Maternal And Child

1. Caesarianwith
Eclampsia

2. I. Intoduction
In women with eclampsia, cesarean section has been the preferred mode
of delivery when the cervix is unfavorable and early delivery is unlikely. This
practice is based on a recommendation that all women with eclampsia should
deliver within 12 hours of admission.2 However, there is no evidence showing
that cesarean section is optimal in terms of maternal and perinatal outcomes.
Eclampsia is a severe progression of preeclampsia. With this condition, high blood
pressure results in seizures. Like preeclampsia, eclampsia occurs during pregnancy
or, rarely, after delivery. Approximately 5 percent of all pregnant women get
preeclampsia.

3. What is eclampsia?
Eclampsia is a severe complication of preeclampsia. It’s a rare but serious condition where
high blood pressure results in seizures during pregnancy.
Seizures are periods of disturbed brain activity that can cause episodes of staring,
decreased alertness, and convulsions (violent shaking). Eclampsia affects about 1 in every
200 women with preeclampsia. You can develop eclampsia even if you don’t have a history
of seizures.
Sign and symptoms
• high blood pressure,usually over 140/90
• headache,often severe
•swelling of the face, hands, feet or limbs
•change in vision
•vomiting
•nausea
•decreased urination
•blurred vision
•rapid weight gain abdominal pain usually on the upper right side of the abdomen

4. Treatment decisions for preeclampsia, eclampsia, and HELLP syndrome
Need to take into account how severe the condition is, the potential for maternal complications, how
far along the pregnancy is, and the potential risks to the fetus. Ideally, the healthcare provider will
minimize risks to the mother while giving the fetus as much time as possible to mature before delivery.
•obesity
• high blood pressure (Hypertension) during
pregnancy
•family history of postpartum preeclampsia
•being a young mother under age 20
• being an older mother above age 40
• having twins or multiple babies
Risk factors

5. Objective
To compare the effects of labor induction with the effects of cesarean
delivery without labor on neonatal outcome in pregnancies complicated by
severe preeclampsia and delivery of very low birth weight infants.

6. II. Pre-eclampsia Pathophysiology Diagram
Genetic factors
(FLT1 SNPs and
Trisomy 13)
Preexisting risk factors
(chronic hypertension, diabetes and anti
phospholipid antibodies)
Immunological factors
(dNK cells and T reg cell
imbalance)
Shallow placentaton
Reduced placental perfusion
(ER and oxidative stress)
↑Circulating sFLT1 and sENG
↓Circulating PIGF and VEGF
Other factors (e.g. obesity, pro-inflammatory factors
and AT1
Autoantibodies)
Systemic vascular dysfunction, capillary leak and vasospasm
>Coagulation Abnormalities (HELLP)
>Cerebral oedema (Eclampsia)
>Proteinuria
>Glomerular endotheliosis
>Angiotensin II sensitivity
>Hypertension
Intrauterine
Growth restriction
Stage I (First
and second
trimesters)
Stage III
(Third
Trimester)

8. III. Pathophysiology and Mangement
Disease Process
Etiology of Eclampsia
Eclampsia is a severe complication of preeclampsia. it Is a serious medical condition that affects many women during
their gestation. High blood pressure is one of the major factor that causes eclampsia to pregnant women because according to Lee
(2018)” force of blood against the walls of your arteries, becomes high enough to damage your arteries and restrict blood flow”
due to this restriction it can produce swelling to blood vessels in the mother’s brain and may interfere with the brains ability to
function and may cause seizure. The second factor that leads to eclampsia is Proteinuria because preeclampsia temporarily
damages this “filter.” Albumin, as well as many other proteins. This condition only occurs during pregnancy. Eclampsia causes
violent shaking, decreased alertness and may also lead to coma.
Premonitory
stage
Clonic Stage Stage of coma
The 4 stages of Eclampsia:
Tonic Stage

9. Premonitory
stage
- Patient becomes unconscious
- Twitching of different types of muscle such as tongue, face and
limbs
- Eyeball rolls simultaneously
- Usually last for 30 secs
Tonic Stage
- Limbs are flexed and hands clenched
- Respiration ceases
- Eyeballs become fixed
- Cyanotic look
- Usually last for 30 secs.
Clonic Stage
- The muscles will begin to jerk violently, while frothy and slightly
bloody saliva will appear.
- Breathing is stertorous & blood-stained frothy secretions fill the
mouth.
- Cyanosis gradually disappears
- May last for 2-4 minutes
Stage of coma
- If not dead, the woman will fall into a deep unconscious state. This
can persist for hours, or pass quickly.
- The patient appears to be in a confused state following the fit &
fails to remember the happenings.

10. Symptomatology
Eclampsia is a condition that only occurs during pregnancy. Each eclampsia condition is unique depending on the patient, some may share the same
condition and some may not. Eclampsia is the final stage of pre-eclampsia and will require immediate medical attention. Most severe cases may require
immediate intervention often in the form of cesarean and induction.
Before Eclampsia, there is Preeclampsia. Basically, the main cause is Preeclampsia but what causes Preeclampsia is High blood pressure and Proteinuria.
During High Blood Pressure, the force of blood will push against the walls of your arteries wherein it will damage your arteries which will result in a
restriction of blood flow and it can produce swelling in the blood vessels in both your brain and to the baby. During Proteinuria, the kidneys' filters, known s
the glomerulli, are damaged, instead of just wastes that are excreted from your body but the protein as well so it is advised that every doctor's
appointment, the urine will be tested in order to look for protein. Those who are at risk are pregnant women with chronic hypertension, first-timer,
diabetes, kidney disease etc. which will affect also the infant inside the womb.
Every case of Eclampsia is unique depending on the patient. Preeclampsia's common symptoms are high blood pressure, swelling, headaches, nausea,
vomiting, abdominal pain, and difficulty urinating but symptoms may vary if they are affected with different conditions such as diabetes or kidney diseases.
Patients with Eclampsia may experience unique symptoms but the most common being seizure, losing consciousness, and agitation.
In order to diagnose a patient who is at risk of preeclampsia, the doctor will conduct a series of test in order to determine if your condition relapsed or
has gotten worse. Doctors may order blood test which include a complete blood count to measure how many red blood cells you have in your body and
platelet count in order to know how well your blood is clotting. Physicians may also request for your urine test to determine your kidney’s excretion rate
and presence of protein. Doctors will monitor the patient’s condition and will need to prescribe the patient with medication that will prevent the condition
from turning into eclampsia. This medication will help keep your blood pressure in a normal range until the baby is mature enough to be delivered.
Delivering the baby is the only cure for eclampsia.

11. DIAGNOSTICS/ LABORATORY CONFIRMATORY TEST
Physical Assessment of the affected system.
Most patients with eclampsia present with hypertension and seizures, along with some combination of
proteinuria and edema. Findings at physical examination may include the following:
· Sustained systolic BP greater than160 mm Hg or diastolic BP greater than 110 mm Hg
· Right upper quadrant or epigastric abdominal tenderness
· Headache (usually frontal)
· Seizure or postictal state
· Generalized edema
· Small fundal height for the estimated gestational age
Medical Diagnostics may include IDEAL or potential diagnostic procedures.
· Blood pressure checks
· Urinalysis: to find any protein in the urine (proteinuria)
· Blood tests: full blood count and biochemistry –to check for low platelet count and signs of kidney
problems and/or impaired liver function
· Imaging: find fluid in the lungs (pulmonary edema)
· Physical assessment: new onset of headaches or visual disturbances
· Fetal ultrasound: to closely monitor for the growth of the baby
· Non-stress test or biophysical profile: to check for the baby’s heart rate reacts when the baby moves

12. MANAGEMENT
1. Medical Management
Supportive Care for Eclamptic Convulsions:
· Secure an intravenous (IV) line with a large-bore catheter
· Initiate cardiac monitoring and administer oxygen, and
· Transport the patient in the left lateral decubitus position.
· Blood pressure (BP) control
· Adequate oxygenation
· Anticonvulsant therapy
2. Surgical Management
Depending on the response to the treatment, the patients are grouped into the following:
GROUP A: Eclampsia features completely subside.
GROUP B: partial control of the eclampsia features but the blood pressure maintains a steady high level.
GROUP C: Persistently increasing BP to serve level.
Methods of Termination
1. Induction of Labor
2. Caesarean section

13. Nursing Diagnosis and Intervention
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION
Subjective:
“ Nahihilo ako at hirap
pa ko makabangon,”as
verbalized by the
patient.
Objective:
• Increased Blood
Pressure (140/100)
• Weak in
appearance
• Restlessness
• Dizziness
Activity Intolerance
Within the nursing
intervention the
patient will
Identify and use
appropriate
intervention to
manage discomfort
Demonstrate
techniques to meet
self care needs
Appear relax able to
rest and move
appropriately
• Monitor Blood
Pressure; every
15mins. During
critical phase; ever
1-4hrs. As
conditions
improves.
• Encourage oral
fluids and diet
initial signs of
healing high in
protein and low
sodium diet.
• Provide adequate
rest by positioning
client.
• Give information
about positive signs
of improvements,
such as decreased
edema, improved
vital signs and
circulation
• Provide quite
environment.
The patient will be
able to maintain
proper function of the
part being affected.
The patient will be
able to have an
adequate rest and
sleep, and the
patient’s blood
pressure will
decreased.
The patient will be
able to respond well
to interventions and
performed actions.

14. IV. Discharge Planning
MEDICATION Take all the prescribed drugs in prescribed dose, time, route, and drug. Make sure that
the drugs intake is continuous to the prescribed length of time and don’t skip taking it.
LIFESTYLE Advise to follow activity restrictions as recommended by his health care provider.
TREATMENT Educate patient to follow the treatment plan of his health care provider prescribes.
HEALTH TEACHINGS Instruct patient or patient’s relatives to contact a health care provider or their doctor if
condition got worse or another health problem happened.
OUT – PATIENT
REFERRAL
Encourage patient to have a visit to hospital if the patient’s condition upon discharge
was not alleviated.
DIET Encourage patient to eat nutritious food and take well-balanced diet

15. Medication
 Drug to be continued, Hydralazine (Apresoline) oral. For
maintenance, adjust dosage to the lowest effective levels.

16. Exercise
 The client should limit the no. of stairs she climbs to one flight/day
for the first week at home. Beginning the second week, if her lochial
discharge is normal, she may start to increase this activity. Limit stair
climbing to only when necessary for first two weeks.

17. Treatment
 Advice client to monitor
blood pressure, take
prescribed medications
and perform wound care
as needed.

18. Health Teaching
Teaching should focus on action to maintain comfort, to promote healing and restore
wellness.
• Avoid heavy work for at least first 3 weeks after birth.
• Get lots of sleep. Sleep when baby sleeps.
• Allow others to do things for you.
• Avoid having sexual intercourse at least a month call your health care provider if you have
any of the warning signs of sickness
• Don’t have sexual intercourse until after you’ve had a checkup with your health care
provider.
• Report increasing pain, swelling, or opening or gaping of wound edges.
• Teach the client how to change wound dressings and perform wound care
• Instruct client to use pain medication as ordered.
• Emphasize the importance of hygiene and hand washing to prevent infection.

19. Out Patient Referral
 The Client should return to her physician 2-4 weeks after.

20. Diet
 The client’s diet is high protein and low sodium diet.

21. Spirituality
 Strengthen faith and
communicate with God.
 Encourage the patient to have
faith and pray to God.
 Encourage the patient to
spend a time of silence in a
day for a moment prayer.

22. X. Related Nursing Theory
While providing care to my patient, I applied Orem’s Theory of Nursing.
Orem’s Theory consists of
1.Theory of self care
2.Theory of self deficit
3.Theory of Nursing System
I applied Orem’s theory as it appeared to be the best possible theory to meet my client’s need while providing nursing care.
Orem’s Theory of Nursing Care
Orem’s theory of nursing has three related theories
1.Theory of self care
2.Theory of self care deficit and
3.Theory of nursing system
By assessing condition of my patient I figured out theory of nursing system as most suitable theory for caring my patient.
Theory of nursing system
It describes how the patients self care needs will be met by the nurse, patient and both
It identifies three classifications of nursing system to meet the self care requisites of the patient
-Wholly compensatory system
-Partly compensatory system
-Supportive- educative system

23. Wholly compensatory nursing system is represented by a situation in which the individual is unable to engage in self care actions requiring self
directed and controlled ambulation and manipulative movement or the medical prescription to refrain from such activities. Person with these
limitations are socially dependent on others for their continued existence and wellbeing. Example patient in coma.
Partly compensatory nursing system represented by a situation in which both nurse and patient perform care measures or other action involving
manipulative tasks or ambulation.
Either patient or nurse may have major role in performance of self care measures. Example person who recently had surgery
Supportive – educative system: in this system the person is able to perform or can and should learn to form required measures of externally or
internally oriented therapeutic self care nut cannot do so without assistance. This is also known a supportive developmental system.
In this system patient is doing all of his self care. The patient’s requirements for help are confined to decision makings behavior control. And
acquiring knowledge and skills.
The nurse’s role is to promote the patient as a self care agent. Example chronic disease patients like hypertension.
I applied Partly compensatory by
 By providing all self care activities like mouth care, back care when my patient was partly conscious
 Her elimination need was fulfilled by catheterization
 Medication
 Providing safe environment
And I applied supportive educative theory by
 Providing information about disease condition
 Medication
 Complication and it’s prognosis
 Home based management of disease and possible risks
 Diet
 Follow up

24. V. Review of Related Studies/Literature
 Eclampsia: an overview clinical presentation, diagnosis and management
 Rose Gasnier, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul,
Brasil
 Published: November 28, 2016
 Hypertensive disorders are among the most common medical complications of pregnancy,
affecting about 7-10% of all pregnant women. These disorders are an important cause of
maternal and perinatal morbidity Preeclampsia is classically recognized as hypertension that
begins after week 20 of pregnancy with significant proteinuria that disappears until 12 weeks
after the labor. The Australasian Society for the Study of Hypertension in Pregnancy (ASSHP)
already had suggested that proteinuria not be included as a diagnostic criterion for
preeclampsia. According to The American Congress of OBGYN Task Force on Hypertension in
Pregnancy, proteinuria was eliminated as a requirement for the diagnosis of preeclampsia.
HELLP syndrome represents a severe form of preeclampsia-eclampsia, currently regarded as a
variant of severe preeclampsia or a complication of the disease, and is characterized by
hemolysis, elevated liver enzymes and low platelets. HELLP syndrome and eclampsia seem to
share the component of endothelial dysfunction in their pathophysiology. The incidence of
HELLP syndrome in association with eclampsia is 10.8 - 32.1%, and the incidence of eclampsia in
association with HELLP syndrome is 6-52%.

25.  Maternal Mortality in Eclampsia after Cesarean Section versus Vaginal Delivery
 Eclampsia, major neurological sequelae of pre-eclampsia, is convulsive
disorder or any other form of altered consciousness observed in a
patient of preeclampsia and which cannot be related to any other
concurrent neurological entity.(1)It caused 14% maternal deaths
throughout the world. (2)According to World Health Organization;
Hypertensive Disease in Pregnancy (HDP) is an established cause of
adverse prenatal consequences. The incidence of eclampsia in
developed nations has been seen to be 1.6 to 2 per 10000 deliveries
and in developing nations it ranges from 6 to 157 cases per 10000
deliveries. (3)In developed part of the globe, women continue die from
preeclampsia and eclampsia. (4)the incidence is on the decline due to
accessible antenatal facilities. However this fall is not reciprocated in
developing countries. (5)These deaths are avoidable as 90% of them
are due to suboptimal care. (6)Fetomaternal prognosis is worsened by
the underutilization of modern ante-natal services as compared to the
Caucasian population.
 10.21649/journal.akemu/2017/23.4.446.450
 Published | December 19, 2017

26. VI. References
 Eclampsia: Causes, Symptoms, and Diagnosis
https://www.healthline.com/health/eclampsia?fbclid=IwAR381nzlFs8zUWYr6eeR2GF2EFjgdRnh3u7UdWsek1FuCGtgvliJBdzA0CA
 Pre-eclampsia vs Eclampsia
https://www.medicinenet.com/pregnancy_preeclampsia_and_eclampsia/article.htm?fbclid=IwAR2cunv475Z9L7ldYL4kPZlNu_a3TsnpvWBJATteuWFMnKgP54I5W9yiZ0I
 Eclampsia: Overview, Etiologic and Risk Factors for Pre-eclampsia
https://emedicine.medscape.com/article/253960-overview?fbclid=IwAR3svpf1pnzKyHw51A6qk5JM2GBI4P2h7MpcZiwB18UnFBnnkJ6p0Vxwdqw
 Pre-eclampsia - Symptoms and Causes
https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745?fbclid=IwAR14qkkYBuIXcVPWUF914REZ0olXfdKsiNmV5jeILv-
xq6aH78FIzWatfzk
 Stacey Fowler rushed in for emergency C-Section after Pre-eclampsia Diagnosis
https://www.tommys.org/pregnancy-information/blogs-and-stories/im-pregnant/pregnancy-news-and-blogs/stacey-fowler-rushed-emergency-c-section-after-pre-
eclampsia-diagnosis?fbclid=IwAR0cdpfnTLWkwlTfQGmZgcRLCJo28FWTL5FQpKvFF3rwp4dCx4Ze3mCAEr8
 Maternal Mortality in Eclampsia after Cesarean Section versus Vaginal Delivery
https://www.researchgate.net/publication/322549535_Maternal_Mortality_in_Eclampsia_after_Cesarean_Section_versus_Vaginal_Delivery
 Eclampsia: an overview clinical presentation, diagnosis and management
https://medcraveonline.com/MOJWH/eclampsia-an-overview-clinical-presentation-diagnosis-and-management.html
 Drug Treatment of Hypertension in Pregnancy
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558097/#:~:text=For%20emergency%20treatment%20in%20preeclampsia,recommended%20%5B21%2C%2017%
5D
 Apresoline (hydralazine hychloride) for hypertension
https://www.rxlist.com/apresoline-drug.htm

27. THANK YOU
Reporter: Group 6