncomplicated delivery
2.Failure of the head to advance with crowning or the head
may advance slowly
3. Difficulty in delivering the face and chin (the chin may
have difficulty in sweeping the perineum)
4. Head is delivered but remains tightly applied to the vulva.
4.When the head is delivered it may look as if it is trying to
return into the vagina (turtle sign).
• This is caused by reverse traction.
 SHOULDER DYSTOCIA cont.

• Diagnosis
• Shoulder dystocia is diagnosed when
manoeuvres normally used by the midwife fail
to accomplish delivery.
 MANAGEMENT
• The midwife must
1.Call the doctor (obstetrician)
2.Explain the condition and the manoeuvers
that will be used to the mother calmly
3.Call the anaesthetist
4.Call the paediatrician or a person who can do
neonatal resuscitation skillfully
 SHOULDER DYSTOCIA cont.

5. If the shoulder are in the anteroposterior

diameter of the outlet
• Attempt first to deliver them in the normal
way
• If this fails, ensure that the hand is not
alongside the head anteriorly (This is because
this can prevent delivery of the anterior
shoulder)
 SHOULDER DYSTOCIA cont.

• If this is found, the posterior shoulder and the

hand are eased out first by using traction towards
the mother’s abdomen.
6.Non invasive procedures can be used. These are;
a. Change in position
• Any change in the maternal position may help
release the foetal shoulder some of the positions
include the McRoberts manoeuvre and the supra
pubic pressure.
MCROBERTS MANOEUVRE AND THE SUPRA
PUBIC PRESSURE.
 SHOULDER DYSTOCIA cont.

1. The McRoberts manoevre

This includes
• Helping the mother to lie flat and to bring her
knees up to her chest as far as possible
• This manoevre will rotate the angle of the
symphysis pubis superiorly and use the weight of
the mother’s legs to create gentle pressure on
her abdomen, releasing the impaction of the
anterior shoulder.
 SHOULDER DYSTOCIA cont.

2.Suprapubic pressure
• Pressure should be exerted on the side of the
foetal back and towards the foetal chest.
• This manoeuvre may help to adduct the
shoulders and push the anterior shoulder
away from the symphysis pubis.
 SHOULDER DYSTOCIA cont.

Note: Adduct means to draw towards the

centre or the midline
• If these fail, manipulative or salvage
procedures are employed.
 SHOULDER DYSTOCIA cont.

Manipulative produres:
• These manipulative procedure include:
i. Position of the mother
ii. Episiotomy
iii. Rubins’s manoeuvre
iv. Wood’s manoeuvre
v. Delivery of the posterior arm
vi. Zavenelli manoeuvre
vii. Symphsiotomy
 SHOULDER DYSTOCIA cont.

i. Position of the mother

1.The McRoberts position
2.Lithotomy position
3.All fours
 SHOULDER DYSTOCIA cont.

ii. Episiotomy
• Episiotomy may be performed to gain access to the
foetus without causing tears to the perineum or
vaginal wall.
iii. Rubin’s manoeuvre
• The midwife identifies the posterior shoulder on
vaginal examination
• She pushes the posterior shoulder in the direction of
the foetal chest, thus rotating the anterior shoulder
away from the symphysis pubis.
 SHOULDER DYSTOCIA cont.

iv. Wood’s manoeuvre

• The midwife inserts her hand into the vagina
and identifies the foetal chest
• She then exerts pressure on the posterior
shoulder and this results in rotation of the
posterior shoulder.
 SHOULDER DYSTOCIA cont.

v. Delivery of the posterior arm

• The midwife inserts her hand into the vagina by
using the space created by the hallow of the sacrum.
• Two fingers then splint the humerus of the posterior
arm, flex the elbow, and sweep the forearm over the
chest to deliver the hand.
• If the rest of the delivery is not achieved
• The second arm is delivered after rotation of the
shoulders using either wood’s or Rubin’s manoeuvre
 Delivery of the posterior arm.
By inserting a hand
into the posterior
vagina and ventrally
rotating the arm at
the shoulder

delivery
over the
perineum
 What measures should be taken if first- and
second-line manoeuvres fail?
• Several third-line methods have been described for
those cases resistant to all simple measures.
• These include :
1. Cleidotomy (bending the clavicle with a finger or
surgical division),
2. Symphysiotomy (dividing the symphyseal ligament)
and the
3. Zavanelli manoeuvre.
• It is rare that these are required.
 SHOULDER DYSTOCIA cont.

vi. Zavanelli manoevre

• This is done if all the maneuvers described
fail.
• It is done by the obstetrician
• The head is returned to where it was before
restitution (pre-restitution position)
 SHOULDER DYSTOCIA cont.

• Pressure is then exerted on the occiput and

the head is returned into the vagina
• Caesarean section is then done immediately
vii. Symphysiotomy
• This surgical separation of the symphysis
pubis.
• It is done to enlarge the pelvis for delivery e.g
CPD and shoulder dystocia.
COMPLICATIONS OF SHOULDER DYSTOCIA
A. Maternal
• Ruptured uterus
• Haemorrhage
• Maternal death

B.Foetal
• Neonatal asphyxia
• Brachial plexus injury resulting in Erb’s palsy (When head and
neck are twisted)
• Neonatal morbidity
• Intrauterine death
Fetal Complications
Release techniquesof Sh D
Brachial plexus injuries
 RUPTURE UTERUS
Description:
• It is the total disruption of the wall of the pregnant uterus
with or without the expulsion of its contents (either the baby
or the placenta).
• Tearing or bursting of the uterus during pregnant or labour.
• It is the disruption in the continuity of the pregnant uterus
• This is a life threatening complication of labour or pregnancy.
• Maternal and foetal mortality can be very high if medical aid
is not promptly available
 RUPTURE UTERUS
• It is one of the most serious complication in
obstetrics.
• It is commonly seen in developing countries
because of the high incidence of contracted
pelvis and poor antenatal and intranatal
(intrapartum) care.
• Therefore, with good antenatal and intrapartum
care (supervision) rapture of the uterus can be
avoided.
 TYPES

• There are two main types namely;

1. COMPLETE: -All the layers of the uterus are
ruptured, with or without expulsion of the
foetus.
• It is an emergency and is one of the leading
causes of maternal death.
2. INCOMPLETE:- The uterus ruptures
(endometrium and myometrium) but does not
involve the peritoneal (perimetrium).
 TYPES

• Ruptured uterus can also be described as:

a)Traumatic – When preceded by some form of
intervention e.g manipulations eg version
b) Spontaneous – when it occurs without any
manipulations.
 DEHISCENCE
• Dehiscence of an existing uterine scar may
also occur.
• This involves rupture of the uterine wall but
the foetal membranes remain intact.
• The foetus is retained within the uterus and
not expelled into the peritoneal cavity.
 CAUSES

1. Obstructed Labour
• The obstruction may be due to foeto-pelvic
disproportion, malpresentation and malposition and
from a contracted pelvis, or a big baby.
2.High parity
3.Uterine hyperstimulation with oxytocin particularly in the
presence of disproportion, mal position or high parity
4.Previously scarred uterus as found in caesarean section,
hysterectomy, repaired uterine rupture, extensive
myomectomy etc.
 CAUSES

5. Intrauterine manipulation during labour and

delivery such as:
 Internal podalic version
 Manual removal of retained placenta
• Neglected labour, where there is previous
history of caesarean section
 CAUSES
7.Extension of severe cervical laceration upwards into
the lower uterine segment-this may be the result of
trauma during an assisted birth or operative vaginal
delivery such as forceps and embryotomy
8.Perforation of the non-pregnant uterus, resulting in
rupture of the uterus in subsequent pregnancy
9.Antenatal rupture of uterus, where there has been a
history of previous classical caesarean section
 WARNING SIGNS AND SYMPTOMS

 All the signs of obstructed labour are present

such as:
• Rising pulse rate (maternal)
• Tonic contractions (pain)
• Bandl’s ring may be seen abdominally
• Tenderness over the lower uterine segment
• Foetal distress
 CLINICAL FEATURES

A. Ruptured caesarean section scar

• This is difficult to detect as the rupture is silent
i. There is lower abdominal pain in between
contractions
ii. Slight vaginal bleeding
iii. Shock if there is greater degree of bleeding or
if the tear becomes complete
 CLINICAL FEATURES
B. Rupture During Obstructed Labour
(Intrapartum rupture)
1. There is a history of long difficult labour, bandl’s
ring and obstructed labour
2. Signs of severe shock such as cold moist skin,
low blood pressure, feeble and rapid pulse rate
(fast, weak pulse).
3. The woman complains of severe abdominal
pains with something giving way, then;
 CLINICAL FEATURES
4. Sudden collapse.
5. Heart sounds may be lost.
6. The uterine contractions may stop.
7. The contour of abdomen changes.
8. The foetal parts can be palpated easily
through the abdominal wall.
 CLINICAL FEATURES
Note:
• The degree and speed of the
mother’s collapse and shock depend
on the extent of the rupture and the
blood loss.
 MANAGEMENT

Community/Health Centre
• The midwife should:
1. Put the client in the lateral position and raise legs on pillows
2. Provide warmth.
3. Take blood for grouping and cross-matching (analysis at the hospital)
4. Give IV fluid using two large bore canulae.
5. Check temperature, pulse, respiration and blood pressure
6. Insert a catheter
7. Organize blood donors
8. Give antibiotics and
9. REFER
 HOSPITAL MANAGEMENT

The midwife should call the doctor

• Put the client in the lateral position and raise
legs on pillows.
• Provide warmth.
• Blood is taken for grouping and cross-matching
• IV fluid is given
• The midwife should check the temperature,
pulse respiration and blood pressure ¼ hourly
 HOSPITAL MANAGEMENT

• A catheter is inserted.
• The doctor will prescribe antibiotics
• The midwife should give the drugs accordingly,
and
• Prepare the client psychologically and physically
for surgery
• The doctor will perform hysterectomy or repair
of the uterus (depending on the severity)
 PRINCIPLES FOR TREATMENT DURING
RUPTURE OF THE UTERUS
• Intensive resuscitation
• Emergency laparotomy
• Broad spectrum antibiotics
• Adequate post operative care
 COMPLICATIONS
Maternal
Before Surgery
• Hypovolaemic shock
• Infection
• Death
After Surgery
• Pyrexia
• Intestinal obstruction
• Anaemia
• Adhesions
• Genital tract and wound sepsis
• Urogenital fistula (vesico vaginal fistula)
 COMPLICATIONS
• Foetal
• Hypoxia
• Anaemia
• Death
AMNIOTIC FLUID EMBOLISM/ ANAPHYLACTIC SYNDROME OF PREGNANCY

• Anaphylactic syndrome of pregnancy, previously

known as amniotic fluid embolism (AFE), is the
escape of amniotic fluid containing debris, such as
meconium, lanugo, and vernix caseosa, into the
maternal circulation
• Usually, this result deposition of fluid or debris in
the pulmonary arterioles, resulting rapidly in
respiratory distress, shock, and the possible
development of DIC(disseminated intravascular
coagulation).
 AMNIOTIC FLUID EMBOLISM/ ANAPHYLACTIC
SYNDROME OF PREGNANCY
• Anaphylactic syndrome of pregnancy is rare (1
in 8,000 births)
• Non-preventable and fatal.
• It can occur in the intra-partum or postpartum
period.
 PREDISPOSING FACTORS

• Abruptio placentae
• Uterine rupture
• Intrauterine foetal death
• Advanced maternal age (older than age 35)
• Polyhydramnios
• Precipitate labour
• Oxytocin induction/augmentation
• Grand multiparity.
 S/S
• Sudden dyspnoea and chest pain
• Cyanosis
• Tachycardia
• Pulmonary oedema
• Vomiting
• Seizures
 S/S
• Chills
• Diaphoresis
• Restlessness and anxiety
• Coughing with frothy, pink sputum
• Profound shock due to:
– Anaphylaxis, which causes vascular collapse.
– Uterine bleeding with development of
hypofibrinogenemia.
 DIAGNOSIS
• From S/S (e.g; rapidly developing dyspnoea,
tachypnoea and cyanosis)
• Lab test to confirm DIC by coagulation studies
(eg; prolonged thrombin time, decreased
factor V, VIII, X; decreased platelets)
 MANAGEMENT

• Be alert to signs and symptoms of potential

anaphylactoid syndrome of pregnancy
• Call for medical aid immediately
• Monitor maternal vital signs to assess for signs
of shock and treat if present.
• Monitor FHR for signs of distress (if situation
happens before birth of foetus).
 MANAGEMENT

• Administer oxygen (8 to 12 L/minute) by face

mask to assist respiratory status.
• Assist with emergency procedures, such as
delivery and with the cardiopulmonary
resuscitation as needed.
• Provide information and comfort to the family
or support persons.
 MEDICAL MANAGEMENT

• Refer a to tertiary care center if woman is not

in one
• Endotracheal intubation is done
• Administration of I.V. crystalloid fluids
• Administration of blood products( fresh frozen
plasma)
 MEDICAL MANAGEMENT

• Heparin to combat DIC

• Establishment of central line
• Immediate delivery of the foetus
• Initiation of cardiopulmonary resuscitation, if
needed
 COMPLICATIONS

1. The maternal-fetal mortality is estimated to

be greater than 85% due to DIC
2. Cardiopulmonary collapse, especially if the
syndrome occurs within 10 to 32 minutes
after delivery or rupture of membranes.
 INVERSION OF THE UTERUS
• It is a rare but a very serious complication of
the 3rd stage of labour.
• This means that the uterus have turned inside
out.
• In serious cases, the inner surface of the
fundus appears at the vaginal outlet.
• In less severe cases, the fundus is dimpled.
 INVERSION OF THE UTERUS
• Inversion often starts with a dimple in the
uterine fundus and may continue until uterus
is completely turned inside out.
• It is therefore necessary for the midwife to be
aware of the precipitating factors in order to
take the necessary precautions to avoid this
emergency.
 CLASSIFICATION

• Classification according to severity;

1. First degree: the fundus reaches the internal
os.
2. Second degree:- The body or corpus of the
uterus is inverted to the vaginal opening
3. Third degree: The uterus, cervix and vagina
are inverted and are visible
THIRD DEGREE INVERSION
 CLASSIFICATION

• According to timing of the inversion

1. Acute inversion; occurs immediately after
delivery with the placenta still attached
2. Sub-acute and chronic: occur after the 1st
24hrs
ACUTE INVERSION
 CAUSES

• Inversions are associated with uterine atony

• Exerting CCT when the uterus is relaxed especially
if placenta is centrally sited in the fundus
• Mismanagement of the third stage of labour.
• Forcible attempt to expel the placenta by using
fundal pressure when the uterus is atonic/not
contracted
• Combining cord traction and fundal pressure to
deliver the placenta
 CAUSES
• Pathologically adherent placenta
• Spontaneous occurrence; cause unknown
• Foetal macrosomia
• Short umbilical cord
• Sudden emptying of a distended uterus
 DIAGNOSIS

• The uterine fundus does not feel hard and

convex but rather concave or the uterus may
not be palpable at all.
• The whole uterus may appear in the vagina or
vulva with or without the placenta still
attached
 SIGNS AND SYMPTOMS

• Vaginal bleeding of about 800 -1800 ml

• Faintness or shock
• Sudden unset of LAP due to stretching of
peritoneal nerves and ovaries
• Tearing abdominal pains
• Shoulder tip pain
 MANAGEMENT
Immediate Action:-
• Call for help
• Replace the uterus by pushing the uterus with palm of the
hand along the direction of the vagina, towards the posterior
fornix
• Do not remove placenta if it is still attached, to prevent
uncontrollable haemorrhage
• Take blood for grouping and x-matching and insert iv canula
and start iv fluid
• Once uterus is repositioned, keep hand in situ until a firm
contraction is palpated
 MANAGEMENT
• Give oxytocic to maintain the contraction
• If manual replacement fails, then surgical
intervention is required.
• The use of hydrostatic method of
replacement involves instillation of warm
saline into the vagina.
 MANAGEMENT
• In the hydrostatic method, a douche nozzle is
put in the posterior fornix of the vagina and
several litres of warm saline or iv solution are
run into the vagina until the uterus is returned
to its normal position.
• Meanwhile raise the foot end of the bed to
help relieve the tension and traction of the
ovaries and alleviate shock.
 MANAGEMENT
• Give injection ergot/synthocinon and
pethidine 100mg im to control bleeding and
relieve pain respectively
• If the uterus is at the vulva, wrap it is a warm
towel socked in hibitane solution.
• IV ergot 0.25mg is given to contract the uterus
before the hand is removed.
 MANAGEMENT
• Inhalation of amylnitrate may be given to relax
the uterine tone where constriction ring
develop between the upper and lower
segment.
• The placenta can be removed manually under
general Anaethesia.
• In extreme cases, hysterectomy may be
performed
 COMPLICATIONS
• Hysterectomy
• shock
• PPH
• Anaemia
• Infection
 ECLAMPTIC FITS
• Eclamptic fits are grand mal-type of
convulsions in a pre-eclamptic woman
• It is associated with increase risks of maternal
and neonatal perinatal morbidity and
mortality
 ECLAMPTIC FITS
1. The attack usually begin with twitching around the
mouth and eyes.
2. TONIC PHASE- here, all the muscles are contracted.
This usually last for 15-20 seconds
3. CLONIC PHASE- violent convulsions of the muscles
take place. The woman is thrown about, the mouth is
opened with grinding of the teeth and the faces is
covered with sweat. This phase usually last 60 seconds
4. COMA PHASE- here, the patient is in coma. The
convulsions can re-occur in this phase.
MANAGEMENT OF ECLAMPTIC FITS
IMMEDIATE CARE;
1. Call for medical help
2. Position the woman in a semi-prone position
to facilitate drainage of saliva and vomit
3. Prevent injury by nursing the woman on the
floor or raise beside rails
4. Clear and maintain patent airway
5. Administer oxygen to prevent hypoxia
MANAGEMENT OF ECLAMPTIC FITS
• MEDICAL MANAGEMENT;
 IV magnesuim sulphate 4g (8ml of 50% is diluted with
12ml normal saline) injected slowly over a period of 4
minutes
THEN
 IM magnesuim sulphate 10g of 50% solution is mixed
with 1ml 1% lignocaine (because the injection is
extremely painful); 5g is injected deeply into each
buttock
 The above is known as the loading dose
 MEDICAL MANAGEMENT
• The maintenance dose is administered 4hrly; 5g
of 50% magnesuim sulphate solution mix with
1ml 1% lignocaine is injected deeply into
alternate buttock
• The maintenance dose is adminstered only if;
 Patellar reflex is present
 Respiration is 16cpm and above
 Urine output in the last 4hours was at least
120mls
MANAGEMENT OF ECLAMPTIC FITS
• Observe patient for signs of respiratory depression.
• If this occur, administer IV 10mls of 10% calcium
gluconate slowly over a period of 3 minutes
• Monitor vital signs; B/P every 15 minutes,
temperature hourly, respiration rate should be
greater than 14cpm
• Do not administered IV fluids, if ordered should be
given with caution since fluid balance is poorly
controlled in eclampsia
MANAGEMENT OF ECLAMPTIC FITS
• Despite oedema, patients usually have
hypovolaemia, therefore, plasma volume
expanders such as haemaccel may be used
• Central line (CVP) is passed to monitor to
monitor the fluid status of the patient.
• Pass catheter to monitor urine output. Urine
should be tested for 4hourly for protein,
acetone and glucose (urine should be 30mls per
hour or more)
 COMPLICATIONS
1. Pulmonary oedema
2. Renal failure
3. Hepatic failure
4. DIC
5. Syndrome haemolysis (H), elevated liver
enzymes (EL) and low platelet count (LP)-
(HELLP)
6. CVA