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On
Mother Care
through Drills:
An Initiative of AOGD & DGF
EXPANDING
HORIZONS
Each Gynaecologist – master it yourself
& Teach to every one in labor room
2012-13 “Drills” to - Gynaecologists
2014 -15 -...
Eclampsia Drill AOGD
CONTRIBUTORS
DR. SHARDA JAIN
DR. MANJU PURI
DR. ILA GUPTA
DR. SHARDA PATRA
Eclampsia DrillEclampsia Drill
Eclampsia is an important obstetric
emergency which if not managed
promptly can lead to lif...
The management of eclampsiaThe management of eclampsia
involvesinvolves
Immediate management
Subsequent management
One s...
Immediate managementImmediate management….….
PrinciplesPrinciples
Speed
Skills
Priorities
Immediate management …..Immediate management …..
Stabilize the woman
Call for Help
Remember A; B; C of
resuscitation
Con...
Initial ResuscitationInitial Resuscitation
Airway
 Place the woman on her left side to reduce the
risk of aspiration of s...
Initial ResuscitationInitial Resuscitation
Breathing Assess – count respiratory rate
.Look, Listen, Feel. Ventilate if ne...
Treat and prevent further fitsTreat and prevent further fits
Administer Magnesium Sulphate
(MgS04)
Regimes: Pritchard or Z...
Loading dose Maintenance dose
4g IV 20% solution over 5
to 10min plus 10g IM
(5 g 50% solution deep
I/M in each buttock)
5...
Mg So4 :Preparation and AdministrationMg So4 :Preparation and Administration
MagSo4 available in 25%, 50% strength
Initi...
Preparation and administrationPreparation and administration
IV 4gms
Take 8amps (16ml)
dilute with 4ml saline
to make it 2...
Preparation and AdministrationPreparation and Administration
5gms deep
IM(10ml) in each
buttock
50% amps (2ml)
contains 1g...
If convulsion recursIf convulsion recurs
Give 2gm IV 20% solution over 5-10mins
and continue the maintenance dose
Monitoring during magnesium sulphateMonitoring during magnesium sulphate
TherapyTherapy
Respiratory rate >14/ min
Presen...
Antidote:Antidote:
In case of respiratory depression or
arrest:
Give calcium gluconate 1 g (10 ml of 10%
solution) IV slo...
CAUTIONCAUTION
Magnesium sulfate should be used with
caution in women with
Impaired renal function.
Patients with a hear...
Controlling blood pressureControlling blood pressure
Antihypertensive drugs should be given if
the diastolic blood pressu...
Labetolol
1. 20 mg I.V over 2mins
wait for 10 mins if no response
40 mg iv
80 mg iv
(can be increased upto 220 mg)
2. 10 m...
NifedipineNifedipine
10 mg tabs orally to repeat every 20
mins up to a maximum dose of
200 mg
Subsequent managementSubsequent management
Once the patient is stabilized and fits
have ceased , then a pervaginum
examin...
Essential careEssential care
Turning the woman two–hourly to
avoid hypostatic pneumonia
Mouth Care, (no oral fluids are ...
Observations:Observations:
Restlessness or twitching which may
herald the onset of another fit
Color is observed for cya...
Do not leave the patient
alone
Place in left lateral position
CALL FOR HELP
Airway
Breathing
Circulation
Assess
Maintain p...
Control of
convulsions
Control of
Hypertension
Loading dose :
4gm IV
20ml is given slow IV over 5-10mins followed by 10gms...
A DRILL …….. EclampsiaA DRILL …….. Eclampsia
The need for good clinical skills to be
able to recognize and act promptly
...
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1 eclampsia drill.ppt dr. sharda jain

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1 eclampsia drill.ppt dr. sharda jain

  1. 1. On Mother Care through Drills: An Initiative of AOGD & DGF EXPANDING HORIZONS
  2. 2. Each Gynaecologist – master it yourself & Teach to every one in labor room 2012-13 “Drills” to - Gynaecologists 2014 -15 - Doctors & Nurses in the LR - Our MMR & Global standing - Focus on Faculty - Learn & Teach - Mother’s Life matters :Talk it out -Future perfect – Safe Motherhood
  3. 3. Eclampsia Drill AOGD
  4. 4. CONTRIBUTORS DR. SHARDA JAIN DR. MANJU PURI DR. ILA GUPTA DR. SHARDA PATRA
  5. 5. Eclampsia DrillEclampsia Drill Eclampsia is an important obstetric emergency which if not managed promptly can lead to life-threatening complications like cerebral haemorrhage, pulmonary edema, abruptio placentae maternal and fetal death Any pregnant woman presenting with CONVULSIONS in later half of pregnancy should be treated as eclampsia until proved otherwise
  6. 6. The management of eclampsiaThe management of eclampsia involvesinvolves Immediate management Subsequent management One should remember that first few minutes following a fit are very crucial and should be handled very fast due to risk of cerebral hypoxia and aspiration which can have serious consequences. .
  7. 7. Immediate managementImmediate management….…. PrinciplesPrinciples Speed Skills Priorities
  8. 8. Immediate management …..Immediate management ….. Stabilize the woman Call for Help Remember A; B; C of resuscitation Control convulsion Control blood pressure
  9. 9. Initial ResuscitationInitial Resuscitation Airway  Place the woman on her left side to reduce the risk of aspiration of secretions, vomit and blood Put an airway in between the tongue and palate to prevent tongue bite and falling of tongue Suction of the secretions is done through this airway by connecting it to a suction machine. Give oxygen (if available15 l /min ) and continue longer if cyanosis persists Stay with the patient to ensure that her airway is clear
  10. 10. Initial ResuscitationInitial Resuscitation Breathing Assess – count respiratory rate .Look, Listen, Feel. Ventilate if necessary   Circulation Assess pulse , BP. CPR if necessary   Secure intravenous access with a cannula (16G ) Send blood for BG, CBC, platelets, clotting screen, KFT, LFT, Uric acid, Serum electrolytes Catheterize the patient to empty the bladder , record output and monitor output subsequently Do a urine examination for proteins
  11. 11. Treat and prevent further fitsTreat and prevent further fits Administer Magnesium Sulphate (MgS04) Regimes: Pritchard or Zuspan
  12. 12. Loading dose Maintenance dose 4g IV 20% solution over 5 to 10min plus 10g IM (5 g 50% solution deep I/M in each buttock) 5g I/M every 4h in alternate buttock till 24 hrs after the last seizure or delivery which ever is later Loading dose Maintenance dose Loading dose 4g IV 20% solution over 5 to 10min 1 to 2 g / h by controlled infusion pump x 24h after the last seizure Pritchard Zuspan
  13. 13. Mg So4 :Preparation and AdministrationMg So4 :Preparation and Administration MagSo4 available in 25%, 50% strength Initial loading dose 14gms 14gms 4gm IV 10 gms IM
  14. 14. Preparation and administrationPreparation and administration IV 4gms Take 8amps (16ml) dilute with 4ml saline to make it 20ml 50% amps (2ml) contains 1gm of magso4 25% ampoules (2ml) contains 0.5 gm magso4 20ml solution contains 4gms Magso4 ( 4gm/20ml 20% Sol) Take 4amps (8ml) dilute with 12ml saline to make it 20ml IV 4gm 20ml is given slow IV over 5-10mins Keep an eye on respiratory rate , facial flushing ,
  15. 15. Preparation and AdministrationPreparation and Administration 5gms deep IM(10ml) in each buttock 50% amps (2ml) contains 1gm of magso4 Take 5amps (10ml) undiluted 10gms IM
  16. 16. If convulsion recursIf convulsion recurs Give 2gm IV 20% solution over 5-10mins and continue the maintenance dose
  17. 17. Monitoring during magnesium sulphateMonitoring during magnesium sulphate TherapyTherapy Respiratory rate >14/ min Presence of patellar reflexes (knee jerk) Urinary output- 25ml/hr or 100ml/4hrs Repeat doses of magnesium sulphate must be withheld or delayed if: The respiratory rate is less than 14 per minute Patellar reflexes are absent Urinary output is less than 100 ml over preceding 4 hours
  18. 18. Antidote:Antidote: In case of respiratory depression or arrest: Give calcium gluconate 1 g (10 ml of 10% solution) IV slowly Assisted ventilation using mask and bag, anesthetic apparatus or intubation
  19. 19. CAUTIONCAUTION Magnesium sulfate should be used with caution in women with Impaired renal function. Patients with a heart block or myocardial damage including a history of cardiac ischaemia
  20. 20. Controlling blood pressureControlling blood pressure Antihypertensive drugs should be given if the diastolic blood pressure is 110 mmHg or more. The aim is to keep the diastolic blood pressure between 90–100 mmHg to prevent cerebral haemorrhage Drug of choice- Labetolol, Nifedepin
  21. 21. Labetolol 1. 20 mg I.V over 2mins wait for 10 mins if no response 40 mg iv 80 mg iv (can be increased upto 220 mg) 2. 10 mg IV 20 mg iv 40 mg iv Target : 40 mg iv Decrease in diastolic BP To 90-100 mgHg 80 mg iv
  22. 22. NifedipineNifedipine 10 mg tabs orally to repeat every 20 mins up to a maximum dose of 200 mg
  23. 23. Subsequent managementSubsequent management Once the patient is stabilized and fits have ceased , then a pervaginum examination is done to assess cervical status Consider for termination of pregnancy if not in labor
  24. 24. Essential careEssential care Turning the woman two–hourly to avoid hypostatic pneumonia Mouth Care, (no oral fluids are given) monitor the Urinary Output.
  25. 25. Observations:Observations: Restlessness or twitching which may herald the onset of another fit Color is observed for cyanosis which indicates the need for oxygen Temperature four hourly. Hyperpyrexia may occur Pulse and respirations are recorded hourly, or more often Blood pressure is recorded at least hourly earlier if >=160/110 Ut contractions and FHS is checked Input output is recorded accurately.
  26. 26. Do not leave the patient alone Place in left lateral position CALL FOR HELP Airway Breathing Circulation Assess Maintain patency Give oxygen Assess Protect Airway Ventilate if required Evaluate pulse and BP Secure IV access A L G O R I T H M
  27. 27. Control of convulsions Control of Hypertension Loading dose : 4gm IV 20ml is given slow IV over 5-10mins followed by 10gms , 5gms deep IM (10ml) in each buttock If fits recur- 2gms , 20% IV Maintenance dose- 5gms IM in alternate buttocks 4 hourly Monitor- Resp rate>16 Presence of Knee jerk Urinary output >25ml/1hr If Mag toxicity- Inj Calcium Gluconate , 10% 10ml , 10mins IV Labetolol 10mg IV , give 20mg IV if noresponse after 10mins, then 40mg, 40mg, 80mg max 220mg Nifedipine 10mg orally , repeat after 20mins if noresponse , max 200 mg, target BP- dbp-90-100 mmHg Delivery
  28. 28. A DRILL …….. EclampsiaA DRILL …….. Eclampsia The need for good clinical skills to be able to recognize and act promptly Be in control of the situation Need to care for the family, who will be extremely distressed to see the woman have a fit; Need for gentleness, so as not to harm the woman if she is unconscious, or stimulate further fits; Need to respect the woman’s dignity at all times; Need for strict attention
  29. 29. ThanksThanks

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