EclampsiaEclampsia

EclampsiaEclampsiaDefinition:Definition:A disorder specific of pregnancy

characterized by convulsionsconvulsions and/or comacoma in a pre-eclampticpre-eclamptic patient

(eclampsia = pre-eclampsia + convulsions and/or coma).

aetiologyEclampsia is preceded by preeclampsia,

rarely developed without any warning sign of preeclampsia .

Cerebral hypoxia due to arteriolar spasm following hypertension is the cause of convulsion especially when blood pressure level above 160/110.

Cerebral edema and dysrhythmia is another factors.

Clinical pictureClinical picture::Pre-convulsive state:Pre-convulsive state:eclampsia is usually preceded by severe

pre-eclampsia (imminent eclampsia) with drowsiness, severe headache, flashes of light or dimness of vision, nausea and vomiting, epigastric or upper right quadrant pain.

Rarely eclampsia develops suddenly Rarely eclampsia develops suddenly without warning signs of pre-eclampsia.without warning signs of pre-eclampsia.

Stages of eclamptic fitStages of eclamptic fit : : Premonitory stage (30-60 seconds): Premonitory stage (30-60 seconds):

dissociationdissociation of the patient from surroundings surroundings upward rolling of eyes eyes twitching of facialfacial and handhand muscles.

Tonic stage (30 seconds): Tonic stage (30 seconds): Loss of consciousness consciousness generalized muscular rigidity rigidity the whole body goes into tonic spasmtonic spasm. The backback arches handshands clench breathingbreathing ceasesceases and patient cyanotic .cyanotic .

Clonic stage (1-4 minutes): Clonic stage (1-4 minutes): episodes of muscular contractionscontractions and

relaxations relaxations the whole body jerksbody jerks. mouthmouth opens and shuts. tonguetongue may be bitten breathingbreathing is irregularirregular and frothy saliva

fills the mouth.

Coma stage: Coma stage: Patient passes into comacoma which may last

hours.

Types of eclampsiaTypes of eclampsia::According to timing of its onset :According to timing of its onset :

1.1. Antepartum eclampsia (50-65%): Antepartum eclampsia (50-65%): occurs during pregnancy the commonest type.

2.2. Intrapartum eclampsia (20-30%): Intrapartum eclampsia (20-30%): convulsions start during labour.

3.3. Post-partum eclampsia (15-20%): Post-partum eclampsia (15-20%): 1. eclamptic fit occurs up to 48 hours after

delivery.2. rare but the most serious typethe most serious type.

Differential diagnosisDifferential diagnosis::1. Epilepsy 2. Hysteria 3. Meningitis 4. Cerebrovascular accident.

Treatment of eclampsiaTreatment of eclampsia::Preventive treatment: Preventive treatment:

Eclampsia is a preventable disorder, this can be achieved by proper antenatal care to prevent and to treat pre-eclampsia.

Actual treatment: Actual treatment: objectives of treatment :objectives of treatment : sedationsedation to decrease sensitivity of brain to external and

internal stimuli. Relief of generalized vasospasm generalized vasospasm correction of hemoconcentrationhemoconcentration and hypovolemiahypovolemia Control of hypertensionhypertension: to prevent cerebrovascular

accident and cardiac failure. correction of electrolyte imbalanceelectrolyte imbalance. Termination of pregnancyTermination of pregnancy.

1-Nursing Care:1-Nursing Care:Patient should be kept in quite room quite room nursed on her side with head and shoulder her side with head and shoulder

slightly raisedraised. OxygenOxygen must be given to improve tissue

oxygenation.A mouth gag mouth gag should be available to avoid

biting of tongue during convulsions.suctionsuction is used to clean mouth, nose and

pharynx of frothy secretion.A doctor or trained nurse doctor or trained nurse should be available

to protect patient from injury during fits and to maintain clear air-way and record vital signs.

Urinary catheter Urinary catheter to calculate urine output.

2-Laboratory tests: 2-Laboratory tests: 1. urinalysis 2. blood urea and creatinine 3. blood electrolytes 4. platelet count 5. coagulation profile.

3- Magnesium sulphate:3- Magnesium sulphate:The standard treatment standard treatment has sedativesedative, anticonvulsantanticonvulsant & hypotensivehypotensive effects .RegimenRegimen:

An initial loading dose of 4-6 grams initial loading dose of 4-6 grams is slowly I.V followed by slow intravenous infusion 1gm/hourintravenous infusion 1gm/hour.

Magnesium sulphate therapy should be continued for 24 continued for 24 hours after delivery.hours after delivery.

Magnesium sulphate intoxicationintoxication should be checked and cancelled in presence of any of the followings: Absent knee jerk Absent knee jerk respiratory rate < 16/minute respiratory rate < 16/minute urine output < 30 ml/hour.urine output < 30 ml/hour.

Intravenous calcium gluconate or chloride Intravenous calcium gluconate or chloride (one gram in 10 ml) is the specific antidote for magnesium antidote for magnesium sulphate intoxicationsulphate intoxication.

4-Hypotensive drugs:4-Hypotensive drugs:Hydralazine: Hydralazine: effective vasodilator drug.Nifedipine: Nifedipine: Calcium channel blocker 5-Plasma volume expanders: 5-Plasma volume expanders: should be carefully monitored to avoid

overload and cardiac failure.6-Diuretics: 6-Diuretics: should be avoided However, recommended in cases of

cerebral edema or cardiac failure.Termination of pregnancy:Termination of pregnancy:should be performed as soon as blood

pressure is controlled.

HELLP Syndrome

HELLP Syndrome is a series of symptoms that make up a syndrome that can affect pregnant women. HELLP syndrome is thought to be a variant of preeclampsia, but it may be an entity all on its own.

The name HELLP stands for:

H- hemolysis ( breakdown of red blood cells)

EL- elevated liver enzymes (liver function)

LP- low platelets counts (platelets help the blood clot)

Causes:

still unclear. Although it is more common in women who have preeclampsia or pregnancy induced hypertension, there are still a number of women who get it without previously showing signs of preeclampsia

Risk factors Previous pregnancy with HELLP Syndrome (19-27% chance

of recurrence in each pregnancy)

Preeclampsia or pregnancy induced hypertension

Women over the age of 25

Caucasian

Multiparous (given birth two or more times)

Symptoms:The most common symptoms of HELLP syndrome include:

Headaches

Nausea and vomiting that continue to get worse (this may also feel like a serious case of the flu.)

Upper right abdominal pain or tenderness

Fatigue or malaise

other symptoms :

Visual disturbancesHigh blood pressureProtein in urineEdema (swelling)Severe headachesBleeding

Diagnosis:

Hemolysis -Red blood bells

Abnormal peripheral smear

Lacatate dehydrogenase >600 U/L

Bilirubin > 1.2 mg/dl

Elevated liver Enzyme levels

Serum aspartate amniotransferase >70 U/L

Lacatate dehydrogenase >600 U/L

Low Platelets count

Complications Placental Abruption

Pulmonary Edema ( fluid buildup in the lungs)

DIC—blood clotting problems that result in hemorrhage

Respiratory distress syndrome (lung failure)

Ruptured liver hematoma

Acute renal failure

IUGR.

managementThe treatment of HELLP Syndrome is primarily based on the

gestation of the pregnancy, but delivery of the baby is the best way to stop this condition from causing any serious complications for mom and baby

Treatment’s that may be used until baby is delivered :

Bed rest and admission into a medical facility to be monitored closely

Corticosteroid ( to help babies lungs develop more rapidly)

Magnesium Sulfate ( to help prevent seizures)

Blood transfusion if platelet count gets too low

Blood pressure medication

Fetal monitoring and tests including biophysical tests, sonograms, non stress tests and fetal movement evaluation