Downloaded 42 times
Eclampsia in Sudan
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.
More Related Content
Similar to Eclampsia in Sudan
More from Reproductive & Child Health Research Unit (RCRU)
Eclampsia in Sudan
- 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 thepresentation ā¢ Definition of Pre-eclampsia ā¢ Diagnosis of Pre-eclampsia ā¢ Importance of Pre- eclampsia ā¢ Risk Factors for Pre- eclampsia ā¢ Incidence in Sudan ā¢ 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 ofMaternal Mortality Qualitative Research Techniques - The four parts of Qualitative Research Techniques are: Haemourage: . Pregnancy-Induced Hypertension Infections Unsafe Abortion
- 8. Risk Factors forPre- 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 ofNeglected 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 Maternaldeath 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 firstfit 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 Fitsbefore 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 āten fits & 39 cases (29.1%) had more than ten fits before they died
- 17. common reported causeof 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 . In68 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. āAā ā airway canāt be inserted during a fit 4. āCā ā includes x2 large bore cannulae 5. Initiate unit ā āEclampsia protocolā # 6. DO NOT NURSE IN THE DARK!! 7. Give loading dose MgSO4 8. Foley catheter/fluid balance 9. Keep NBM
- 21. Management ā¢Antihypertensive ( Labetalol , Hydralazine , Methyl Dopa & Nifedipine) ā¢Magnesium sulphate #
- 22. Prevention ā¢ Reducing maternal death from Eclampsia:- ā¢ Availing of magnesium sulfate. ā¢ Availing of Hydralazine. # ā¢ 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