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Analysis of Eclampsia situation in Sudan, as a second cause of Maternal Death.

Analysis of Eclampsia situation in Sudan, as a second cause of Maternal Death.

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  • 1. ECLAMPSIA in SudanGeneva Foundation for Medical Education and Research GFMER Sudan 2012 Forum No: ( 1 )
  • 2. Name of presenterName Position InstitutionDr/ SAMI MAHMOUD Obstetrician/Gynecologist Reproductive Health Care Centre Name of contributorsName Position InstitutionDr/ MAJDI SABAHELZAIN Pharmacist/ MSc. Public University of Medical and Tropical Health Sciences and Technology
  • 3. Content of the presentation• Definition of Pre-eclampsia• Diagnosis of Pre-eclampsia• Importance of Pre- eclampsia• Risk Factors for Pre- eclampsia• Incidence in Sudan• Management and
  • 4. Definition Appearance of seizures in a patient (often with pre- existing pre-eclampsia) # In 20%, BP can be normal Can occur before, during or after delivery 1/3 are post-delivery
  • 5. Diagnosis . Classic Triad: -hypertension (>140/90) -proteinuria (>1+ or >0.3g/24hours) -generalized oedema (least reliable) . Hypertension and proteinuria must # be present on two occasions. .Rapid weight gain is supportive evidence
  • 6. Importance .Second cause of Maternal Mortality in Sudan. .A cause of perinatal morbidity & Mortality. .Risk of CVA # .Renal failure .Risk of iatrogenic fluid overload. .HELLP Syndrome
  • 7. Main Causes of Maternal MortalityQualitative Research Techniques - The four parts of Qualitative Research Techniques are: Haemourage: . Pregnancy-Induced Hypertension Infections Unsafe Abortion
  • 8. Risk Factors for Pre-eclampsia. Nulliparity .Chronic renal disease. Maternal age <16 or>40yrs .Antiphospholipid syndrome (APLS). Multiple pregnancy . Diabetes mellitus # #. Family history of pre-eclampsia or eclampsia. Chronic (pre-existing)hypertension
  • 9. Severe pre-eclampsia: symptoms & Headaches Visual Disturbances Pulmonary Oedema Hepatic Dysfunction RUQ or Epigastric PainOliguriaElevated CreatinineProteinuria of 5 g or more in 24 hrs Systolic BP > 160 to 180 mm Hg Diastolic BP > 110 mm Hg Thrombocytopaenia or haemolysis
  • 10. inical Course of Neglected Severe Pre-eclamps CNS Eyes Seizures Arteriolar Spasm Intracranial Haemorrhage Retinal Haemorrhage CVA Papilloedema Encephalopathy Transient Scotomata Pancreas Respiratory System Ischaemic Pancreatitis Pulmonary Oedema ARDS Kidneys Acute Renal Failure Liver Subcapsular Haemorrhage Uteroplacental Circulation Hepatic Rupture IUGR Haematopoietic System Abruption HELLP Syndrome Fetal Compromise DIC Fetal Demise
  • 11. Aetiology .Uncertain - cerebral oedema, ischaemia are possible # causes.
  • 12. Incidence in Sudan .Distribution of maternal death report according to cause of death (Jan 2010- Dec 2010) Cause of Maternal Death , No. 889 1-Obstetric Haemorrhage # 225 (25.1%) 2-Eclampsia 134 (14.9%)
  • 13. Eclampsia Effects Maternal death from 60% eclampsia in Sudan 50% in 2010 affects 134 cases (14.9%), 40% . 71 case (53.0%) 30% 20% ante partum, # 10% .48 cases (35.8%) 0% post partum . fifteen cases (11.2%) intrapartum.
  • 14. Fit Starting 90.00% 80.00% .(79.9%), the first 70.00% 60.00% 50.00% fit started at home 40.00% 30.00% . (16.4%) first fit 20.00% 10.00% # 0.00% occurred in hospital & .(3.7%) on the way to hospital.
  • 15. Interval from first fit tilldeath from first fit till death 40.00% Interval was: 35.00% . Less than two hours in 30.00% 25.00% thirty cases (22.4%), 20.00% . Two-six hours, 24 cases 15.00% # (17.9%), 10.00% . Seven- 24 hours, thirty 5.00% cases (22.4%) & 0.00% Less 2-6 7-24 More . More than 24 hours in fifty than 2 hours hours than hours 24 cases (37.3%). hours
  • 16. No. of Fits before Death No. of Fits before Death .Sixteen cases (11.9%) died at home, 118 cases reached hospital: 4 -5 Fits . Almost 52 cases # 5 -10 Fits (38.8%) had four or less fits before their death, More than 10 . 43 cases (32.1%) had five –ten fits & 39 cases (29.1%) had more than ten fits before they died
  • 17. common reported cause of maternaldeathCVA was the common . reported cause of maternal 45 40 death, 54 cases 35 (40.3%), followed by 30 25 . acute pulmonary 20 15 edema, 31 cases (23.1), 10 # .acute renal failure, twenty 5 0 two cases (16.4%), .HELLP syndrome, fifteen cases (11.2%) & air way obstruction twelve cases (9.0%).
  • 18. Helth Professionals. In 68 cases (57.6%) aconsultant was involved inthe management; consultants. while in fifty cases #(42.4%) were managed Juniorby a junior..
  • 19. Receivingtreatment Receiving treatment .Sixty three cases(53.4%) receivedanticonvulsant(diazepam ormagnesium sulfate), Received # . while fifty five cases Not received(46.6%) did not receivedany anticonvulsant
  • 20. Management 1. CALL FOR HELP +++++ 2. EMPHASISE IMPORTANCE OF BASIC ABCs 3. ‘A’ – airway can’t be inserted during a fit 4. ‘C’ – includes x2 large bore cannulae 5. Initiate unit – ‘Eclampsia protocol’ # 6. DO NOT NURSE IN THE DARK!! 7. Give loading dose MgSO4 8. Foley catheter/fluid balance 9. Keep NBM
  • 21. Management •Antihypertensive ( Labetalol , Hydralazine , Methyl Dopa & Nifedipine) •Magnesium sulphate #
  • 22. Prevention • Reducing maternal death from Eclampsia:- • Availing of magnesium sulfate. • Availing of Hydralazine. # • Training of care providers on magnesium sulfate use & monitoring side effects.
  • 23. 22 August 2012 Ian Donald Symposium 23
  • 24. ThankYou22 August 2012 Ian Donald School 24