Eclampsia case study

1. Obstetric Case Presentation
Nick Harper

2. Ms X
•17 yo
•G1 P0
•38 weeks gestation
•Admitted in early labor
•Discharged

3. 4X tonic-clonic seizures
Presenting Complaint

4. History of Presenting Complaint
•8/10 pain headache
•8/10 pain abdo pain
•4X tonic-clonic seizures
•Witnessed by boyfriend and sister
•Admission via Ambulance

5. Obstetric History
•38/40
•1+ protein seen from 28/40
•BP 92/50 @ 25 weeks
•BP 130/80 @ 37 weeks

6. Differential Diagnosis
•Eclampsia
•Epilepsy
–1/3 have inc. seizures
–Decreased drug levels
•Severe hypoglycaemia

7. Initial management
Diazepam 10mg IV (ambulance)
MgSO4 (St Michaels)

8. Investigations
•BP 200/120 (<140/90)
•Creatinine 123 (60-100)
•Uric Acid0.66 (0.19-0.36)
•ALT 145 (5-40)
•Platelets435 (150-400)
•Hb 11.0 (12-16)

9. •“Shining Forth”
•One or more convulsions superimposed
on pre-eclampsia
Eclampsia
Diagnosis
•Severe pre eclampsia5:1000
•Eclampsia 5:10,000
•14 deaths (2000-2002)

10. Risk Factors

11. Signs & Symptoms

12. Management - BP
•BP >160/110
•Hydralazine 5mg IV unless pulse >120
•Labetolol 20mg IV (total 200mg)
•Restrict fluids 90mL/h

13. Management - Seizures
•Magnesium sulphate4g IVI 5 min
•Magnesium sulphate1g/hIVI 24 hrs
•Magnesium sulphate2g IVI 5 min
•Diazepam 5mg IV
•Stop MgSO4 if RR <14 or lose tendon reflex
•Calcium Gluconate

14. Ms X
•MgSO4 commenced
•MgSO4 maintenance infusion
•190mg Labetolol given in 25mg boluses
•Into theatre
•Spinal
•Forceps delivery, 2
nd
degree tear
•Healthy baby

15. Important points
•BP not a good measure
•Do not ignore 1+ of protein
•Delivery is only cure
•44% of fits are post partum
•Inform intensive care facilities early