ECLAMPSIA

 

DEFINE ECLAMPSIA

Eclampsia is occurrence of one or more convulsions in association with hypertension, proteinuria and oedema which occur after 20th week of gestation.

Eclampsia is occurrence of one or more convulsions in association with the symptoms of pre-eclampsia.

STATE FIVE (5) PREDISPOAING FACTORS TO PRE-ECLAMPSIA  

1. Young and elderly primigravidae

2. Essential hypertension

3. Multiple pregnancy

4. History of pregnancy induced hypertension

5. Hydatidiform mole

6. Polyhydramnios

7. Chronic nephritis

8. Rhesus iso-immunisation

DESCRIBE THE FOUR (4) STAGES OF AN ECLAMPTIC FIT 

Premonitory stage

Duration: 10-20seconds. It is characterized by twitching of facial muscles and the head is drawn to one side. The mother is restless and there are rapid eye movements.

Tonic stage

Duration: 10-20 seconds. It is characterized by rigidity of the body (muscle spasms) and the patient’s teeth become tightly clenched. There is staring of the eyes.

Clonic stage

Duration: 60-90 seconds.It is characterized by convulsive movements of the body as a result of violet contraction and intermittent and relaxation of maternal muscles. Salvation increases and foaming at the mouth occurs. The mother may bite the tongue during this period.

Coma stage

Duration: Minutes to hours. It is characterized by stertorous breathing. The mother goes into deep sleep and further convulsions may occur before regaining consciousness.

DESCRIBE THE MANAGEMENT OF SEVERE PRE-ECLAMPSIA 

• To reduce the diastolic blood pressure between 90mmHg and 100mmHg

• To prevent convulsions

• To minimize or avoid complications

• To deliver the fetus in optimal condition

Admssion

Immediately admit the woman and give before transfer to the antenatal ward 10-20mg of diazepam Im stat. 

Medical treatment

Antihypertensive therapy

These should be given because her diastolic blood pressure is over 110mmHg.

Give hydralazine 5mg IV slowly every 5 minutes until BP is lowered. Repeat ½- hourly until diastolic BP is less than 110mmHg. The dosage can be given up 10-40mg intravenously.

Or give Nifedipine 5-10mg sublingually. Repeat the dose after 10 minutes if no good response. The dosage can be given up to 20mg.

Anticonvulsant drugs

Give Magnesium sulphat which is the drug of choice for preventing and treatment of convulsions in severe pre-eclampsia.

Loading dose

• Give Magnesium sulphate 20% solution 4g IV over 5minutes

• Followed by 10g of 50% solution magnesium sulphate,5g in each buttock as deep IM injection with 1ml of 2% lignocaine in the same syringe. Or dilute with 20mls normal saline and give IVslowly over 10 minutes.

Maintenance dose

• Give 5g magnesium sulphate 50% solution plus 1ml of lignocaine or 10mls N/S IM every 4hours into alternate buttocks.

• Continue treatment for 24 hours after delivery or last convulsion whichever comes first.

• Before repeating the dose of MgSo4 ensure that:

o Respiratory rate is at least 16

o Patella reflex are present

o Urinary output is at least 30mls per hour.

NURSING MANAGEMENT

Environment

Nurse the mother in a quiet, isolated room with all the equipment such as emergency tray and suction machine. Nurse the mother in a dark room but with enough light to monitor her condition. Restrict visitors and minimize noise levels in the ward to allow the patient to have adequate rest. 

Psychological care

• Explain the condition in simple terms to the mother and the support person. Counsel the client on the need of isolation. Provide support, encouragement and assurance. The patient must not be left alone and doctor is immediately there is a change in the patient’s condition.

Observations

• Monitor bloo pressure 2hourly and any elevation or sudden fall is immediately reported to the doctor.

• Monitor pulse 1/2hourly and temperature 4hourly.

• Assess for any cerebral irritation,prepare fit charts and monitor any convulsions ie duration and frequency.

• Watch for signs of early labour

• Fetal heart rate is monitored ½ hourly, normal rate 120-160bpm

• Daily physical examination is done to assess oedema and patient is weighed on each alternate day.

• Fluid intake and output is recorded and fluid balance is monitored closely until normal.

• Watch for any side effects of drugs

 Drug therapy

Continue giving the maintenance doses of anticonvulsants and hypertensives. Monitor blood pressure 1/2hourly while taking drugs. Assess response to treatment. 

Bladder care

Monitor urinary output and should be at least 30ml/hr. catheterize the woman to monitor urine out, proteinuria and acetone. Urinalysis is done until urine is free of proteins.

Nutrition

In the acute allow IV fluids ,5% dextrose, continue IV fluids until the woman is stable and able to take orally. Provide a well-balanced diet rich in proteins and vitamins but low in salt and fat.

Hygiene/Prevention of infection

• Change soiled bed linen frequently.

• Vulva hygiene should be maintained.

• Administer the prescribed antibiotics

Obstetrical Management

Depending on the maternal and fetal condition the doctor may decide to deliver mother or do conservative Management. In conservative Management the patient is put on bed rest ant treat with antihypertensive to control blood pressure and anticonvulsants to prevent convulsions.

If the condition does not respond well to treatment induction of labour is performed after 24 hours regardless of the gestational age. The doctor may perform caesarean section if labour is detrimental to maternal and fetal condition. As midwife prepare the woman for caesarean section. Obtain a written consent from the client after explaining the need for the operation to her and the family. After preparing wheel the mother to theatre and wait to receive the baby. 

 Induction of labour may also be performed when blood pressure is uncontrolled, poor renal function and evidence of IUGR by scan. Observe the maternal and fetal wellbeing including progress of labour closely until delivery. Episiotomy is carried out to prevent exertion of the patient as may result into eclampsia. The pediatrician and obstetrician must be present during delivery to resuscitate the baby

CARE AFTER DELIVERY

• Close observations and attendance is carried for the first 12-24 hours.

• Patient is kept sedated under doctor’s orders

• Blood pressure is monitored hourly for 6 hours ,then 4houlr for 24 hours and 12hourly if stable.

• Monitor fluid balance until normal

• Urinalysis is done until urine is free of urine 

• Patient is discharged when blood pressure returns to normal and proteinuria is absent from urine.