Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Eclampsia case study

8,182 views

Published on

  • Login to see the comments

Eclampsia case study

  1. 1. Obstetric Case Presentation Nick Harper
  2. 2. Ms X • 17 yo • G1 P0 • 38 weeks gestation • Admitted in early labor • Discharged
  3. 3. 4X tonic-clonic seizures Presenting Complaint
  4. 4. History of Presenting Complaint • 8/10 pain headache • 8/10 pain abdo pain • 4X tonic-clonic seizures • Witnessed by boyfriend and sister • Admission via Ambulance
  5. 5. Obstetric History • 38/40 • 1+ protein seen from 28/40 •BP 92/50 @ 25 weeks •BP 130/80 @ 37 weeks
  6. 6. Differential Diagnosis • Eclampsia • Epilepsy – 1/3 have inc. seizures – Decreased drug levels • Severe hypoglycaemia
  7. 7. Initial management Diazepam 10mg IV (ambulance) MgSO4 (St Michaels)
  8. 8. Investigations • BP 200/120 (<140/90) • Creatinine 123 (60-100) • Uric Acid 0.66 (0.19-0.36) • ALT 145 (5-40) • Platelets 435 (150-400) • Hb 11.0 (12-16)
  9. 9. •“Shining Forth” •One or more convulsions superimposed on pre-eclampsia Eclampsia Diagnosis •Severe pre eclampsia5:1000 •Eclampsia 5:10,000 •14 deaths (2000-2002)
  10. 10. Risk Factors
  11. 11. Signs & Symptoms
  12. 12. Management - BP • BP >160/110 • Hydralazine 5mg IV unless pulse >120 • Labetolol 20mg IV (total 200mg) • Restrict fluids 90mL/h
  13. 13. Management - Seizures • Magnesium sulphate 4g IVI 5 min • Magnesium sulphate 1g/h IVI 24 hrs •Magnesium sulphate 2g IVI 5 min •Diazepam 5mg IV •Stop MgSO4 if RR <14 or lose tendon reflex •Calcium Gluconate
  14. 14. Ms X • MgSO4 commenced • MgSO4 maintenance infusion • 190mg Labetolol given in 25mg boluses • Into theatre • Spinal • Forceps delivery, 2nd degree tear • Healthy baby
  15. 15. Important points • BP not a good measure • Do not ignore 1+ of protein • Delivery is only cure • 44% of fits are post partum • Inform intensive care facilities early

×