DR HAIZUN HASSAN

WHAT IS ECLAMPSIA?
NICE GUIDELINES: Eclampsia is a
convulsive condition associated with pre-
eclampsia.

In Europe and other developed countries
eclampsia complicates approximately 1 in
2000 deliveries
in developing countries estimates vary
between 1 in 100 to 1 in 1700.
Forty-four per cent of seizures occur
postnatally, the remainder being
antepartum (38%) or intrapartum (18%).
(BMJ)
PRE-ECLAMPSIA
new hypertension presenting after
20 weeks with significant
proteinuria. (NICE)
WHAT ARE THE RISK FACTOR?
Nulliparity
Family history of preeclampsia, previous
preeclampsia and eclampsia
Poor outcome of previous pregnancy
Multifetal gestations, hydatid mole, fetal
hydrops
Teen pregnancy
Primigravida
Age 35 years
Lower socioeconomic status
Preexisting medical conditions
The precise mechanism that is
responsible for the development of
seizures is not clear, but proposed
theories include cerebral
vasospasm, edema, and the
possibility that severe hypertension
might disturb cerebral
autoregulation and disrupt the
bloodbrain barrier
http://cjasn.asnjournals.org/content/2/3/543.f
ull

Management?
General
condition
Anticonvulsive
therapy
Blood
pressure
control
Delivery
Post partum
General condition
Airway: position pt to the left side,
give O2
Breathing
Circulation- insert 2 large bore
branullas, blood ix, restrict fluid
Anticonvulsive therapy

mgso4
Dose
monitoring
Adverse
effect
aim
aim
to stop any convulsion that is
present and
to try and prevent any recurrence
of convulsions

dose
Stat dose: 4 g mgso4 bolus over 15-
20 min
Maintenance dose: 1 g/hour over
24 hour
?? How to dilute
monitoring
Vital sign
Urine output
Patellar rerflex

Adverse effect
Hypotension
Arrhythmias
Respiratory depression
Flushing
Nausea/vomiting
Drowsiness
Double vision
Calcium gluconate
Control blod pressure
Nifedipine
Labetolol
Iv hydralazine
Post partum
Cont mgso4 until 24 hours post
partum
Control Blood pressure to decide
either to cont antihypertensive
post partumly
pre pregnancy counselling