1. The document discusses the management of eclampsia, a condition characterized by seizures in women with preeclampsia. 2. Treatment involves stabilizing the patient by securing the airway and administering oxygen. Magnesium sulfate is given to control seizures while antihypertensives lower blood pressure if elevated. Delivery is done after stabilization. 3. Complications include respiratory issues, trauma, infections and fetal distress. Prevention focuses on calcium supplementation in high risk women, aspirin, and good prenatal care.

1. Dilla University College of Medicine and Health Science
School of Medicine
Department of Obstetric and Gynaecology
SEMINAR ABOUT MANAGEMENT OF
ECLAMPSIA
4/12/2023
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Moderator:- Dr.Melese (Obstetrician and Gynecologist)
Prepared by:- Tadele.Y (Intern)

2. MANAGEMENT OF ECLAMPSIA

3.  Out line
Introduction
Management
Complications
Reference

4. ECLAMPSIA
 refers to the occurrence of one or more generalized convulsions and/or
coma in the setting of preeclampsia and in the absence of other neurologic
conditions
epilepsy; encephalitis; meningitis; metabolic(hypoglycemia;
hypocalcaemia);
stroke; poisoning ; hemolytic uremic syndrome ; hepatic failure etc

5. Cont…..
• Diagnosis
 Preeclamptic patient +
 Seizure (that cannot be attributed to other cause)
 Occurs in 1-3 per 1000 of preeclampsia patients
 GTC convulsions, mostly self limited (1-2 min)
 May also result in coma.

6. • The cause of eclampsia is poorly understood but is thought
to result from a breakdown in the autoregulatory system of
cerebral circulation due to hyperperfusion, endothelial
dysfunction,and brain edema.
• Complications of eclampsia include cerebral hemorrhage,
aspiration pneumonia, hypoxic encephalopathy, and
thromboembolic events.
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7. • Seizures in the eclamptic patient are tonic–clonic in
nature and may or may not be preceded by an aura.
• These seizures may develop before labor (59%),during
labor (20%), or after delivery (21%).
• Most postpartum seizures occur within the first 48 hours
after delivery, but will occasionally occur as late as
several weeks after delivery.
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8. • Fetal bradycardia can also occur during and after an
eclamptic seizure.
• In general, the fetal tracing improves with supportive
maternal care, fetal resuscitative measures, and seizure
resolution.
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9. Management
• Eclampsia is a clinical diagnosis and should be treated
promptly upon recognition.
• Treatment strategies for eclamptic patients include seizure
management, BP control, and prophylaxis against further
convulsions.
• Seizure management should always start with the ABCs
(airway, breathing,circulation), although the majority of
seizures are unwitnessed by clinicians and will resolve
spontaneously without major morbidity.
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10. • Hypertension management can usually be achieved using
hydralazine or labetalol to lower the BP to less than
160/110 mm Hg. For seizure control and
prophylaxis,eclamptic patients are treated with MgSO4 to
decrease hyperreflexia and prevent further seizures by
raising the seizure threshold.
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11. • In eclampsia, MgSO4 therapy is initiated at the time of
diagnosis and continued for 12 to 24 hours after delivery.
The goal of MgSO4 therapy is to reach a therapeutic
level, although avoiding toxicity through careful clinical
monitoring .
• In the case of overdose, 10 mL 10% calcium chloride or
calcium gluconate should be rapidly administered
intravenously for cardiac protection.
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12. • Delivery should be initiated only after the eclamptic patient
has been stabilized and convulsions have been controlled.
• It is common for prolonged fetal heart rate (FHR)
decelerations to occur in the setting of an eclamptic
seizure.
• The most appropriate way to treat the fetus is to stabilize
the mother by establishing adequate maternal oxygenation
and cardiac output.
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13. • Occasionally, the FHR abnormalities will not resolve, and
emergent cesarean delivery will be necessary.
• Otherwise, cesarean delivery should be reserved for
obstetric indications, and such patients can undergo an
induction of labor after they are stabilized.
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16. Before repeat administration, ensure that
 Respiratory rate is at least 16 per minute.
 Patellar reflexes are present.
 Urinary output is at least 100 ml over 4 hours.
Withhold or delay drug if:
 Respiratory rate falls below 16 per minute.
 Patellar reflexes are absent.
 Urinary output falls below 30 mL per hour
over preceding 4 hours.

17. Toxicity:
 Diminished or loss of patellar reflex
 Diminished respiration
 Muscle paralysis
 Blurred speech
 Cardiac arrest

18. 18

19. How to prevent toxicity?
 Frequent evaluation of patellar reflex and respirations
 Maintenance of urine output at >25 ml/hr or 600 ml/d
Reversal of toxicity:
 Give Slowly intravenous calcium gluconate 1 g (10 mL of 10% solution)
 Oxygen supplementation
 Cardiorespiratory support

20. Management Description
General •Airway and oxygenation- put in left lateral position; suction airway, insert airway to depress ton
gue and prevent injury, administer oxygen via face mask or endotracheal tube if in respiratory fai
lure
•Prevent trauma – tongue depressor; fall accident etc
•Fluid resuscitation if in hemodynamic instability- IV line and fluids
Control convulsions Administer anticonvulsants – Magnesium sulphate (first line drug); diazepam ( if magnesium is
not available); phenobarbitone; phenytoin… can also be used if the two are not available
Control severe hypertensi
on
If BP >160/110 mmHg, use fast acting antihypertensives (hydralazine; labetalol; diazoxide; sodi
um nitroprusside) to maintain BP between 140/90-160/110.
Fluid Mx Restrict fluid administration to 125ml/hr and monitor input-output including urine output
Organ support If any evidence of organ failure; requires critical care and organ support to maintain homeostasis
Delivery After the above measures are taken and patient is stabilized; pregnancy should be terminated by t
he most appropriate route. No conservative Mx !

23. Complications of Eclampsia
 Aspiration
 Trauma from fall accidents and tongue injury
 Preterm labor
 Higher risk of infections such as pneumonia
 Fetal distress and asphyxia
 Cerebral edema in prolonged or repetitive seizures
 hypoxic encephalopathy

24. Prevention
 Calcium supplementation: not effective in low risk women bur show effect in
high risk group
 Aspirin (antithrombotic)
 Good prenatal care and regular visits
 Baseline test for high-risk women
 Eclampsia cannot always be prevented, it may occur suddenly and without
warning.

25. Refference