Education is power

1. HYPERTENSIVE DISORDERS OF
PREGNANCY

2. Hypertensive Disorder of pregnancy
• Term that is used to describe conditions in
which hypertension is present in pregnancy
• Also referred to as toxemia of pregnancy

3. Classifications
Pregnancy induced Hypertension
• Also called Gestation hypertension
• Condition in which there is raised (elevation
of) blood pressure of 140/90mmhg or more
occurring after the 20th week of gestation but
not accompanied by proteinuria and oedema
• The condition resolves within three months
after delivery

4. Classifications Cont’
Pre Eclampsia/ Eclampsia
• Raised Blood pressure accompanied by
proteinuria and oedema (oedema may not
always be present)
• In Eclampsia, there are also convulsions

5. Classifications cont’
Chronic Hypertension
• There is Raised blood pressure before
pregnancy or before the 20th week of
gestation and continues even after delivery
• Classified into two
1. Primary/ Essential/ idiopathic Hypertension
• Also divided into two:

6. Classifications cont’
Benign Essential hypertension
• One in which there is slow progression and a
person may stay with it for years without
causing serious problems
Malignant Essential Hypertension
• One in which there is rapid progression and
may cause serious organ failure (renal,
hepatic, brain damage etc)

7. Classifications cont’
2. Secondary hypertension
• Type of hypertension which has an underlying
cause (associated with co existing conditions)

8. Note
Primary Hypertension
• For blood pressure to rise, there must be an
increase in either cardiac output (CO) or
Systemic Vascular Resistance (SVR)
• Sometimes, the CO may come to normal
while the SVR may persistently rise and
persistent SVR is the hallmark of hypertension

9. Other classification of pregnancy
induced Hypertension
Before first 20 weeks of gestation:
– Chronic hypertension
– Chronic hypertension with superimposed mild
pre-eclampsia
After 20 weeks gestation:
– Hypertension without proteinuria
– Mild pre-eclampsia
– Severe pre-eclampsia
– Eclampsia

10. Pre Eclampsia/ Eclampsia
General Objective
• At the end of the lecture/ discussion, students
should demonstrate an understanding of pre
eclampsia and eclampsia and be able to care
for patients with such conditions.

11. Specific Objective
At the end of the lecture/ Discussion, students
should be able to:
• define pre eclampsia
• state the classification of pre eclampsia
• explain the etiology of Pre eclampsia
• mention the risk factors of pre eclampsia
• explain the pathogenesis of pre eclampsia
• state the signs and symptoms of pre eclampsia

12. Specific Objective
• make a diagnosis of pre eclampsia
• explain how to manage pre eclampsia
• explain the complications of pre eclampsia

13. Pre Eclampsia / Eclampsia
Introduction
• Pre Eclampsia and Eclampsia are conditions
that occur in pregnancy and they are ranked
amongst the hypertensive diseases that cause
maternal and fetal morbidity and mortality
• Eclampsia is the 5th global cause of maternal
deaths

14. 24.8
14.9
12.9
6.9
12.9
7.9
19.8
Hemorrhage 24.8%
Infection 14.9%
Eclampsia 12.9%
Obstructed Labor
6.9%
Unsafe Abortion
12.9%
Other Direct Causes
7.9%
Indirect Causes
19.8%
Introduction Cont’
Global causes of Maternal Mortality

15. Introduction
• These Obstetric complications must be
watched for in every antenatal woman as they
posse a danger to both the mother and the
baby.
• The conditions usually occur in the 2nd and 3rd
trimesters
• There also instances where they can occur in
intrapartum and postpartum periods

16. Pre Eclampsia
• Also called Gestation proteinuric Hypertension
• Peculiar condition in pregnancy which occurs
after the 20th week of gestation characterised
by hypertension, proteinuria and oedema
(however oedema may be present or not)
• A woman over 20 weeks of gestation with
diastolic blood pressure above 90mmgh and
has proteinuria.

17. Classification of Pre Eclampsia
According to severity:
1. Mild Pre eclampsia
• 2 readings of diastolic blood pressure of 90-
110 mmhg done 4 hours apart after the 20th
weeks of gestation
• Proteinuria up to ++

18. Classification of Pre Eclampsia
2. Severe Pre eclampsia
• Diastolic blood pressure of 110 mmhg and
more
• Proteinuria of +++
Note;
Diastolic is not affected by excitement

19. Etiology of Pre Eclampsia
• Generally, the placenta is considered to be the
main cause of hypertensive disorders in
pregnancy
• This is because the condition of the mother
returns back to normal after delivery
(regresses)
• Abnormal placentation is attributed to be the
cause

20. Etiology of Pre Eclampsia cont’
• In normal placentation, between the 16 and
20th weeks of gestation, the trophoblasts
erodes arteries of the myometrium thereby
altering the elasticity of the tissue
• This results in dilated blood vessels which will
not be constricting
• This creates low pressure and high blood flow
into the placenta with maximum perfusion

21. Etiology of Pre Eclampsia cont’
• In Pre Eclampsia however, the invasion of the
arteries of the myometrium by the
trophoblastic cells is inhibited
• This results in vaso-constriction and hence
decreased placental perfusion
• And this leads to early placental hypoxia
related to low blood flow and high pressure
causing spasms and later ischeamia

22. Risk factors
• Genetic factors i.e. runs in families
• Previous history of pre eclampsia/ eclampsia
• pregnancy induced hypertension
• First pregnancy from a new partner
• Risk age groups (Extreme ages like teenage prime
Gravida, 16 years and less and pts older than 35
years). Blood vessels are not very distensible
• Obesity

23. Risk factors Cont’
• Medical conditions e.g Renal diseases (renal
hypertension), Diabetes mellitus
• Multiple pregnancy , hydatidiform mole,
diabetes mellitus causes excessive placental
mass
• Low social economic status (lack of ANC, good
diet and poor health seeking behaviour)
• Alcohol intake, it has calories which increases
body weight

24. Risk factors Cont’
• Smoking, nicotine in cigarettes constrict the
blood vessels
• Sedentary life style, inactivity
• Nutritional factors, very rich foods

25. Pathogenesis of Pre Eclampsia
• Pre eclampsia has been called a disease of
theory because the true mechanism behind
the pathogenesis is unknown
• Women who develop this condition become
sensitive to substances that increase the
blood pressure rather than less sensitive to
them as in normal pregnancy

26. Pathogenesis of Pre Eclampsia Cont’
• This response is attributed to the ratio
between prostacyclin and thromboxane
• Prostacyclin, prostaglandin hormone
produced by the endothelial cell is a vaso
dilator which decreases blood pressure,
prevents platelet aggregation and promotes
uterine blood flow

27. Pathogenesis of Pre Eclampsia Cont’
• Thromboxane (produced by the platelets) on
the other hand causes vaso constriction and
platelet agglutination
• In Pre Eclampsia, prostacyclin is decreased
while thromboxane levels increases causing
vaso constriction and platelet aggregating
effect

28. Pathogenesis of Pre Eclampsia Cont’
• These hormones are also partially produced
by the placenta
• This therefore explains why the condition is
reversed when the placenta is delivered and
why the incidence is increased when there is a
larger than normal placental mass such as in
conditions like hydrops fetalis, multiple
pregnancy and hydatidiform mole

29. Pathogenesis of Pre Eclampsia Cont’
• Because of this changes, there is generalised vaso
constrictions leading to reduction in blood flow to
the majority of important internal organs
• And because of increased pressure, there is also
increased endothelial damage leading to capillary
permeability
• This results in the escape of proteins and
eventually loss of fluids from the vessels to the
tissue causing oedema

30. Pathogenesis of Pre Eclampsia Cont’
• Because of this and more events, certain pathological
changes takes place and these changes affect a number
of organs and systems as explained below:
Blood
• High blood pressure coupled with endothelial cell
damage affect capillary permeability leading to leakage
of plasma proteins from the damaged blood vessels
• This causes a decrease in the plasma colloidal pressure
and escape of fluids in the tissues causing oedema
• This loss of fluids cause hypovolaemia and hemo
concentration, evidenced by elevated hematocrit level

31. Pathogenesis of Pre Eclampsia Cont’
• Damage of the vascular endothelium (vessels)
lead to the activation of the coagulation cascade
leading increased utilisation of the platelets
• This causes thrombocytopenia and DIC
(disseminated intravascular coagulation)
• In severe cases, there is deposition of the clotting
factors (fibrin, platelets) leading to the occlusion
of blood flow to organs e.g renal, placenta, brain

32. Pathogenesis of Pre Eclampsia Cont’
Kidneys
• Vaso constriction causes reduced renal flow
resulting in reduced glomerular filtration which
should normally increase in pregnancy
• Increased blood pressure causes damage to the
bowman’s capsule allowing proteins to escape
leading to proteinuria
• This also causes increased reabsorption of fluids
• If the condition worsens, oliguria sets in, a sign
of renal damage and severe pre eclampsia

33. Pathogenesis of Pre Eclampsia Cont’
Liver
• Vaso constriction cause hypoxia and oedema of
the liver cells leading to epigastric pain
• In severe cases intra capsular haemorrhage and
necrosis worsens the above symptom
• Impaired liver function may result in altered liver
enzymes and albumin levels
• There is also impairment in the release of
clotting factors leading to impaired coagulation
(DIC)

34. Pathogenesis of Pre Eclampsia Cont’
Brain
• Constricted blood vessel and increased
capillary permeability may lead to cerebral
vascular accidents(CVA) and cerebral oedema
• This may result in headache, visual
disturbance and convulsions
• If the condition worsen, it may lead to
hypertensive encephalopathy

35. Pathogenesis of Pre Eclampsia Cont’
Lungs
• The lungs become congested with fluids
causing pulmonary oedema
• This results in impaired gaseous exchange
leading to cyanosis and hypoxia
• Vessel of the lungs may rapture and pt may
cough and vomit blood

36. Pathogenesis of Pre Eclampsia Cont’
Eyes
• Small vessels of the eye may rapture leading to blurred
vision
Foetal placental unit
• The vaso constriction causes reduced blood flow to the
placenta
• The constricted vessels may rapture causing
detachment of the placenta (placenta abruptio) and
DIC might follow
• The placenta may become ischemic due to reduced
oxygen levels and nutrients

37. Pathogenesis of Pre Eclampsia Cont’
• There is also diminished oxygen and nutrition
supply to the fetus leading to fetal hypoxia,
growth fetal retardation and even fetal death
• The reduced placental functioning may cause
impairment in hormonal output
compromising the survival of the fetus

38. Signs and Symptoms
• Raised blood pressure of 140/90 mmhg and
above
• Proteinuria
• Oedema may be present or not
Oedema grading
Grade 1 (+) - ankle oedema
Grade 2(++) - oedema involving lower limbs
Grade 3(+++) – generalised oedema

39. Signs and Symptoms Cont’
• Severe frontal headache
• Irritability
• Visual distance or blurred vision
• Epigastric pain
• Nausea and vomiting
• Cyanosis and tissue hypoxia
• coughing

40. Diagnosis
• History taking antenatally will highlight the risk
factors
• Signs and symptoms
• Blood pressure checking
• Urinalysis for proteins
• Platelet count will be low (thrombocytopenia)
• Clotting time will be prolonged
• FBC will reveal increased haemoglobin and
hematocrit levels

41. Diagnosis Cont’
• Renal function test will reveal raised
creatinine and urea levels
• Liver function test will reveal increased liver
enzymes
• Obstetric ultra sound scanning
Note:
Other investigations can be done depending on
the suspected cause and the damage caused by
the disease process

42. Management of Pre eclampsia
Aim
• To monitor the disease and prevent it from
worsening
• To provide enough rest and tranquil environment
• To prolong the pregnancy until the fetus is
sufficiently mature to survive extra uterine life
while safe guarding the life of the mother
• Provide psychological care to the woman and the
family or support person

43. Mild Pre eclampsia
Gestation Less than 37 Weeks
• Managed as an out patient with good ANC
• Focused ANC , frequent visits
• Ascertain the risk factor
• Explain the disease process

44. Gestation Less than 37 Weeks Cont’
• Counsel woman and family about danger signs
of severe pre-eclampsia and eclampsia
• Rest to minimise stimulation of the CNS
• Rest 12 hours of night and 3 hours during the
day to promote improved blood flow to the
heart and therefore to the placenta

45. Gestation Less than 37 Weeks Cont’
• Normal diet
• However ,avoid added salt, increase proteins,
fibres and vitamin, reduce fat and
carbohydrates for the obese
• Avoid Constipation
• Do not give anticonvulsants, antihypertensive,
sedatives or tranquilizers

46. Gestation Less than 37 Weeks Cont’
Admit the to hospital if follow up is not possible:
• Normal diet
• However, avoid added salt, fats and carbohydrates if obese,
increase proteins, fibres and vitamin
• Avoid constipation
• Monitor blood pressure (twice daily) and urine for
proteinuria (daily)
• Abdominal girth measurement for fetal growth
• Daily weighing to assess reduction of oedema

47. Gestation Less than 37 Weeks Cont’
• Do not give anticonvulsants, anti
hypertensive, sedatives or tranquilizers unless
blood pressure or urinary protein level
increase
• Do not give diuretics
• Only give diuretics, Lasix 40 mg when there is
pulmonary oedema
• Rest

48. Gestation Less than 37 Weeks Cont’
• If diastolic pressure decreases to normal, send
woman home
• If signs remain unchanged, keep woman in
hospital
• If there are signs of growth restriction, consider
early childbirth
• If urinary protein level increases, manage as
severe pre-eclampsia

49. Gestation More than 37 Weeks
• If there are signs of fetal compromise, assess
cervix and expedite childbirth:
– If cervix is favorable, rupture membranes with
amniotic hook or a Kocher clamp and induce labor
using oxytocin or prostaglandins
– If cervix is unfavorable, ripen the cervix using
prostaglandins or Foley catheter or deliver by
caesarean section

50. Management of severe pre eclampsia
Aim
• To prevent convulsions
• To control blood pressure
• To prevent complications
• To serve the life of mother and fetus

51. Management of severe pre eclampsia
Cont’
• Diastolic blood pressure > 110 mmHg
• Proteinuria > 3+
• Other signs and symptoms sometimes present:
– Epigastric tenderness
– Headache
– Visual changes, blurred
– Hyperreflexia(nervous system's reaction to a stimulus is
increased)
– Pulmonary edema
– Oliguria

52. Management of severe pre eclampsia
Cont’
Antihypertensive drugs
• If diastolic blood pressure remains above 110 mmHg,
give antihypertensive drugs. Reduce diastolic blood
pressure to less than 100 mmHg but not below 90
mmHg
• Drugs used:
methyldopa
Nifedipine
Hydralazine IV if diastolic is above 110 mmhg

53. Management of severe pre eclampsia
Cont’
Diuretics
• Auscultate lung bases every hour for
rales(crackling and bubbling sound) indicating
pulmonary edema. If rales are heard, withhold
fluids and give frusemide 40 mg IV once
Anticonvulsive drugs and sedatives
• To prevent convulsions or reduce excitation
threshold of the CNS
• Sedatives facilitates rest
• These include magnesium sulfate / diazepam

54. Management of severe pre eclampsia
Cont’
fluids
• IV fluids can be given but strict intake and output
should be monitored
• In pulmonary oedema, fluids must be
discontinued
Steroids
• Given when pre eclampsia develop in late
gestation to reduce the risk of RDS
• Example is dexamethasone 4mg , 12hourly for
48hours

55. Specific Nursing Management in
Severe pre eclampsia
Room
• Nursed in an Eclamptic room
• Resuscitative equipment and drugs
• Railed bed
• Woman should never be left alone
• Dim light to facilitate rest and to prevent
provoking a convulsion

56. Specific Nursing Management in
Severe pre eclampsia Cont’
Psychological care
• Disease process
• Explain condition of the baby, the prognosis for the
pregnancy and the potential for perinatal loss to the
mother herself and the support persons
• Possible intervention should the condition worsens
• Involve the significant other in the care and
management
• Importance of diet modification
• Procedures such as urinalysis should be explained

57. Specific Nursing Management in
Severe pre eclampsia Cont’
• Explain the importance of rest
• Explain the reason for being nursed in an
eclamptic room
Position
• left lateral position
• To prevent compression on the venacava or
aorta which might lead to supine hypotension

58. Specific Nursing Management in
Severe pre eclampsia Cont’
Rest
• Rest to minimise stimulation of the CNS
• Rest promote improved blood flow to the
heart and therefore to the placenta
• Restrict visitors but allow the support person
• Mild sedatives to ensure rest and sleep

59. Specific Nursing Management in
Severe pre eclampsia Cont’
Diet
• No added salt
• High protein, high fibres and high vitamin
• Low carbohydrates and fat diet for the obsess
• Fluids restricted if there is pulmonary oedema
• Avoid constipation to prevent straining

60. Specific Nursing Management in
Severe pre eclampsia Cont’
Observations
• Observe vital signs, reflexes and fetal heart rate every
hour
• Auscultate lung bases every hour for rales to rule out
pulmonary edema
• Maintain strict fluid balance chart and monitor amount
of fluids administered and urine output (output should
be 30mls/ hour, less than 30 mls is suggestive of
oliguria )
• Catheterize bladder to monitor urine output
• proteinuria hourly

61. Specific Nursing Management in
Severe pre eclampsia Cont’
• Observe and advise the patient to report any of
the following signs and symptoms
– Epigastric tenderness
– Headache
– Visual changes
– Hyperreflexia(nervous system's reaction to a
stimulus is increased)
– Pulmonary edema
– Oliguria

62. Specific Nursing Management in
Severe pre eclampsia Cont’
• Observe for any bleeding tendencies
• Monitor fetal well being
4 hrly fetal heart sound or less
kick count test(no of kicks recorded in
30min)

63. Specific Nursing Management in
Severe pre eclampsia
Observe for warning signs of eclampsia
• marked / rapid raise in blood pressure
diastolic above 110mmhg
• marked proteinuria 3+
• oedema +/- , if present it is generalised
• Oliguria
• Severe headache

64. Specific Nursing Management in
Severe pre eclampsia
• Severe epigastric pain and tenderness due to
liver capsular haemorrhage and oedema
• Drowsiness and confusion due to cerebral
oedema
• Blurred vision and flushes of light due to
retinol oedema
• Dizziness

65. Complications Pre Eclampsia
Maternal
• Eclampsia related to cerebral oedema and cerebral
hypoxia
• Placenta abruptio
• Cerebral vascular accident
• Renal failure
• Hepatic failure
• Disseminated intravascular coagulation
• Blindness
• Pulmonary oedema
• Increased maternal mortality

66. Complications Pre Eclampsia
HELLP syndrome
• life-threatening pregnancy complication
usually considered to be a variant or
complication of severe pre eclampsia
• It is a rare liver and blood clotting disorder
that can affect pregnant women.
• It's most likely to occur immediately after the
baby is delivered, but can appear any time
after 20 weeks of pregnancy

67. HELLP syndrome
• Potentially as dangerous as eclampsia, and is
slightly more common.
• The only way to treat the condition is to
deliver the baby as soon as possible.

68. HELLP syndrome
The letters in the name HELLP stand for each part of
the condition:
• H Hemolysis
Red blood cells in the blood break down
• EL Elevated liver enzymes
High number of enzymes in the liver is a sign of liver
damage
• LP low platelet count
platelets are substances in the blood that help it to
clot

69. Complications Pre Eclampsia cont’
Fetal complications
• Intra uterine fetal growth retardation
• Low birth weight/ small for dates
• Prematurity
• Respiratory distress syndrome
• Fetal distress
• Asphyxia Neonatorum
• Intra uterine fetal death

70. Preventive measures
• Early booking so that the risk factors are
identified
• Careful and accurate history e.g history of pre
eclampsia/ eclampsia in previous pregnancies
• Careful physical examination so that indicators
such as oedema are identified
• Blood pressure checking
• Urinalysis for proteins
• Intensifying ANC visits

71. Eclampsia
• A condition which occurs in pregnancy after
the 20th week of gestation characterised by
tonic – clonic convulsions (fits) and is usually
accompanied by hypertension, proteinuria
and oedema (which may be present or not)

72. Eclampsia
Note
• All obstetric patients with seizures should be
considered eclamptic until proven otherwise
• Eclampsia in the absence of hypertension with
proteinuria has been demonstrated to occur
in 38% of cases reported in the United
Kingdom.
• Similarly, hypertension was absent in 16% of
cases reviewed in the United States.

73. Management of Eclampsia
Aim
• Control the convulsion
• Control Hypertension
• Deliver the baby

74. Control of convulsions
• Anticonvulsive drugs:
–Magnesium sulfate (first choice)
–Diazepam

75. Magnesium sulphate administration
Loading dose (14g magnesium sulfate )
• Give magnesium sulfate 20% solution 4 g IV
slowly over 5 min.
• Follow promptly with magnesium sulfate 50%
solution 5 g deep IM injection in each buttock
with lignocaine 2% solution 1 mL
• If convulsions recur after 15 min., give
magnesium sulfate 50% solution 2 g IV over 5
min.

76. Magnesium sulphate administration
Cont’
Magnesium sulphate maintenance dose
• IM injections:
–Magnesium sulfate 50% solution 5 g IM +
lignocaine 2% solution 1 ml
–Give every 4 hours into alternate buttocks
• Continue treatment with magnesium sulfate
for 24 hrs after childbirth or after the last
convulsion, whichever occurs last

77. Magnesium sulphate administration
Cont’
• If 50% mgso4 not available, give 1g of 20% mgso4 IV
slowly hourly for 24 hours
• Diluting 50% mgso4 20%
Total parts of H2o
% concentrate/ % diluent – 1
50/20 – 1
1.5mls
• Therefore add 1.5mls of water to 1 part (1g) of 50%
mgso4

78. Magnesium sulphate administration
Cont’
• Before each injection ensure that:
– Respirations > 16 breaths/min.
– Patellar reflex present
– Urine output > 30 ml/hour over 4 hours
• Withhold magnesium sulfate temporarily if:
– Respiration rate < 16 breaths/min.
– Patellar reflexes are absent
– Urine output < 30 mL/hour during preceding 4 hrs

79. Magnesium sulphate administration
Cont’
• If woman is unarousable or in case of
respiratory arrest:
–Assist ventilation
–Give calcium gluconate 1 g (10 mL of 10%
solution) IV slowly

80. IV Administration of Diazepam
• If magnesium sulfate is not available, diazepam may
be used.
• Loading dose
– 10 mg IV slowly over 2 min.
– If convulsions recur, repeat dose
• Maintenance dose
– 40 mg in 500 ml IV fluids
– Titrate to keep woman sedated but arousable

81. IV Administration of Diazepam Cont’
Caution
• Do not give more than 100 mg in 24 hrs
• Maternal respiratory depression may occur
when dose exceeds 30 mg in 1 hour
• Assist ventilation, if necessary

82. Rectal Administration of Diazepam
• Used when IV access not possible
• Loading dose is 20 mg in 10 mL syringe
• Remove needle, lubricate barrel and insert syringe
into rectum to half its length
• Discharge contents and hold barrel in place for 10
min.
• If convulsions are not controlled in 10 min., repeat
with 10 mg

83. Control of Hypertension
Administration of Antihypertensive Drugs
Hydralazine
• 5 mg IV slowly every 25-30 min. until blood
pressure is less than 110 mmHg
• Goal is to have between 90 and 100 mmHg
• Repeat hourly as needed or give hydralazine
12.5 mg IM every 2 hours as needed

84. Control of Hypertension Cont’
Labetolol
• 10 mg IV
• If no response in 10 min., give 20 mg IV
• If no response, give 40 mg, then 80 mg IV to
maximum dose of 300 mg
Nifedipine
• 5 mg sublingually
• Repeat once if needed

85. Management of eclampsia at the
clinic
• Call for help and contact the hospital and
make arrangements to transport the patient
• Don’t leave the patient alone
• Continue checking the vital signs
• If possible do urinalysis
• Insert the airway if the patient is fitting or
unconscious
• Do not restrain pt during convulsions

86. Management of eclampsia at the
clinic
• If a railed bed is not available, use floor bed
• If available administer oxygen
• Administer initial dose of diazepam
• Secure intravenous access for resuscitations
• Insert catheter and monitor intake and output
• Lateral position should be used to prevent supine
hypotension
• Transfer pt to the hospital and continue
administering oxygen and keep patient sedated

87. Management of eclampsia at the
Hospital
• Call for help
• Nurse the patient in an obstetrical intensive care unit
with a midwife in constant attendant and if possible
a doctor.
• Patient should not be left alone
• The room should be quiet and dim-lit to avoid
stimulation
• Railed bed can be used to prevent injury, if not
available use a floor bed
• It should have all the resuscitative equipment and
drugs

88. Management of eclampsia at the
Hospital
• Anything that can injure the patient is kept
away (e.g drip stands, trolleys)
• Tight clothing are loosened to facilitate good
circulation
• Lateral position is used for easy drainage of
secretion and to prevent the tongue from
falling back
• This position also prevents supine
hypotension

89. Management of eclampsia at the
Hospital
• Padded spatula or oral pharyngeal air way is
inserted to prevent tongue biting during a
convulsion and tongue from falling back
• Oxygen therapy is administered to prevent
cyanosis and tissue hypoxia
• Suctioning is done to clear the airway

90. Management of eclampsia at the
Hospital
• vital signs are checked ¼ hourly
• Monitor the fetal well being ¼ hourly
• Urinalysis is done every two hours or less
• Withhold oral fluids, however, patient is
canulated for resuscitations
• Insert urinary catheter and monitor urinary
output.

91. Management of eclampsia at the
Hospital
• Monitor convulsions and record for time,
frequency, duration and type.
• Administer the appropriate anti convulsive,
anti hypertensive

92. Management of eclampsia at the
Hospital
• Pre patient in anticipation for caesarian
section
• Obtain specimen for grouping and cross-
matching.
• Keep the relatives or support person well
informed about the patient’s condition.
• Obtain consent for operation

93. Childbirth in Eclampsia
• Childbirth should take place as soon as the
woman’s condition has stabilized
• Delaying childbirth to increase fetal maturity
will risk the lives of both the woman and the
fetus.

94. Childbirth in Eclampsia Cont’
• Assess cervix
• If cervix is favorable, rupture the membranes with an
amniotic hook or a Kocher clamp and induce labor
using oxytocin or prostaglandins
• Deliver by cesarean section if:
– Vaginal delivery is not anticipated within 12 hours (for
eclampsia) or 24 hours (for severe pre-eclampsia)
– Fetal heart rate is less than 100 or more than 180
beats/min.
– Cervix is not favorable

95. Childbirth in Eclampsia Cont’
• If safe anesthesia is not available for caesarean section
or if fetus is dead or too premature for survival:
– Attempt vaginal delivery
– Ripen cervix (if necessary) using misoprostol,
prostaglandins or Foley catheter
Note:
Severe pre eclampsia deliver within 24 hours
Eclampsia deliver within 12 hours

96. Postpartum Care
• Anticonvulsive therapy should be maintained
for 24 hours after childbirth or last convulsion,
whichever occurs last
• Continue antihypertensive therapy as long as
diastolic pressure is 110 mmHg or more
• Continue to monitor urine output

97. Conclusion
• It is important that all the pregnant women
are screened for pre-eclampsia as early as
possible to reduce the complications.
• Midwives and nurses should be alert at all
times as they attend to pregnant women so as
to detect this disease early and prevent it
from getting worse.