Management protocol for Eclampsia

on 25.1.11 with 0 comments

A pregnant mother came to you with eclamptic fits :

First, guard the mother against cardiorespiratory compromise and secondary injury due to seizure activity,

a) Give supplementary oxygen
b) Place the mother in left lateral position

This is to relieve compression of gravid uterus against Inferior vena cavae
And also to prevent aspiration during convulsions

c) Raised guardrails and padding to prevent maternal injury
d) Use padded tongue blade in between teeth and perform oral suction as required

Now, convulsions ceases. Gain IV access stat

a) Use 16G-18G IV cannula to gain IV access
b) For fluid therapy, withdrawal of blood for investigation and rapid administration of drugs

Start controlling the seizures

a) Magnesium sulphate (MgSO4)

A loading dose of 4-6gm bolus IV given over a period of 20 minutes
If convulsions persist even after 20 minutes, 2-4 gm of additional dose to be given.
Maintenance dose of 1-2 gm/hr started after 20 minutes

b) Recurrent seizures

Start IV Valium (diazepam) 5-10 mg slowly
May be repeated every 15 minutes upto 30 mg of maximum dosage

Control the blood pressure

a) 50 mg of IV hydralazine in 500ml of Normal saline started at 5 drops/min
b) Infusion can be increased by 5 drops/min every 5 minutes
c) Aim is to reduce DBP < 110 mmHg
d) After BP has stabilised for 4 hours, IV hydralazine can be tailed off, and oral antihypertensive is re-instituted.

To monitor :

1) Neurological signs of raised ICP/bleeding

Cranial nerve examination, fundoscopic examination for papilloedema and knee jerk

2) Input/output chart, maternal respiratory rate and oxygen saturation

3) Continuous fetal monitoring (CTG)

Mother is to be kept nil by mouth until she is stabilized medically or delivered

Now, decide on the mode of delivery.
Bear in mind that the definite treatment for eclampsia is delivery.
But, NO one should conduct delivery, vaginally or via LSCS until the mother has recovered from the acute phase of eclampsia.

a) Induce labour and conduct vaginal delivery if :

Period of gestation is > 30 weeks
No fetal malpresentation or fetal distress present

b) Perform LSCS if :

Period of gestation is 30 weeks or less
Unfavourable cervix

Investigations to be done

a) Full blood count
b) BUSE/Creatinine/Uric acid
c) Liver function test
d) Coagulation profile
e) Serum glucose
f) Urine FEME

Imaging is done by CT scan of brain if the diagnosis is in doubt or mother suffers form secondary injury as a result of the seizures

Category: Obstetrics Notes



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