Eclampsia Drill Dr Sharda Patra( Asso. Prof) Prof Manju Puri Department of Obstetrics & Gynecology Lady Hardinge Medical College & Smt SK Hospital New Delhi
Dec 15, 2015
Eclampsia Drill
Dr Sharda Patra( Asso. Prof) Prof Manju PuriDepartment of Obstetrics & GynecologyLady Hardinge Medical College & Smt SK Hospital New Delhi
Eclampsia Drill Eclampsia is an important
obstetric emergency which if not managed promptly can lead to life-threatening complications like cerebral haemorrhage, pulmonary edema, abruptio placentae maternal and fetal death
Any pregnant woman presenting with convulsions in later half of pregnancy should be treated as eclampsia until proved otherwise
The management of eclampsia involves
Immediate managementSubsequent management
One should remember that first few minutes following a fit are very crucial and should be handled very fast due to risk of cerebral hypoxia and aspiration which can have serious consequences.
.
Immediate management …..
Stabilize the woman Call for Help Remember A; B; C of resuscitationControl convulsionControl blood pressure
Initial Resuscitation Airway Place the woman on her left side to reduce the
risk of aspiration of secretions, vomit and blood
Put an airway in between the tongue and palate to prevent tongue bite and falling of tongue
Suction of the secretions is done through this airway by connecting it to a suction machine.
Give oxygen (if available15 l /min ) and continue longer if cyanosis persists
Stay with the patient to ensure that her airway is clear
Initial Resuscitation
Breathing Assess – count respiratory rate .Look, Listen, Feel. Ventilate if necessary
Circulation Assess pulse , BP. CPR if necessary Secure intravenous access with a cannula
(16G )Send blood for BG, CBC, platelets, clotting
screen, KFT, LFT, Uric acid, Serum electrolytes Catheterize the patient to empty the bladder ,
record output and monitor output subsequentlyDo a urine examination for proteins
Loading dose Maintenance dose
4g IV 20% solution over 5 to 10min plus 10g IM (5 g 50% solution deep I/M in each buttock)
5g I/M every 4h in alternate buttock till 24 hrs after the last seizure or delivery which ever is later
Loading dose Maintenance dose
Loading dose 4g IV 20% solution over 5 to 10min
1 to 2 g / h by controlled infusion pump x 24h after the last seizure
Pritchard
Zuspan
Mg So4 :Preparation and Administration
MagSo4 available in 25%, 50% strength
Initial loading dose 14gms14gms
4gm IV 10 gms
IM
Preparation and administration
IV 4gms
Take 8amps (16ml) dilute with 4ml
saline to make it 20ml
50% amps (2ml) contains 1gm of
magso4
25% ampoules
(2ml) contains 0.5 gm magso4
20ml solution contains 4gms Magso4
( 4gm/20ml 20% Sol)
Take 4amps (8ml) dilute
with 12ml saline to make it 20ml
IV 4gm20ml is given
slow IV over 5-10mins
Keep an eye on respiratory
rate , facial flushing ,
Preparation and Administration
5gms deep IM(10ml) in
each buttock
50% amps (2ml) contains 1gm of magso4
Take 5amps (10ml)
undiluted
10gms IM
Monitoring during magnesium sulphate TherapyRespiratory rate >14/ minPresence of patellar reflexes (knee jerk)Urinary output- 25ml/hr or 100ml/4hrs
Repeat doses of magnesium sulphate must be withheld or delayed if:
The respiratory rate is less than 14 per minute
Patellar reflexes are absentUrinary output is less than 100 ml over
preceding 4 hours
Antidote:
In case of respiratory depression or arrest:
Give calcium gluconate 1 g (10 ml of 10% solution) IV slowly
Assisted ventilation using mask and bag, anesthetic apparatus or intubation
CAUTION
Magnesium sulfate should be used with caution in women with
Impaired renal function.Patients with a heart block or
myocardial damage including a history of cardiac ischaemia
Controlling blood pressureAntihypertensive drugs should be
given if the diastolic blood pressure is 110 mmHg or more.
The aim is to keep the diastolic blood pressure between 90–100 mmHg to prevent cerebral haemorrhage
Drug of choice- Labetolol, Nifedepin
Labetolol
1. 20 mg I.V over 2mins
wait for 10 mins if no response 40 mg iv
80 mg iv (can be increased upto 220 mg)
2. 10 mg IV 20 mg iv
40 mg iv
Target : 40 mg ivDecrease in diastolic BPTo 90-100 mgHg 80 mg iv
Subsequent management Once the patient is stabilized and
fits have ceased , then a pervaginum examination is done to assess cervical status
Consider for termination of pregnancy if not in labor
Essential careTurning the woman two–hourly to
avoid hypostatic pneumoniamouth care, (no oral fluids are
given)monitor the urinary output.
Observations:
Restlessness or twitching which may herald the onset of another fit
Color is observed for cyanosis which indicates the need for oxygen
Temperature four hourly. Hyperpyrexia may occur
Pulse and respirations are recorded hourly, or more often
Blood pressure is recorded at least hourly earlier if >=160/110
Ut contractions and FHS is checked Input output is recorded accurately.
Do not leave the patient alone
Place in left lateral position
CALL FOR HELP
Airway
Breathing
Circulation
AssessMaintain patency
Give oxygen
Assess Protect Airway
Ventilate if required
Evaluate pulse and BP
Secure IV access
Observation
Pulse, BP, resp rate,
temp, urinary output, level
of consciousnessUrine proteins
Investigations
BG, CBC, platelets,
clotting screen, KFT, LFT, Uric acid, Serum electrolytes
ALGORITHM
Control of convulsio
ns
Control of Hypertensio
n
Loading dose : 4gm IV
20ml is given slow IV over 5-10mins followed by 10gms , 5gms deep IM (10ml) in each buttock
If fits recur- 2gms , 20% IVMaintenance dose- 5gms IM in alternate
buttocks 4 hourly Monitor- Resp rate>16
Presence of Knee jerk Urinary output >25ml/1hr
If Mag toxicity- Inj Calcium Gluconate , 10% 10ml , 10mins IV
Labetolol 10mg IV , give 20mg IV if noresponse after
10mins, then 40mg, 40mg, 80mg max 220mgNifedipine
10mg orally , repeat after 20mins if noresponse , max 200 mg, target BP- dbp-90-100 mmHg
Delivery
A DRILL …….. Eclampsia The need for good clinical skills to be
able to recognize and act promptlyBe in control of the situation Need to care for the family, who will
be extremely distressed to see the woman have a fit;
Need for gentleness, so as not to harm the woman if she is unconscious, or stimulate further fits;
Need to respect the woman’s dignity at all times;
Need for strict attention