It is derived from the 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 to those of pre-eclampsia.
- Cerebral irritation leading to convulsion
- It may be provoked by – Anoxia, cerebral edema cerebral dysrhythmia.
Anoxia – spasm of cerebral vessel
Increased cerebral vascular resistance
Fall in cerebral oxygen consumption cause anoxia
- Cerebral Oedema – causes irritation.
- Cerebral dysrhythmia – Increase following anoxia &, Oedema.
Fits are epileptiform is consist of 4 stages –
1. Premonitory stage – Patient become unconscious. Twitching of the muscles of the face, tongue &, limbs. Eyeballs 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 & the tongue protrudes between the teeth, cyanosis appears. Eyeballs become fixed. Last for 30 seconds.
3. Clonic stage- All the voluntary muscles 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. The 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 convulsion. The patient appears to be in a confused state following the fit & fails to remember the happenings.
– 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 is to be taken.
2) General abdominal, vaginal examination is made. The self-retaining catheter is introduced & urine is tested for protein continuous drainage to facilitate output measurement & periodic urine analysis.
3) ½ Hourly pulse, respiration rate, BP are to be noted. Abdominal palpation for the progress of labour because immediately 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 the 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 their recurrence.
Regimen Loading Dose
I/M (Pritchard) 4 gm IV over 3-5 min followed by 10gm IM
I/V Zuspan 4-6 gm IV over 15-20 min
7) In spite of anticonvulsant & sedative regimen if BP remains>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 the procedure fails to use complete anesthesia, muscle relaxant & assisted ventilation can be employed. In unresponsive cases, a cesarean section is ideal, in status eclamptic.
9) Anuria – Dopamine infusion (1 mg/kg) is given. In pulmonary edema-frusemide 40 mg, I.V followed by 20 gm of mannitol I.V reduces pulmonary edema.
10) During fits – A mouth gag is placed in between the teeth to prevent tongue bite & should be removed after the clonic phase is over. The 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.
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