This document defines eclampsia as pre-eclampsia complicated by seizures. It discusses that eclampsia has no known cause but risk factors include primigravidity, family history, and obesity. Symptoms include headaches and epigastric pain. Management involves magnesium sulfate to prevent seizures, controlling blood pressure, and delivery of the baby and placenta. Complications can include maternal organ damage, coma, and death as well as preterm birth and fetal growth issues for the baby. Overall, early detection and treatment can reduce mortality rates to under 2% for both mother and baby.

1. Welcome

2. ECLAMPSIA
Dr. Ataul karim
Intern Doctor
East West medical college Hospital

3. DEFINITION :
Pre-eclampsia when complicated with
convulsions and/or coma is called
eclampsia.
 Pre-eclampsia is a multisystem disorder of
unknown etiology characterized by
development of hypertension to the extent of
140/90 mm Hg or more with proteinuria after
the 20th weeks of gestation in a previously
normotensive and non proteinuric woman.

4. Incidence
 The incidence varies widely from
country to country and even
between different zones of the same
country. It is more common in
primigravidae (75%), five times more
common in twins than in single
pregnancies and occurs between the
36th week and term in more than
50%.

5.  Primigravidae
 Family History
 Placental abnormalities
 Obesity
 Pre- existing vascular Disease
 New Paternity
 Thrombophilia

6. CAUSES OF CONVULSION
 Cerebral Hypoxia
 Cerebral Oedema
 Cerebral Dysrthymia

7. Pathophysiology

8. ONSET OF FITS
 • Antepartum (50%) : Fits occur before the onset of labor
 • Intrapartum (30%): Fits occur for the first time during
labor
 • Postpartum (20%):Fits occur for the first time in
puerperium, usually within 48 hours of delivery.

9. CLINICAL FEATURES OF ECLAMPSIA
 Except on rare occasion an eclamptic patient always shows
previous manifestations of acute fulminating pre-eclampsia

10.  Headache  Disturbed sleep

11. Epigastric Pain Decreased urine
output
 Eye symptoms

12. Prognosis
 MATERNAL
• Immediate: Once the convulsion occurs, the prognosis becomes
uncertain. Prognosis depends on many factors and the ominous
features are:
(1) Long interval between the onset of fit and commencement of
treatment (late referral).
(2) Antepartum eclampsia specially with long delivery interval.
(3) Number of fits more than 10.
(4) Coma in between fits.
(5) Temperature over 102°F with pulse rate above 120/minute.
(6) Blood pressure over 200 mm Hg systolic.
(7) Oliguria (< 400 mL/24 hours) with proteinuria > 5 gm/24 hours.
(8) Nonresponse to treatment.
(9) Jaundice.

13. • Mortality:
Maternal mortality in eclampsia 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%.
• Remote:
Recurrence of eclampsia in subsequent
pregnancies is uncommon, although
chance of preeclampsia is about 30%.

14. FETAL
Perinatal mortality is very high to the extent of
about 30–50%.
 The causes are:
(1)Prematurity
(2)Intrauterine asphyxia
(3)Effects of the drugs used to control convulsions
(4)Trauma during operative delivery.

15. Investigation
Urine R/M/E: to see proteinuria
 Ophthalmoscopic examination: to see
retinal edema, constriction of the arterioles,
alteration of normal ratio of vein: arteriole &
haemorrhage

16. Blood values:
 Serum uric acid level may be increased
Blood urea level remains normal or slightly raised.
 Serum creatinine level may be more than 1 mg/dL.
There may be thrombocytopenia and abnormal
coagulation profile
 Hepatic enzyme levels may be increased

17. MANAGEMENT
1.GENERAL MANAGEMENT
2.CONTROL OF FITS
3.CONTROL OF HYPERTENSION
4.OBSTRETIC MANAGEMENT
5.MANAGEMENT OF COMPLICATION

18. GENERAL MANAGEMENT
The aim of management of eclampsia is to
prevention of Maternal and fetal death by
preventing respiratory distress and convulsion.
 Maintain eclamptic position- patient should be
kept in left lateral position with head extended,
lower leg straight, upper leg flexed over the
abdomen.
 Maintain airway.
 Ensure oxygenation.

19.  (I/V) fluid is to be started. Normally, it
should not exceed 2 litres in 24 hours.
 Catheterisation by self retaining
catheter
a. To record urine volume and adjust
fluid intake
b. Detect albunemia

20. Antibiotic: To prevent infection,
Broad spectrum antibiotics is given.

21. SPECIFIC MANAGEMENT
 Anticonvulsant : MgSO4 is the
drug of choice
 • Loading Dose (10gm) : 4gm
dissolved with 12cc distilled water
then I/V slowly over 10-20 min . Then
3gm I/M in each buttock.
 • Maintenance Dose : 2.5gm I/M in
alternative buttock 4 hourly upto 24hr
from the last convulsion or delivery
which comes later.

22.  Inj MgSo4 I/V Protocol (inj Nalepsin)
 Loading dose :
Inj Nalepsin 4 gm in 100ml rapid I/V at 60-75
drops/min over a period of 20 minutes.
 Maintenance dose :
Inj Nalepsin 100ml (4gm) @ 6-7 drops/min [need 4
hours to finish 1 bottle & continue 6 bottles for 24
hours (4x6 = 24gm)]
 [Inj Nalepsin (4gm/100ml) in 4 hours
=1gm/hr (i,e 25 ml/hr)
=25ml/hr x 15 drops/hrs (15 drops/ml)
=375 drops/60min =6-7 drops/min]

23. Antihypertensives and diuretics:
Inspite of anticonvulsant and sedative regime, if
the blood pressure remains more than 160/110
mm Hg, antihypertensive drugs should be
administered. Drugs commonly used are
hydralazine, labetalol, calcium channel blockers
or nitroglycerin.

24. Obstretic Management

25. Complication:
Maternal complication
 Tongue biting
 Aspiration
 Head injury
 CNS damage
 Intracranial haemorrhage
 Renal failure
 Injuries due to falling from bed
 Psychosis
 Shock
 Death

26. Fetal Complication
1 Prematurity
2 IUGR
3 Fetal Death

27. THANKS
TO
ALL