Management of ECLAMPSIA

K . Mohan Ram

The management of eclampsia involves six

stages:1.Making sure the airways are

clear and the woman can breathe.2.Controlling the fits.3.Controlling the blood pressure.4.General care and monitoring.5.Delivering the baby.6.Care after delivery.

1

Making sure the woman can breathe

• Place the woman on her left side to reduce the risk of aspiration.

• Give oxygen and continue for five minutes after each fit, or longer if cyanosis persists.

• After a convulsion, aspirate the mouth and throat as necessary to clear the airway.

• Monitor her and ensure that her airway is clear.

2

Controlling the fits

• MAGNESIUM SULFATE is the drug of choice– How to administer?– What all to monitor?– In case of Respiratory Arrest?

How to administer?LOADING DOSE• 4g of 20%MgSO4 slow IV infusion for 5 mins.• 5g of 50%MgSO4 IM in each buttock.• If convulsions recur after 15 minutes, give 2g 50%MgSO4 slow IV for 5 minute.

MAINTENANCE DOSE• 5g 50%MgSO4 IM every 4 hrs.

MAXIMUM DOSE• 20g in 24 hrs

What all to monitor?

• Respiratory Rate : <16/min

• Patellar Reflex : absent

• Urine Output : <30ml/hr

In case of Respiratory Arrest?

• 1g of 10% calcium gluconate(10ml) slow IV infusion until respiration begins

• Assisted ventilation

3

Controlling blood pressure

AIM• Maintain the diastolic blood pressure between 90-100mmHg

DRUGS USED• Hydralazine• Labetolol• Nifedipine

4

General care and monitoring

• Turning the woman two-hourly.• Quiet dark room with an attendant.• NPO.• Bladder is catherised.• Antibiotics.• Throat is kept clear of mucus.• Anaesthetic instruments, suction apparatus and oxygen equipment must be ready for use by the bedside

• Restlessness/twitching• Color is observed for cyanosis• Temperature 4 hourly• Pulse & Respiration hourly• BP twice hourly• Fetal heart hourly• Signs of labour• Fluid balance• Clotting status

5

Delivering the baby

FAVOURABLE CERVIX (soft,thin,partly dilated)

• ROM induction vaginal delivery

UNFAVOURABLE CERVIX (firm,thick,closed)

• Caesarean section

Caesarean Section

INDICATIONS• Unfavourable cervix• Fetal heart abnormalities• vaginal delivery not anticipated within 12 hours

CONTRAINDICATIONS• Unsafe anaesthesia• Fetus too premature for survival• Intrauterine fetal death.

• delivery should occur within 12 hours of the onset of convulsions

6

Care after delivery• Careful observations for at least 48 hours after

delivery.• Anticonvulsive therapy should be maintained for 24

hours after• delivery/last convulsion, whichever occurs last.• Antihypertensive therapy is continued until the

diastolic blood• pressure decreases to less than 100 mmHg.• Quiet, dark room with attendant.• Monitor urinary output• If after 48 hours there are no fits, the urinary

output is good and the diastolic blood pressure is below 100 mmHg, the woman can be transferred to the main ward to recover.

• Continue four–hourly blood pressure checks for a few days.

• Follow up six weeks after delivery.

Complications

• Aspiration pneumonitis• Pulmonary edema• Renal failure• Cerebral hemorrhage

• Thank You