ECLAMPSIA

EclampsiaIt is a derived from greek word meaning like ‘Flash of Light’ – may occur quite abruptly.

Definition – Pre-eclampsia when complicated with generalized tonic- clonic convulsions or coma is called eclampsia.

Pathophysiology – Eclampsia is a severe form of pre-eclampsia, histopathological & biochemical changes are similar those of pre-eclampsia.

  • Cerebral irritation leading to convulsion

It may be provoked by – Anoxia, cerebral oedema cerebral dysrhythmia.

Anoxia – spasm of celebral vessel

Increased cerebral vascular resistance

Fall in cerebral oxygen consumption cause anoxia

  • Cerebral Oedema – cause irritation.
  • Cerebral dysrhythmnia – Increase following anoxia &,Oedema.

Clinical features :-

Fits are epileptiform is consist of 4 stages –

1. Premonitory stage – Patient become unconscious. Twitching of the muscles of the face, tongue &, limbs. Eye balls roll or are turned to one side and become fixed. Last for 30 seconds.

2.  Tonic stage – Whole body goes into a tonic spasm – the trunk – opisthotonus, limbs are flexed & , hands clenched. Respiration ceases &tongue protrudes between the teeth, cyanosis appears. Eye balls become fixed. Last for 30 seconds.

3. Clonic stage- All the voluntary muscle undergo alternate contraction & relaxation. The twitchings start in the face then involve one side of the extremities & ultimately the whole body is involved in the convulsion. Bitting of the tongue occurs. Breathing is stertorous & blood stained frothy secretions fill the mouth. Cyanosis gradually disappears. Stage lasts for 1-4 minutes.

4.-Stage of coma-Following the fit, the patient passes on to the stage of coma. It may last for a brief period or in other deep coma persists till another convulsions. The patient appears to be in a confused state following the fit & fails to remember the happenings.

Management :-

Principles –
– Maintain airway, breathing, circulation.
– Oxygen administration 8-10 L/min.
– Prevention of injury, prevent aspiration.
– Delivery by 6-8 hours.
– Prevention of complication.
– Postpartum care.

1) Detailed history, relevant to eclampsia, duration of pregnancy, number of fits are to be taken.
2) General abdominal, vaginal examination are made. Self retaining catheter is introduced & urine is tested for protein continuous drainage facilitate output measurement & periodic urine analysis.
3) ½ Hourly pulse, respiration rate, BP are to be noted . Abdominal palpation for progress of labour because immediate after convulsion, fetal bradycardia is common.
4) Crystalloid solution (RL) is started. Total fluid should not exceed the previous 24 hours urinary output + 1000ml. infusion of balanced salt solution should be at 1ml/kg/hr. CVP monitoring is needed for a patient with severe HTN & reduced urine output.
5) To prevent infection ceftriaxone 1 gm IV twice daily is given.
6) Anticonvulsant & sedative – To control the fits & to prevent its recurrence.
•MgSO4 (Magnesium Sulphate) is drug of choice. It acts as a membrane stabilizer & neuro protector.
It reduces motor endplate sensitivity to acetylcholine. It blocks neuronal calcium influx. It induces cerebral vasodilatation, dilates uterine arteries, increases production of endothelial prostacyclin &  inhibit platelet activation.

Regimen               Loading dose                                                            Maintenance dose
I/M (Pritchard)     4 gm IV over 3-5 min followedby 10gm IM            5 gm I/M- 4 hourly

I/V Zuspan             4-6 gm IV over 15-20 min                                          1-2 gm/hr IV infusion

7) Inspite of anticonvulsant & sedative regimen if BP remain >160/110 mmHg antihypertensive drugs should be administered.
8) Thiopentone sodium .5 gm in 20 ml of 5% dextrose is given I/V very slowly. If procedure fails use of complete anesthesia, muscle relaxant &  assisted ventilation can be employed. In unresponsive cases, caesarean section in ideal, in status eclampticus.
9) Anuria – Dopamine infusion (1 mg/kg) is given. In pulmonary oedema-frusemide 40 mg I.V followed by 20 gm of mannitol I.V reduces pulmonary oedema.
10) During fits – A mouth gag is placed in between the teeth to prevent tongue bite &  should be removed after clonic phase is over. Air passage is to be cleared off the mucus with the mucus sucker. The patient’s head is to be turned to one side and the pillow is taken off. Raising the foot end of the bed. Oxygen is given until cyanosis disappears.