This document discusses eclampsia in Sudan. It defines eclampsia as seizures occurring in patients with pre-existing pre-eclampsia. The presentation provides details on diagnosing pre-eclampsia, risk factors, incidence in Sudan, management of severe cases, and prevention. Eclampsia is a major cause of maternal mortality in Sudan, responsible for 14.9% of deaths in 2010. Management involves anticonvulsants like magnesium sulfate, antihypertensives, and preventing future cases through availability of treatments and provider training.

1. ECLAMPSIA
in Sudan
Geneva Foundation for Medical
Education and Research
GFMER Sudan 2012
Forum No: ( 1 )

2. Name of presenter
Name Position Institution
Dr/ SAMI MAHMOUD Obstetrician/Gynecologist Reproductive Health Care
Centre
Name of contributors
Name Position Institution
Dr/ MAJDI SABAHELZAIN Pharmacist/ MSc. Public University of Medical
and Tropical Health Sciences and Technology

3. Content of the presentation
• Definition of Pre-eclampsia
• Diagnosis of Pre-eclampsia
• Importance of Pre-
eclampsia
• Risk Factors for Pre-
eclampsia
• Incidence in Sudan
• Management and

4. Definition
Appearance of seizures in a
patient (often with pre-
existing pre-eclampsia)
#
In 20%, BP can be normal
Can occur before, during or
after delivery
1/3 are post-delivery

5. Diagnosis
. Classic Triad:
-hypertension (>140/90)
-proteinuria (>1+ or >0.3g/24hours)
-generalized oedema (least reliable)
. Hypertension and proteinuria must
#
be present on two occasions.
.Rapid weight gain is supportive
evidence

6. Importance
.Second cause of Maternal Mortality in
Sudan.
.A cause of perinatal morbidity & Mortality.
.Risk of CVA #
.Renal failure
.Risk of iatrogenic fluid overload.
.HELLP Syndrome

7. Main Causes of Maternal Mortality
Qualitative Research Techniques - The four parts of Qualitative Research Techniques are:
Haemourage:
.
Pregnancy-Induced
Hypertension
Infections
Unsafe Abortion

8. Risk Factors for Pre-
eclampsia
. Nulliparity .Chronic renal
disease
. Maternal age <16 or
>40yrs .Antiphospholipid
syndrome (APLS)
. Multiple pregnancy
. Diabetes mellitus
#
#
. Family history of pre-
eclampsia or eclampsia
. Chronic (pre-existing)
hypertension

9. Severe pre-eclampsia: symptoms &
Headaches
Visual Disturbances
Pulmonary Oedema
Hepatic Dysfunction
RUQ or Epigastric Pain
Oliguria
Elevated Creatinine
Proteinuria of 5 g or more in 24 hrs
Systolic BP > 160 to 180 mm Hg
Diastolic BP > 110 mm Hg
Thrombocytopaenia or haemolysis

10. inical Course of Neglected Severe Pre-eclamps
CNS
Eyes Seizures
Arteriolar Spasm Intracranial Haemorrhage
Retinal Haemorrhage CVA
Papilloedema Encephalopathy
Transient Scotomata
Pancreas
Respiratory System Ischaemic Pancreatitis
Pulmonary Oedema
ARDS Kidneys
Acute Renal Failure
Liver
Subcapsular Haemorrhage Uteroplacental Circulation
Hepatic Rupture IUGR
Haematopoietic System Abruption
HELLP Syndrome Fetal Compromise
DIC Fetal Demise

11. Aetiology
.Uncertain
- cerebral oedema,
ischaemia are possible
#
causes.

12. Incidence in Sudan
.Distribution of maternal
death report according to
cause of death
(Jan 2010- Dec 2010)
Cause of Maternal Death ,
No. 889
1-Obstetric Haemorrhage
#
225 (25.1%)
2-Eclampsia
134 (14.9%)

13. Eclampsia Effects
Maternal death from 60%
eclampsia in Sudan
50%
in 2010 affects 134
cases (14.9%), 40%
. 71 case (53.0%) 30%
20%
ante partum,
#
10%
.48 cases (35.8%) 0%
post partum
. fifteen cases
(11.2%) intrapartum.

14. Fit Starting
90.00%
80.00%
.(79.9%), the first 70.00%
60.00%
50.00%
fit started at home 40.00%
30.00%
. (16.4%) first fit 20.00%
10.00%
#
0.00%
occurred in hospital
&
.(3.7%) on the way
to hospital.

15. Interval from first fit till
death from first fit till death 40.00%
Interval
was: 35.00%
. Less than two hours in 30.00%
25.00%
thirty cases (22.4%),
20.00%
. Two-six hours, 24 cases 15.00%
#
(17.9%), 10.00%
. Seven- 24 hours, thirty 5.00%
cases (22.4%) & 0.00%
Less 2-6 7-24 More
. More than 24 hours in fifty than 2 hours hours than
hours 24
cases (37.3%). hours

16. No. of Fits before
Death No. of Fits before Death
.Sixteen cases (11.9%)
died at home, 118 cases
reached hospital:
4 -5 Fits
. Almost 52 cases
#
5 -10 Fits
(38.8%) had four or less
fits before their death, More than
10
. 43 cases (32.1%) had
five –ten fits & 39 cases
(29.1%) had more than
ten fits before they died

17. common reported cause of maternal
deathCVA was the common
.
reported cause of maternal 45
40
death, 54 cases 35
(40.3%), followed by 30
25
. acute pulmonary 20
15
edema, 31 cases (23.1), 10
#
.acute renal failure, twenty 5
0
two cases (16.4%),
.HELLP syndrome, fifteen
cases (11.2%) & air way
obstruction twelve cases
(9.0%).

18. Helth Professionals
. In 68 cases (57.6%) a
consultant was involved in
the management;
consultants
. while in fifty cases
#
(42.4%) were managed Junior
by a junior.
.

19. Receiving
treatment
Receiving treatment
.Sixty three cases
(53.4%) received
anticonvulsant
(diazepam or
magnesium sulfate), Received
#
. while fifty five cases Not
received
(46.6%) did not received
any anticonvulsant

20. Management
1. CALL FOR HELP +++++
2. EMPHASISE IMPORTANCE OF BASIC
ABCs
3. ‘A’ – airway can’t be inserted during a fit
4. ‘C’ – includes x2 large bore cannulae
5. Initiate unit – ‘Eclampsia protocol’
#
6. DO NOT NURSE IN THE DARK!!
7. Give loading dose MgSO4
8. Foley catheter/fluid balance
9. Keep NBM

21. Management
•Antihypertensive ( Labetalol
, Hydralazine , Methyl Dopa &
Nifedipine)
•Magnesium sulphate
#

22. Prevention
• Reducing maternal death from
Eclampsia:-
• Availing of magnesium sulfate.
• Availing of Hydralazine.
#
• Training of care providers on
magnesium sulfate use &
monitoring side effects.

23. 22 August 2012 Ian Donald Symposium 23

24. Thank
You
22 August 2012 Ian Donald School 24