ECLAMPSIA in SudanGeneva Foundation for Medical Education and Research GFMER Sudan 2012 Forum No: ( 1 )
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
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
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
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
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
Main Causes of Maternal MortalityQualitative Research Techniques - The four parts of Qualitative Research Techniques are: Haemourage: . Pregnancy-Induced Hypertension Infections Unsafe Abortion
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
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
Aetiology .Uncertain - cerebral oedema, ischaemia are possible # causes.
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%)
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.
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.
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
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
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%).
Helth Professionals. In 68 cases (57.6%) aconsultant was involved inthe management; consultants. while in fifty cases #(42.4%) were managed Juniorby a junior..
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
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