Download to read offline
MANAGEMENT OF ECLAMPSIA.pptjtxgkzfjstjts4js4jsj4s4jsj4sr4jrx
- 1. MANAGEMENT OF ECLAMPSIA Haran SamrajC Roll no. 36
- 2. Management In a pregnantwoman with convulsions, the first diagnoses should be eclampsia unless proven otherwise. Based on a quick history/referral letter and after checking the Mood pressure and urine for albumin, the diagnosis should be made. Inappropriate management during and after an eclamptic convulsion can be detrimental to the mother and fetus. A senior obstetrician and anesthesiologist should be involved in the management.
- 3. Eclampsia tray inthe labour room At least 14 amps of MgSO4, At least 2 amps of calcium gluconate (10 ml. amp) 20 cc syringe Oxygen with face mask Airway Suction cannula Adult Ambu bag Knee hammer Injection labetalol Tablet nifedipine
- 4. PRINCIPLES OF MANAGEMENT General management Control of seizures Control of hypertension Anticipate complications Terminate pregnancy
- 5. GENERAL MANAGEMENT Mosteclamptic convulsions are self-limiting. Therefore, during a seizure, one must resist the impulse to administer anticonvulsive drugs. The woman should he turned on her side, her airway should be secured and any vomitus should be cleared. It is vital to support maternal respiratory, and cardiovascular functions. Oxygen should be delivered via face mask at the rate of 8-10 L/minute. Pulse oximetry should be used to monitor oxygen saturation with the goal of keeping it above 94%. The woman should be positioned in the lateral position to minimise aspiration of oral secretions. Blood samples should be sent for investigations-CBC, RFT LFT and coagulation profile. In eclampsia, meticulous monitoring is required. The heart rate should be monitored continuously with an ECG monitor as these women are prone to ventricular arrhythmias. Blood pressure and oxygen saturation should be monitored continuously and documented every 15 minutes. Invasive hemodynamic monitoring may be required in intractable cardiac failure, severe renal disease, refractory hypertension, pulmonary edema and oliguria
- 6. ANTICONVULSANT THERAPY Currenily,parenteral magnesium sulphate is the drug of choice for the control of convulsions in eclampsia. In women with pre-eclampsia, magnesium sulphate has been shown to improve cerebral arterial circulation. It also protects the endothelial cells from damage by free radicals, prevents calcium entry into the ischemic cells and acts as a competitive antagonist to the glutamate N-methyl-D-aspartate receptor. Pritchard's regimen Loading dose (intravenously) The total loading dose is 14 g of 50% MgSO 4 g is given by the intravenous route as 20 ml. of 20% solution given over a period of 20 minutes. This is followed by 5 g (5 amps) of the same solution in each buttock, deep IM (total of 10 g IM), with 1 ml. of lignocaine in the same syringe, A large-bore needle may be required. Maintenance dose (intramuscularly) 5 g (5 amps) of a 50% solution + 1 ml. of 2% lignocaine IM is administered every 4 hours into alternate buttocks
- 7. MOITORING OF WOMANWHILE ON MAGNESIUM SULPHATE Deep reflexes hourly Respiratory rate > 16/minute Urine output>30 ml/hour The signs of hypermagnesemia are as followS Respiratory rate <16/minute Knee-jerk reflexes absent Urine output monitoring is important as impaired renal function can increase magnesium toxicity.
- 8. When thereare clinical signs of hypermagnesemia. further doses of magnesium sulphate should be withheld, and an injection of 10% calcium gluconate should be given intravenously. Once the clinical signs of hypermagnesemia resolve, 2 g of MgSO, should be given IV over 5-10 minutes and followed up with the maintenance dose. In case of respiratory depression, intubation and mechanical ventilation should be started without any delay. Other side effects of magnesium sulphate Warmth, flushing, nausea, vomiting, diplopia, slurred speech, hypotension and arrhythmias can occur; it can also potentiate muscle relaxant activity. Magnesium sulphate may relax the uterus, and there may be fetal heart rate abnormalities. In women with elevated creatinine levels, the loading dose should be reduced to 4 g.
- 9. CONTROL OF HYPERTENSION The goal of antihypertensive therapy is to keep systolic BP between 140 and 155 mmHg and diastolic between 90 and 100 mmHg. Eclampsia patients have raised intracranial pressure, and therefore, it is important to lower the blood pressure gradually, otherwise the intracranial pressure will rise further. Hydralazine and nifedipine are associated with tachycardia and should be avoided in patients with a heart rate above 110 bpm; labetalol can be used instead. In patients with bradycardia (heart rate <60 bpm), asthma or congestive heart failure, labetalol should be avoided. Nifedipine is associated with improved renal blood flow and a resultant increase in urine output, making it preferable for patients with decreased urine output.
- 10. DIFFERENTIAL DIAGNOSIS Cerebrovascularaccidents Epilepsy Meningitis, encephalitis Intracerebral hemorrhage due to a ruptured aneurysm Cerebral venous thrombosis Arterial or venous infarcts Angiomas Hypertensive encephalopathy Previously undiagnosed brain tumours Metastatic gestational trophoblastic disease Metabolic diseases Postdural puncture syndrome