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12. eclampsia and severe_preeclampsia_rev_19.5.10.

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12. eclampsia and severe_preeclampsia_rev_19.5.10.

  1. 1. IN PARTNERSHIP WITHLiverpool School of Tropical MedicineLiverpoolAssociates in Tropical HealthEclampsia and severepreeclampsiaEclampsia and SeverePre-eclampsia
  2. 2. Aims To recognise eclampsia and severe pre-eclampsia To practise an effective response to awoman with eclampsia (fit) or severepre-eclampsia To achieve competence in those skills
  3. 3. Principles of management Stabilise mother and then deliver fetus Treat and prevent fits Treat blood pressure Attention to fluid balance Be aware of and prevent complications
  4. 4. Signs and Symptoms of Pre-Eclampsia• Headache• Blurred vision• Upper epigastric pain• Hyperreflexia/clonusDiagnosis:BP > 140/90Urine protien +
  5. 5. Eclampsia - recognition Fitting or unconscious
  6. 6. Management of fits
  7. 7. Fitting or unconscious Call for help Recovery position Open and maintain airway iv access and give magnesium sulphate 1 litre Ringer’s lactate to be given veryslowly iv
  8. 8. Magnesium sulphate The anticonvulsant of choice Loading dose is given IV and IM 4g given IV (dilutent N/S!) 10g IM (diluent 2% Lignocaine) Give 5g to each buttock If unable to give IV loading dose give IMloading dose only
  9. 9. Magnesium Sulphate: MaintenancedoseIV route Magnesium sulphate (10g) in 1000 ml normalSaline IV infusion at rate of 1g/hourORIM route After loading dose continue with 5 g IM every 4hoursContinue maintenance dose until 24 hoursafter birth or 24 hours after last convulsion
  10. 10. Magnesium caution! Do not give the next dose of magnesium if Absent knee jerk Urine output less than 100 mls in last 4hours Respiratory rate less than 16 breaths perminute
  11. 11. • If respiratory rate less than 16 breaths /minute stop magnesium and givecalcium gluconate 1 g iv over 10minutes
  12. 12. Magnesium Sulphate If convulsions recur give an additional2-4g iv over 10-15 minutes Consider giving lower dose (2g) ifpatient is small and/ or weight is lessthan 70kgs
  13. 13.  Magnesium sulphate has variousconcentrations For IV injection concentration ofmagnesium should not exceed 20% 20% solution=200mg/ml
  14. 14. Diazepam Only use if magnesium not available ormagnesium toxicity develops
  15. 15. Blood pressure Uncontrolled blood pressure leads tointracranial haemorrhage and death Monitor Treat if BP diastolic >110 mm Hg orsystolic >160 mmHg Nifedipine, hydralazine, labetalolaccording to local protocol
  16. 16. Delivery Assess fetal heart, gestational age, lie of thebaby and assess cervix Vaginal delivery or CS? Vaginal if no maternal or fetal distress, noobstetric contraindication and cervixfavourable CS if repeated fits, fetal distress orunfavourable cervix
  17. 17. Fluid Careful fluid balance required Capillaries are ‘leaky’ therefore control fluidinput to prevent pulmonary oedema Monitor closely via fluid in and output chart Restrict iv fluids to 30 drops per minute
  18. 18. Complications of (pre) eclampsia Brain Lung Liver Clotting (abruption, DIC) Heart Kidney Eye Fetal Death
  19. 19. Monitor! HR BP Urine Output RR Reflexes Fluid in and output Temperature Fundi Bloods (platelets, clotting, Hb,renal function)
  20. 20. After delivery Monitor, monitor, monitor Remember (pre-)eclampsia get worse orfirst fit can occur in post partum period Continue magnesium for 24 hours afterdelivery or after last fit – no need to “tailoff”
  21. 21. IN PARTNERSHIP WITHLiverpool School of Tropical MedicineLiverpoolAssociates in Tropical Health??
  22. 22. IN PARTNERSHIP WITHLiverpool School of Tropical MedicineLiverpoolAssociates in Tropical HealthRECAPRecognition of Eclampsia and Severe pre-eclampsiaManagement of fits and blood pressureDecision on deliveryMonitoring of patientComplications

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