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5. Eclampsia
Eclampsia, what is eclampsia ?
Pre-eclampsia when complicated with convulsions and comas is called Eclampsia . Coming to the onset of convulsions , antepartum: fits occur before the onset of labor, and it has 50% of chances
Intrapartum fits occur during labour and it has 30% of chances
Postpartum fits within the first 48 hours of Delivery during purpureum and the chance here is 20%
Coming to the stage of eclamptic convulsions we have four stages : pre monitory , tonic , clonic and stage of coma . Now let us discuss about the first stage which is premonitory stage.
In premonitory stage, the patient becomes unconscious. The eyeballs are rotated or turned to one side. The stage last for about 30 seconds.
Now let us know about the second stage which is Tonic stage .
In Tonic stage, the whole body goes to a Tonic spasm, spasm means movement of muscles , the limbs of fixed and hands clenched , respiration, Cases and the tongue protrudes between the teeth . Cyanosis appears eyeballs gets fixed. Last for 30 seconds.
The third stage which is clonic stage
In clonic stage, all the voluntary muscles undergo contraction and relaxation.
Biting of the tongue occurs , breathing becomes stertorous and blood stained frothy secretions fill the mouth , cyanosis gradually disappears, the stage last for 1 to 4 minutes.
The last stage, which is, it may last for a brief period of time or until the next convulsions .
Now let us come to the complications that the patient may face: injuries , vasospasm , hypovolemia , cerebral hemorrhage and disturbed vision .
Let us come to the fetal complications. The first one is placental abruption, fetal disruption and intrauterine fetal death .
Coming to the general management of Eclampsia , We need to remember these following important steps :
To prevent serious maternal injury from fall, to prevent aspiration , to maintain airway, to ensure oxygenation , to prevent complications, to deliver by 6 to 8 hours, and postpartum care.
Coming to the specific management the first one is in anticonvulsant regime, the aim is to control the fits and to prevent its recurrence . The drug of choice is magnesium sulphate or Mgso4 it has an excellent maternal mortality rate of about 3% However, it does not helps to control hypertension. For IV administration, concentration of Mgso4 should not exceed 20%. To make it 20%, one part of 50% of Mgso4 is diluted with 1.5 parts of water for injection . Magnesium sulphate is continued for 24 hours after the last Caesar or delivery . For the recurrence of Fits further 2 gram IV bolus is given over 5 minutes . Therapeutic range for Mgso4 is 4 to 8 milli equivalent per liter and calcium gluconate is administered in order to prevent cardiac toxicity due to hypermagnesemia .
Second management is antihypertensives and diuretics, in spite of Mgso4 is the blood pressure is above 160/110 mm Hg antihypertensive drugs should be administered. The first line of antihypertensive, drugs are : Labetalol and Hydralazine . Presence of pulmonary oedema requires diuretics and the most potent one is furosemide which should be administered 20 to 40 mg intravenously during interval
the third management is management during fit, in the premonitory stage a mouth gag is placed in between the teeth to prevent tongue bite and should be removed after the clonic phase is over.
Second , the air passage is to be cleared off the mucus with mucus sucker, the patient’s head is to be turned to one side and the pillow is taken off , oxygen is given until cyanosis disappears.
Then the last we have a status Eclampticus , thiopentone sodium, 0.5 g, dissolved in 20 ml of 5% dextrose is given intravenously very slowly, this is what we have known about the basic concept of eclampsia , see you in the next video . Thank you !
