Managment of eclampsia

Managment of eclampsia

1. Management of ECLAMPSIA K . Mohan Ram

2. The management of eclampsia involves six stages: Making sure the airways are clear and the woman can breathe. Controlling the fits. Controlling the blood pressure. General care and monitoring. Delivering the baby. Care after delivery.

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4. Making sure the woman can breathe Place the woman on her left side to reduce the risk of aspiration. Give oxygen and continue for five minutes after each fit, or longer if cyanosis persists. After a convulsion, aspirate the mouth and throat as necessary to clear the airway. Monitor her and ensure that her airway is clear.

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6. Controlling the fits MAGNESIUM SULFATE is the drug of choice How to administer? What all to monitor? In case of Respiratory Arrest?

7. How to administer? LOADING DOSE 4g of 20%MgSO4 slow IV infusion for 5 mins. 5g of 50%MgSO4 IM in each buttock. If convulsions recur after 15 minutes, give 2g 50%MgSO4 slow IV for 5 minute. MAINTENANCE DOSE 5g 50%MgSO4 IM every 4 hrs. MAXIMUM DOSE 20g in 24 hrs

8. What all to monitor? Respiratory Rate : <16/min Patellar Reflex : absent Urine Output : <30ml/hr

9. In case of Respiratory Arrest? 1g of 10% calcium gluconate(10ml) slow IV infusion until respiration begins Assisted ventilation

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11. Controlling blood pressure AIM Maintain the diastolic blood pressure between 90-100mmHg DRUGS USED Hydralazine Labetolol Nifedipine

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13. General care and monitoring Turning the woman two-hourly. Quiet dark room with an attendant. NPO. Bladder is catherised. Antibiotics. Throat is kept clear of mucus. Anaesthetic instruments, suction apparatus and oxygen equipment must be ready for use by the bedside

14. Restlessness/twitching Color is observed for cyanosis Temperature 4 hourly Pulse & Respiration hourly BP twice hourly Fetal heart hourly Signs of labour Fluid balance Clotting status

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16. Delivering the baby FAVOURABLE CERVIX (soft,thin,partly dilated) ROM  induction  vaginal delivery UNFAVOURABLE CERVIX (firm,thick,closed) Caesarean section

17. Caesarean Section INDICATIONS Unfavourable cervix Fetal heart abnormalities vaginal delivery not anticipated within 12 hours CONTRAINDICATIONS Unsafe anaesthesia Fetus too premature for survival Intrauterine fetal death.

18. delivery should occur within 12 hours of the onset of convulsions

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20. Care after delivery Careful observations for at least 48 hours after delivery. Anticonvulsive therapy should be maintained for 24 hours after delivery/last convulsion, whichever occurs last. Antihypertensive therapy is continued until the diastolic blood pressure decreases to less than 100 mmHg. Quiet, dark room with attendant. Monitor urinary output If after 48 hours there are no fits, the urinary output is good and the diastolic blood pressure is below 100 mmHg, the woman can be transferred to the main ward to recover. Continue four–hourly blood pressure checks for a few days. Follow up six weeks after delivery.

21. Complications Aspiration pneumonitis Pulmonary edema Renal failure Cerebral hemorrhage

22. Thank You