-ECLAMPSIA in pregnancy obstetric and gynaec

eclampsia in pregnancy

1. SHRI SHANKARACHARYA COLLEGE OF NURSING SUBJECT : MIDWIFERY & OBSTETRICS TOPIC : PREGNANCY INDUCED HYPERTENSION PRESENTATION BY , EASOW JOHN VARUGHESE B.Sc. NURSING 4 TH YEAR

2. INTRODUCTION HYPERTENSION IS ONE OF THE COMMON COMPLICATIONS MET WITH IN PREGNANCY & CONTRIBUTES SIGNIFICANTLY TO MATERNAL AND PERINATAL MORTALITY . THE TERM ECLAMPSIA IS DERIVED FROM A GREEK WORD MEANS “LIKE A FLASH OF LIGHTENING” IT MAY OCCUR QUITE ABRUPTLY WITHOUT WARNING MANIFESTATIONS.

3. DEFINITION PRE-ECLAMPSIA :- “PRE-ECLAMPSIA IS A CONDITION OCCURING IN LATE PRERGNANCY THE SYMPTOMS INCLUDE PROTEINURIA .” BAILLIERE’S NURSES DICTIONARY ECLAMPSIA:- “PRE-ECLAMPSIA WHEN COMPLICATED WITH CONVULSIONS OR COMA IS CALLED ECLAMPSIA.”

4. INCIDENCE MORE COMMEN IN PRIMIGRAVIDA (75%) 5 TIMES MORE COMMON IN TWINS THAN IN SINGLETON PREGNANCIES

5. TYPES OF ECLAMPSIA 1.ANTEPARTUM (50%) 2.INTRAPARTUM (30%) 3. POSTPARTUM (20%)

6. ETIOLOGY

7. CAUSES OF CONVULSIONS HYPOXIA/ANOXIA CEREBRAL OEDEMA/CEREBRAL HAEMORRHAGE CEREBRAL DYSRHYTHMIA

8. PATHOPHYSIOLOGY :- DUE TO ANY ETIOLOGICAL FACTORS IMBALANCED IN DIFFERENT COMPOUNDS OF PROSTAGLANDINS DEFICIENCY OF VASODILATORS PROSTAGLANDIN INCREASE SYNTHESIS ORF THROMBOXANE (TXA2) ( A PATENT VASOCONSTRICTOR) HYPERTENSION.

9. CLINICAL FEATURES

10. CONVULSION PREMONITORY STAGE TONIC STAGE CLONIC STAGE STAGE OF COMA HEADACHE. EPIGASTRIC OR UPPER PAIN . PHOTOPHOBIA/ BLURRED VISION 40-50%. HYPERACTIVE DEEP TENDON REFLEXES. A MARKED DIURESIS SEEN FOR ABOUT 48 HRS.

11. DIFFERENTIAL DIAGNOSIS EPILEPSY HYSTERIA ENCEPHALITIS MENINGITIS PURPUERAL CERERBRAL THROMBOSIS INTRACRANIAL TUMOURS

12. DIAGNOSTICAL EVALUATION VITAL SIGNS URINE ANALYSIS BLOOD STUDIES EEG C.T. SCAN & M.R.I.

13. MANAGEMENT

14. GENERAL MANAGEMENT RESUSCITATION – MAINTAIN AIRWAY OXYGEN ADMINISTRATION VENTILATORY SUPPORT IF NEEDED HAEMODYNAMIC STABILIZATION -CRYSTALLOIDS(R.L.) -COLLOIDS ( ALBUMIN) ORGANIZE INVESTIGATION DELIVER BY 6-8 HOURS POST PARTUM CARE(INTENSIVE) ANTIBIOTIC (AMPICILLIN -500MG I.M. 6 HRLY)

15. SPECIFIC MANAGEMENT ANTICONVULSANT MAGNESIUM SULPHATES(MgSO4) - INTRAMUSCULAR(PITCHARD) :- 5 GM I.M. IN EACH BUTTOCK AFTER 4GM I.V. OVER 3-5 MIN. - INTRAVENOUS (ZUSPAN OR SIBAI):- 4-6 GM I.V. OVER 15-20 MINUTES. DIAZEPAM -LEAN REGIMEN 40 MG I.V. - A FURTHER 40 MG IN 500ML OF 5% DEXTROSE

16. CONT… 3. PHENYTOIN - 10MG /KG FOLLOWED BY 5MG /KG 2 HOURS LATER. - GIVEN BY SLOW I.V.WITH E.C.G. MONITORING. 4. ANTIHYPERTENSIVE THERAPY - HYDRALAZINE 10-25MG - LABETALOL 250MG - NIFEDIPINE 10-20MG

17. SCHEME OF OBSTETRIC MANAGEMENT OF ECLAMPSIA ECLAMPSIA ANTICONVULSANT, ANTIHYPERTENSIVE NOT IN LABOUR IN LABOUR C.S. A.R.M . FORCEPS VENTOUSE TO CUT SHORT 2 ND STAGE

18. FITS CONTROLLED FITS NOT CONTROLLED BABY 6-8 HRS MATURE TERMINATION INDUCTION OF LABOUR -PGE2 GEL - A.R.M. - OXYTOCIN TERMINATION TO ASSESS INDUCTION SCORE FAVOURABLE UNFAVOURABLE C.S. INDUCTION PREMATURE DEAD WAIT FOR SPONTANEOUS EXPULSION C.S.

19. COMPLICATIONS

20. 1.MATERNAL COMPLICATIONS DUE TO CONVULSIONS -INJURIES -ASPIRATION -EXHAUTION ACUTE LEFT VENTRICULAR FAILURE HELLP SYNDROME PULMONARY OEDEMA/EMBOLISM PNEUMONIA ANURIA POST PARTUM SHOCK

21. CONT………. HEPATIC NECROSIS PSYCHOSIS PERIPHERAL SEPSIS EYE COMPLICATION DIC ARDS DEATH

22. FOETAL COMPLICATION PERINATAL MORTALITY IS VERY HIGH (30-50%) DUE TO PREMATURITY AND I.U.G.R. INTRAUTERINE HYPOXIA TRAUMA DURING OPERATIVE DELIVERY.

23. CONCLUSION

24. THANK YOU….