The document provides a comprehensive overview of pre-eclampsia and eclampsia, detailing definitions, causes, types, diagnosis, and management strategies aimed at empowering student midwives. It outlines essential information on recognizing the conditions, including blood pressure monitoring and magnesium sulfate administration, along with complications for both mother and baby. Additionally, it emphasizes the importance of thorough observation and management post-delivery.

1. PRE-ECLAMPSIA & ECLAMPSIA
BY G. CHIMOWA
10th JUNE, 2022

2. BROAD OBJECTIVES
 By the end of this presentation student
midwives should acquire appropriate
knowledge, skills and attitudes
necessary for the management of women
with pre-eclampsia and eclampsia.

3. SPECIFIC OBJECTIVES
 By the end of this presentation student
midwives should be able to:
Define chronic hypertension, gestational
hypertension, pre-eclampsia and eclampsia
Explain the predisposing factors for
developing pre-eclampsia or eclampsia
Explain the types of pre-eclampsia

4. SPECIFIC OBJECTIVES cont
Explain how to diagnose pre-eclampsia and
eclampsia
Explain management of women with pre-
eclampsia or eclampsia.
Explain the complications of pre-eclampsia
and eclampsia

5. DEFINITIONS
 Chronic hypertension is a rise in BP
that is present before 20 weeks
gestation characterised by BP of
≥140/90
 Gestational hypertension is new rise
in BP presenting after 20 weeks
gestation without significant
proteinuria.

6. DEFINITIONS
PRE-ECLAMPSIA:
 Pre-eclampsia is a condition in pregnancy
occurring after 20 weeks gestation,
characterized by hypertension and
proteinuria.
ECLAMPSIA:
 Eclampsia is a hypertensive disorder
induced by pregnancy with convulsions.

7. CAUSES / PREDISPOSING FACTORS
Cause is unknown but predisposing factors
include:
Age below 20 or above 35
Primigravidity.
1st pregnancy with new partner (new set of
paternal antigen- immunological response)
Multiple gestation
Personal history of pre-eclampsia
Family history of pre-eclampsia
Obesity

8. CAUSES / PREDISPOSING FACTORS
Large placenta
Diabetes mellitus
Renal diseases
Chronic hypertension
Clotting disorders
Lupus (an inflammatory disease caused
when the immune system attacks its
own tissues)

9. TYPES OF PRE-ECLAMPSIA
MILD
• BP
≥140/90
• No protein
in urine
• Oedema +
MODERATE
• BP
≥150/90
• Proteinuria
+
• Oedema ++
SEVERE
• BP≥160/110
• Proteinuria
++
• Oedema
+++

10. TYPES OF PRE-ECLAMPSIA cont
Additional diagnostic signs and symptoms
of severe Pre-eclampsia.
 BP / Proteinuria with any one of the
following:
Pulmonary oedema
Epigastric or right upper quadrant pain.
Severe headache
Blurred vision

11. Oliguliria (<400ml urine in 24 hours)
HELLP Syndrome (Hemolysis, Elevated
Liver Enzymes and Low Platelet count).

12. DIAGNOSIS
 Proteinuria and high blood pressure is
used for diagnosis of pre-eclampsia

13. MANAGEMENT OF PRE-ECLAMPSIA
ANTENATALLY: depends on severerity
Mild and moderate pre-eclampsia
 Explain the condition to pt for cooperation
and to allay anxiety.
 Advise the pt to be on bed-rest to prevent
further BP rise.
 Counsel her on worsening signs of the
condition and should report if any arises.

14. MANAGEMENT cont
 Monitor condition wkly to ensure BP is
under control.
 Admit the pt if coming too far away from
hospital until BP has been controlled.
 Counsel on diet (rich in protein, fibre and
vitamins but low in carbohydrates and
salts)
NOTE: No sedatives in mild pre-eclampsia.

15. MANAGEMENT OF SEVERE PRE-
ECLAMPSIA
 Admit in Labour Ward at a quiet corner &
on a low bed for observations,
management, prevent worsening condition,
prevent injury.
 Administer Magnesium Sulfate.

16. MANAGEMENT OF SEVERE PRE-
ECLAMPSIA
 Monitor vital signs.
 Watch for signs of impending eclampsia.
 Check urine for protein.
 Monitor fluid intake and output. Do not
give more than one litre per day.
 Catheterise the bladder for easy
monitoring of urinary output
 If at health centre refer immediately

17. ADMINISTER MAGNESIUM SULFATE
ALWAYS READ THE LABEL
 Magnesium sulphate comes in different
concentrations.
 May come in ampoules, bottles, or vials

18. MAGNESIUM SULFATE
NOTE:
 Available concentrations of Magnesium
Sulfate
 20% Magnesium solution
 50% Magnesium solution (commonly available)
 To be administered through different routes
 IV/IM
 IV only

19. IV/IM MAGNESIUM SULFATE
Loading dose
 Administer 4 g of 20% Magnesium Sulfate
solution IV slow push over 15-20minutes
Dilution:
 Draw up 8ml of 50% Mag Sulph & dilute
with 12ml of sterile water or NS to make
20ml of 20% Magnesium Sulfate solution.


20.  AND
Administers 5g of 50% Magnesium Sulfate
solution (20 ml) with 1 ml of 2% Lignocaine
deep IM on each buttock (total 10g).
Dilution:
 Draw up 10ml of 50% Mag Sulph & add 1 ml
of 2% Lignocane which will give you 11ml
for each buttock (total 22Ml for both
buttocks).

21. MAINTENANCE DOSE
 Prior to administration of the maintenance
dose make sure that:
 Respirations are more than 16 breaths per
minute.
 Patellar reflexes are present
 Urine output is more than 30ml/hr in
preceding 4 hours
 Lungs are clear without rales
NOTE: If the pt is in respiratory arrest
administer 1g (10 mls) of 10% Calcium
Gluconate over 3 minutes

22.  If a woman convulses again after
15min, admin 2g of 20% Magnesium
sulfate solution, IV slow push over a 5
min period.
Maintenance dose given when there is no
sign of toxicity
 Administers 5 g of 50% (10 ml)
Magnesium Sulfate solution with 1 ml of
2% lignocaine deep IM alternately in
each buttock every 4 hours.

23. 50% MAGNESIUM SULFATE FOR IV ONLY
 Loading dose
 4g of 50% MgSO4 (8mls) diluted in a
bolus of 250mls of Normal Saline or
Ringers Lactate administered over a
period of 15-20 minutes
 If a woman convulses after 15min of
loading dose, admin 2g of 50%
Magnesium sulfate solution (4mls)in 6mls
of N/S or R/L (total 10mls), IV over 2
min.

24. MAINTENANCE DOSE
 4 g of 50% MgSO4 (8mls) diluted in 200
mls of normal saline administered over a
period of 4 hours at a rate of 50mls (1g)
per hour until 24 hours post-delivery or
last convulsion, whichever comes last

25. MANAGE HYPERTENSION
Medications for severe blood pressure
(SBP >160 or DBP >110)
 Hydralazine IV
 5mg starting dose. Check 20 minutes
after administration; if still elevated,
give an additional 10 mg
 Max dose 25 mg/24 hours

26.  Nifedipine PO
 10mg starting dose. Check 20 minutes
after administration; if still elevated,
give an additional 20 mg.
 Max dose 120mg/24 hours
 Can cause maternal headache or
dizziness

27. DURING LABOUR
 Close observations of maternal and fetal
well being.
 Monitor BP ¼ hourly.
 Conduct delivery with vacuum extraction.
 Conduct active management of third stage
of labour by controlled cord traction with
Oxytocin.
 Check urine for protein
 If not effective, terminate pregnancy by
C/S or induction.

28. ECLAMPSIA

29. SIGNS OF IMPENDING ECLAMPSIA
• A sharp rise in blood pressure
• Decreased urinary output
• Increased proteinuria
• Severe headache
• Drowsiness
• Mental confusion
• Visual disturbance (e.g. blurred vision,
flashes of light)
• Epigastric pain
• Nausea

30. PRINCIPLES OF MANAGING ECLAMPSIA
(ABC)
 Maintain open airway
 Control fits
 Reduce blood pressure
 Maintain fluid balance
 Termination of pregnancy

31. EMERGENCY MANAGEMENT
1. Note time of the fit.
2. Call for assistance
3. Position on the side
4. Protect from injury (padded spatula,
remove harmful objects)
5. Administer appropriate sedatives
6. Stay with the patient throughout

32. Make sure the woman can breathe
This is achieved in four steps:
 Place the woman on her side (in the
semi-prone position) so that mucous or
saliva will drain out, to prevent
aspiration during deep breathing.
 Clean the mouth and nostrils gently and
remove secretions. Use suction
apparatus very gently.

33.  Give oxygen (if available) and continue
for five minutes after each fit, or
longer if cyanosis persists.
 Stay with the woman to make sure that;
 her airway remains clear
 injury is prevented during the clonic
stage

34. CONTROL FITS
 Administer magnesium sulfate
• NOTE: if there were convulsions,
delivery should take place within 12
hours or, in the absence of convulsions,
within 24 hours.
• ADVANTAGE OF MAGNESIUM
SULPHATE:
Magnesium sulphate has shown to be more
effective than diazepum or phenytoin in
preventing the recurrence of fits.

35. DISADVANTAGE OF MAGNESIUM
SULPHATE
Magnesium sulphate can cause
respiratory depression in mother and
fetus (decrease in tendon reflex)

36. CONTROLLING BLOOD PRESSURE
Antihypertensive treatment (if diastolic BP is
110 mmHg or more):
• This management can be given for
eclampsia or severe pre-eclampsia.
• The management should be started if the
diastolic blood pressure reached 110 mmHg
or more on two readings to prevent
occurrence of hypertensive complications
such as cerebral haemorrhage.

37. CONTROLLING BLOOD PRESSURE
Advantages of Hydralazine
Hydralazine will reduce the blood
pressure quickly when hypertension is
severe.
It does not cause semi-consciousness
and associated problems.

38. CONTROLLING BLOOD PRESSURE
Disadvantages of Hydralazine
 In the mother hydralazine may cause:-
nausea and vomiting, headache, muscle
tremors.
 There may also be foetal distress
because of the sudden fall in blood
pressure the circulation of blood through
the uterus and placenta will be reduced.

39. CONTROLLING FLUID BALANCE
 Insert an indwelling urinary catheter
with an open drainage system, to monitor
the urine output.
 Record the urine output every 4 hours.
 Record the fluid intake.
 Suspect kidney failure if the urine
output is less than 30 mls per hour

40. ECLAMPSIA BEFORE LABOUR OR IN THE
LATENT PHASE
 Labour will be induced by giving
Oxytocin, only if:
 the cervix is very ripe (almost fully
effaced, dilatation 2-3 cm)
 the foetus is of normal or small size
 the pelvis appears of normal size by
vaginal examination
 no other contra-indications for vaginal
delivery exist

41. DELIVERY OF THE BABY
 Caesarean section will be performed if:
 there is a contra-indication to induction
 active labour does not follow within four
hours of induction
 If caesarean section is necessary the
anaesthetist will, of course, take into
account the drugs already given.
 This is particularly important with regard
to Magnesium Sulphate which will lessen
the amount of muscle relaxation needed

42. ECLAMPSIA IN THE ACTIVE PHASE OF
FIRST STAGE OF LABOUR
• Allow vaginal delivery only if:
labour is progressing quickly (on the alert
line of the partograph or to the left of it);
there are no contra-indications to vaginal
delivery.
• Difficult deliveries must be avoided. If
there is delay, caesarean section must
be carried out immediately

43.  ECLAMPSIA IN THE SECOND STAGE
OF LABOUR
 Deliver the baby by the quickest and
easiest route i.e. vacuum extraction.
 Delivery of an eclamptic patient should
occur within 12 hours after the onset of
fits.
 Avoid Ergometrine in the 3rd stage
because it causes a rise in BP, instead
give Oxytocin 10 IU IM.

44. CARE AFTER DELIVERY
 It is important to realize that fits can
occur for the first time after delivery.
Fits can also recur after delivery.
Therefore the patient must be very
carefully observed.
Points to be noted in providing care
 Careful observation and management
should be continued for at least 48 hours
after delivery if necessary.
 If the patient has fits after delivery,
continue observations and management
for 48 hours after the last fit.

45. CARE AFTER DELIVERY cont
• Nurse the patient in labour ward or other
area of intensive care where she can be
closely observed.
• Monitor blood pressure hourly. Continue
giving Hydralazine 10-20 mg IM until
diastolic blood pressure drops below 110
mmHg.

46. CARE AFTER DELIVERY cont
 Monitor urinary output very carefully.
The woman tends to retain fluids. This is
because the kidneys are slow to excrete
the extra circulating fluid after delivery
 This can cause a rise in blood pressure.
Be careful not to give too much fluid
intravenously during this period.

47. CARE AFTER DELIVERY cont
• If, after 48 hours, there are no fits, the
urinary output is good and the diastolic
blood pressure is below 100 mmHg the
patient can be transferred to the ward.
• Continue 4 hourly blood pressure checks
until diastolic pressure is less than 90mmHg
.
• Arrange for follow-up one week after
delivery then at 6 weeks.

48. COMPLICATIONS TO MOTHER
 Injuries
 Pneumonia
 hypertension
 Renal damage
 Liver damage
 Disemintaed Intravascular Coagulation
(DIC), cerebral haemorrhage leading
to CVA, APH placenta abruptio

49. COMPLICATIONS TO BABY
 Intrauterine Growth Retardation
(IUGR)
 Intrauterine Death (IUD)
 Asphyxia
 Fetal distress
 NND