Hypertension is a prevalent medical issue during pregnancy, causing significant maternal and fetal health concerns, including increased risk of maternal mortality through conditions like pre-eclampsia and eclampsia. The document outlines the pathophysiology, clinical features, prevention strategies, and management approaches for eclampsia, emphasizing the importance of early detection and effective treatment. Specific interventions include the use of magnesium sulfate for convulsions, careful monitoring, and potential termination of pregnancy in severe cases.

4. INTRODUCTION
 Hypertension is the most common medical problem
encountered during pregnancy.
 Hypertensive disorders in pregnancy may cause maternal &
fetal morbidity & leading cause of maternal mortality.
 Hypertensive disorders are :
1. Pre-eclampsia
2. Eclampsia
3. Gestational Hypertension
4. Chronic Hypertension

5. DEFINITION
 Varadaeus coined the term eclampsia, is derived from a
Greek word, meaning is “ like a flash of lightening”.
 The International Society for the study of Hypertension
in pregnancy (ISSHP), defines as the “Occurrence of
generalized convulsions associated with signs of pre-
eclampsia during pregnancy, labour or within 7 days of
delivery and not caused by epilepsy or other convulsive
disorders.

6. Contd……………………….
 Pre- eclampsia when complicated with generalized tonic-
clonic convulsions and/or coma is called eclampsia.

7. PATHOPHYSIOLOGY
Placental hypo perfusion
Constriction of small arteries
Reduced blood flow to multiple organs
Increased vascular permeability
Shift of extracellular fluid from the blood to the interstitial
space

8. Contd…………………………
Reduced blood flow and edema
Hypertension, Renal ,Pulmonary and Hepatic dysfunction
and cerebral edema with cerebral dysfunction and
convulsion.

9. CLINICAL FEATURES
It consist of four stages, that are:-
 PREMONITORY STAGE :-
 The patient becomes unconscious.
 There is twitching of muscles of face, tongue and limbs.
 Eye balls roll or are turned to one side and becomes
fixed.
 This stage lasts for about 30 second.

10. Contd………………………..
 TONIC STAGE :-
 The whole body goes into a spasm called trunk
opisthotonus.
 Limbs are flexed and hands clenched.
 Respiration ceases and tongue protrudes between the
teeth.
 Cyanosis appears.

11. Contd……………………………………
 Eye balls become fixed.
 This stage lasts for about 30 seconds.
 CLONIC STAGE :-
 All the voluntary muscles undergo alternate contraction
and relaxation.
 The twitching starts in face then involve one side of
extremities and ultimately the whole body is involved

12. Contd……………………
in the convulsion.
 Biting of tongue occurs.
 Breathing is stertorous and blood stained frothy
secretions fill the mouth.
 Cyanosis gradually disappears.
 This stage lasts for 1 – 4 minutes.

14. Contd……………………………
 STAGE OF COMA :-
 Following the fit, the patient passes on the stage
of coma.
 It may last for a brief period or in others deep
coma persists till another convulsion.
 On occasion, the patient appears to be in a

15. Contd………………………………….
confused state following the fit and fail to remember the
happenings.
 The fits are usually multiple, recurring at varying
intervals.
 When it occurs continuously it is called status
eclampticus.
 Following the convulsion, temperature rises, pulse and

16. Contd…………………………..
respiration rate are increased and blood pressure also
increases.
 The urinary output is markedly diminished, proteinuria
is in pronounced and blood uric acid is raised.

17. OTHER CLINICAL FEATURES
 Headache
 Visual disturbance
 Epigastric pain
 Oedema
 High blood pressure
 Fluid retension
 Fundal height less than approximate date

19. MANAGEMENT
Aim of management.
Prediction & prevention.
First aid treatment outside the hospital.
General management (medical & nursing).
Specific management.
Obstetric management.

20. 1. AIM OF MANAGEMENT :-
Arrest convulsion
Maintenance of patent airway, breathing and
circulation.
Oxygen administration at the rate 8-10 L/minute.
Terminate pregnancy.
Ventilatory support.
Prevention of complication.

21. Contd…………………………………..
Prevention of life threatening situation.
Postpartum care.
Medicine and regular follow up.

22. Contd……………………………
2. PREDICTION AND PREVENTION :-
In majority of cases, eclampsia is preceded by pre-
eclampsia.
Thus prevention of eclampsia rest on early detection
and effective institutional treatment with judicious
treatment of pregnancy with eclampsia.

23. Contd……………………..
Use of anti-hypertensive drugs, anti- convulsent therapy
and timely delivery are important steps.
Close monitoring during labour and 24 hours of
postpartum, are also important in prevention of
eclampsia.
Unfortunately 30 -85% of cases of eclampsia remained
unpreventable.

24. Contd……………………………..
Use of magnesium sulphate lowers the risk of eclampsia.
3. FIRST AID TREATMENT OUTSIDE THE
HOSPITAL :-
The patient, either at home or in the health center
should be shifted urgently to the tertiary referral care
hospitals, because there is no place of continuing the
treatment in such place.

25. Contd………………………………….
Transport of an eclamptic to a teritiary care centre is very
important.
Such patient needs neonatal and obstetric intensive care
management.
 IMPORATANT STEPS IN TRANSPORT ARE :-
a. All maternal records and detailed summary should be
sent with patient.

26. Contd…………………………….
b. Drugs should be established and convulsions should be
arrested.
c. Drugs should be give like: magnesium sulphate,
labetalol, diuretics, diazepam.
d. One medical personnel and a trained midwife should
accompany with the patient in a well equipped
ambulance to prevent injury and complications.

27. Contd……………………….
4. GENERAL MANAGEMENT :-
SUPPORTIVE CARE :-
 Aims to prevent serious maternal injury from fall, to
prevent aspiration, to maintain airway and to ensure
oxygenation.
 Patient is kept in railed cot and a tongue depressor is
inserted between teeth.

28. Contd……………………
• She is kept in lateral position to avoid aspiration.
• Vomitus and oral secretion are removed by frequent
suctioning, oxygenation is maintained through face mask
to prevent respiratory acidosis.
• ABG analysis is needed when oxygen saturation falls
below 92%.
• Sodium bicarbonate is given when PH is below 7.10.

29. Contd……………..
HISTORY :-
 Detailed history is to be taken from relatives, relevant to
diagnosis of eclampsia, duration of pregnancy, number
of fits and nature of medications administered outside.
EXAMINATION:-
 Once the patient is stabilized, abdominal and vaginal
examination are made. A self retaining catheter is
introduced and urine if tested for protein.

30. Contd……………………..
MONITORING :-
 Half hourly pulse, respiration rate are recorded.
 Hourly urine output is to be noted.
 If undelivered the uterus should be palpated at regular
intervals to detect the progress of labour and fetal heart
rate is to be monitored (bradycardia occurs).

31. Contd………………………
FLUID BALANCE :-
 Ringer’s lactate solution.
 A excess of dextrose or crystalline solutions not be used
as it will aggravate the tissue are overload leading to
pulmonary edema, circulatory overload and ARDS.
ANTIBIOTIC:-
 Ceftriaxone 1gm IV, BD.

32. Contd………………………..
5. SPECIFIC MANAGEMENT:-
Anti- convlsant and Sedative therapy:-
 Magnesium sulfate is the drug of choice.
 Other regimen are:-
a) Phenytoin
b) Diazepam
c) Lytic cocktail(MENON 1961) using
chlorpromazine, pethadine, promethazine.

33. Contd…………………………
Anti – hypertensive and diuretics :-
 Drugs commonly used are:-
a) Hydralazine
b) Labetalol
c) Calcium channel blocker or nitroglycerine.
 Diuretics in case of pulmonary edema. Frusimide is
given in dose of 20-40 mg IV .
Management during fits:-

34. Contd………………………..
Status Eclampticus:-
 Thiopentone sodium 0.5gm dissolved in 20ml of 5%
dextrose is given very slowly.
Treatment of complication:-
 Prophylactic antibiotics.
 For pulmonary edema and ARDS, frusemide 40mg IV
followed by 20gm of mannitol IV.

35. Contd………………………..
 For heart failure, dopamine infusion if given.
 For psychosis, chlorpromazine or trifluoperazine is quite
effective.
6. OBSTETRIC MANAGEMENT:-
Fits controlled
1) Baby mature
2) Baby premature(<37 weeks)
3) Baby dead

36. Contd……………………..
Fits not controlled:-
 Termination of pregnancy.
 Low rupture of the membranes is to be done to
accelerate the labour.

37. BIBLIOGRAPHY
DC DUTTA’S TEXTBOOK OF OBSTETRICS,
PAGE NO: 230- 236.
ESSENTIAL OBSTETRICS AND GYNACOLOGY, E.
MALCOLM SYMONDS & IAN. M. SYMONDS, PAGE
NO: 107-110.
ECLAMPSIA – SLIDE SHARE PRESENTATION BY
V. SHARMA,4TH YEAR NSG, BANGLORE.