eclampsia is the onset of seizure in a women with pre-eclampsia. study material for nursing youtube

2. The word eclampsia is derived from Greek
word that means “ a flash of lightning”.
Eclampsia is commonly defined as new
onset of grand mal seizures activity and or
unexplained coma during pregnancy or
postpartum in a woman with signs and
symptoms of pre eclampsia.

3. DEFINITION : The term eclampsia is derived
from Greek word , meaning like a flash of
lightning. It may occur quite abruptly ,
without any warning manifestations.
Pre eclampsia when complicated with
convulsion and coma is known as eclampsia.
INCIDENCE : In India it ranges from 1 in 500 to
1 in 30. Its more common in primigravida
(75%) , 5 times more common in twins than
in singles pregnancies and occurs between
the 36 week and term in more than 50%.

4. The cause of cerebral irritation leading to
convulsion is not clear.
The irritation maybe provoked by :
1. Anoxia : Spasm of the cerebral vessels
following hypertension → increase cerebral
vascular resistance → fall in cerebral oxygen
consumption → anoxia.
2. Cerebral edema : May contribute to
irritation.
3. Cerebral dysrhythmia : Increases following
anoxia and edema.

5. Convulsion occur more frequently beyond 36
week. On rare occasions , convulsions may
occur in early months as in hydatidiform
mole: 1. Antepartum (50%) : Fits occur
before onset of labor.
2. Intrapartum (30%) : 0ccurs for the
first time during labor.
3. Postpartum (20%) : Occur for the
first time in pueperium , usually within 48 hr
of delivery.

6. The convulsions are epileptic form and
consist of four stages :
PRE-MONITORY STAGE :
The patient becomes unconscious.
There is twitching of the face , tongue and
limbs. Eyeballs are rolled or turned to one
side and become fixed. This stage last for
about 30 seconds.

7.  TONIC STAGE
The whole body goes into a tonic
spasm.
The trunk , limbs are fixed and hands
clenched.
Respiration ceases and the tongue
protrudes between the teeth. Cyanosis
appears. Eyeballs become fixed. This last for
about 30 seconds.

8.  CLONIC STAGE
All the voluntary muscles undergo
alternate contraction and relaxation. The
twitching starts in the face and then involve
one side of the extremities and ultimately
the whole body is involved in the convulsion.
Biting of the tongue occurs , breathing
becomes stertorons and blood – stained
frothy secretions fill the mouth. Cyanosis
gradually disappears.

9.  STAGE OF COMA
Rarely coma occurs without convulsion.
The fits usually are multiple , recurring at
varying intervals. When it occurs in quick
succession , it is called status eclampticus.

10.  In the premonitory stage , a mouth gag is placed
in between the teeth to prevent tongue bite and
should be removed after the clonic phase is over.
 The air passage is to be cleared off the mucus
with a mucus sucker. The patient’s head to be
turned to one side and the pillow is taken off.
Raising the end of the bed, facilitates postural
drainage of the upper respiratory tract.
 Oxygen is given until cyanosis disappears.

11.  STATUS ECLAMPTICUS MANAGEMENT
Thiopentone sodium 0.5 gm dissolved in
20ml of 5% dextrose is given IV very slowly.
The procedure should be supervised by an
expert anaesthetist.

12.  Injuries : Tongue bite , bed sore.
 Pulmonary edema : due to leaky blood
capillaries.
 Pneumonia : aspiration , hypostatic or
infective.
 Acute left ventricular failure.
 Hyperpyrexia , renal failure.
 Puerperal sepsis.

13.  MATERNAL
Immediate : prognosis depends on many
factors and the features
1. Long interval between the onset of fit and
commencement of treatment.
2. Number of fits more than 10.
3. Temperature over 102 F with pulse rate above
4. Blood pressure over 200 mm of Hg systolic.
5. Non – respond to treatment.
Once the convulsion occurs , the prognosis
becomes uncertain.

14.  Mortality
Maternal mortality in eclampsia is very high
in India and varies from 2 to 30% , much
more in rural based hospital than in the
urban counterpart.
However , if treated early and
adequately, the mortality should be even less
than 2%.

15.  Cardiac failure
 Anuria
 Cerebral haemorrhage
 Postpartum embolism
 Puerperal sepsis
Remote : If the patient recovers from acute
illness , she is likely to remover rapidly
within 2-3 weeks.

16.  Fetal
The prenatal mortality is very high to the extent
of 30 - 50% .
The causes are :
1. Prematurity – spontaneous or induced.
2. Intrauterine asphyxia due to placental
insufficiency arising out of infraction ,
retroplacental haemorrhage and spasm of
uteroplacental vasculature.
3. Effects of the drugs used to control
convulsions.
4. Trauma during operative delivery.

17. First aid treatment outside the hospital.
The patient , either at home or in the
peripheral health centres should be shifted
urgently to the referral hospitals.

18. THE PRINCIPLES
 Resuscitation : maintain airway
 Arrest convulsions
 Organise investigations
 Hemodynamic stabilisation
 Delivery by 6- 8 hours
 Postpartum care i.e intensive care

19.  The patient should be placed in a railed cot
in an isolated room , protected from noxious
stimuli.
Airway is maintained , oxygen is
administered.
 Detailed history to be taken from the
relatives, relevant to the diagnosis of
eclampsia , duration of pregnancy , number
of fits and nature of medication administered
outside.

20.  If the patient is unconscious , a self retaining
catheter is introduced and the urine is tested
for protein.
 Half hourly pulse , respiration rates and
blood pressure to be recorded.
 Fluid balance : crystalloid solution ( RL ) is
started as first choice.
 Total fluids should not exceed the previous
24 hr urinary output plus 1000 ml.
 Antibiotic : To prevent infection , ampicillin
500 mg IM or IV 6 hourly is administered.

21.  Anticonvulsant therapy is given to control
the fit and to prevent its recurrence.
Magnesium sulphate is the drug of choice.
Administration of Magnesium sulphate
The regimen given below :
1. Zuspan regimen :
> Loading dose : 4g IV over 5 – 10 mint.
> Maintenance dose : 2g/hr IV infusion.

22.  Saibai regimen
> Loading dose : 6g IV over 20 minute.
> Maintenance dose : 2g/hr IV infusion.
The therapeutic level of serum magnesium is
4.7 mEq/L. Magnesium sulphate is continued
for 24hr after the last seizure . For
recurrence of fits , further 2g IV bolus is
given over 5 mint in the above regimens.

23. If the BP remains more than 160/110 mm of
Hg antihypertensive drugs should be
administered.
Hydralazine is quite effective in such acute
condition. A dose of 5mg is given IV slowly
and to be repeated after 2o mints with 10
mg, if there is no response. The BP should be
monitored every 5 mint. It is given next
whenever the diastolic pressure rises 110mm
of Hg.

24. Alternatively labetalol ( combined a and p
receptor blocker ) is given by slow IV route
20 mg/hr , for smooth control of BP.
Dose may be doubled by every 30 min.
Unlike hydralazine , labetalol does not
precipitate headache and palpitation.

25. Prophylactic use of antibiotics markedly
reduces the complications like pulmonary
and puerperal infection.
Pulmonary edema : Frusemide 40mg IV
followed by 20 --> of mannitol IV. Aspiration
of the mucus from the tracheobronchial tree
by a suction apparatus is done.

26. Heart failure : Oxygen inhalation , parental
lasix and digitalis are used.
Hyperpyrexia : cold sponging and
antipyretics.
Psychosis : Chlorpromazine or eskazine
(trifluoperazine ) is quite effective.

27. Patient with multiple medical problem needs
to be admitted in an intensive care unit
where is look after by a team consisting of an
obstetrician , a physician and expert
anaesthetist. Cardiac , renal or pulmonary
complication are manage effectively.
Use of blood gas analyzer pulse oxymetry
and central venous pressure monitored
should be done depending on individual case.

28.  The women should be placed in a sound
protected room to minimize auditory
stimulation.
 Eye pads to be applied to minimize optic
stimulation.
 The room should be well – lighted. So as not
to miss development of cyanosis.

29.  Bed railings to be padded in order to
minimize physical injury during convulsion.
 Patient to be placed in semi prone position
and the position to be change at every 2hr if
the patient s heavily sedate or in deep coma
to avoid hypostatic pneumonia and bed sore.
 Keep Foley ‘s catheter in the urinary bladder
and chart urine output every hour.

30.  Minimal handling and stimulation in order to
reduce the risk of occurrence of another
convulsion.
 Maintain an IV line patent , preferably in a
central vein.
 Keep a tracheotomy tray available.
 Apply a thromboplastic stocking to prevent
deep vein thrombosis.

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