Eclampsia

Eclampsia
Definition: A disorder specific of pregnancy characterized by convulsions and/or coma in a pre-eclamptic patient (eclampsia = pre-eclampsia + convulsions and/or coma).

aetiology
Eclampsia is preceded by preeclampsia, rarely developed without any warning sign of preeclampsia .
Cerebral hypoxia due to arteriolar spasm following hypertension is the cause of convulsion especially when blood pressure level above 160/110. Cerebral edema and dysrhythmia is another factors.

Clinical picture:
Pre-convulsive state: eclampsia is usually preceded by severe preeclampsia (imminent eclampsia) with drowsiness, severe headache, flashes of light or dimness of vision, nausea and vomiting, epigastric or upper right quadrant pain. Rarely eclampsia develops suddenly without warning signs of pre-eclampsia.

Stages of eclamptic fit :

Premonitory stage (30-60 seconds):
dissociation of the patient from surroundings

upward rolling of eyes

twitching of facial and hand muscles.

Tonic stage (30 seconds):

Loss of consciousness
generalized muscular rigidity the whole body goes into tonic spasm. The back arches hands clench breathing ceases and patient cyanotic .

 Clonic stage (1-4 minutes):

episodes

of

muscular

contractions

and

relaxations the whole body jerks. mouth opens and shuts. tongue may be bitten breathing is irregular and frothy saliva fills the mouth.
Coma stage:
Patient passes into coma which may last hours.

Types of eclampsia:
According to timing of its onset : 1. Antepartum eclampsia (50-65%): occurs during pregnancy the commonest type. 2. Intrapartum eclampsia (20-30%): convulsions start during labour. 3. Post-partum eclampsia (15-20%): eclamptic fit occurs up to 48 hours after delivery. rare but the most serious type.

Differential diagnosis:
1. Epilepsy
2. Hysteria 3. Meningitis

4. Cerebrovascular accident.

Treatment of eclampsia:
Preventive treatment:
Eclampsia is a preventable disorder, this can be

achieved by proper antenatal care to prevent and to treat pre-eclampsia. Actual treatment: objectives of treatment : 1. sedation to decrease sensitivity of brain to external and internal stimuli. 2. Relief of generalized vasospasm 3. correction of hemoconcentration and hypovolemia 4. Control of hypertension: to prevent cerebrovascular accident and cardiac failure. 5. correction of electrolyte imbalance. 6. Termination of pregnancy.

1-Nursing Care: Patient should be kept in quite room nursed on her side with head and shoulder slightly raised. Oxygen must be given to improve tissue oxygenation. A mouth gag should be available to avoid biting of tongue during convulsions. suction is used to clean mouth, nose and pharynx of frothy secretion. A doctor or trained nurse should be available to protect patient from injury during fits and to maintain clear air-way and record vital signs. Urinary catheter to calculate urine output.

2-Laboratory tests: 1. urinalysis 2. blood urea and creatinine 3. blood electrolytes 4. platelet count 5. coagulation profile.

3- Magnesium sulphate: The standard treatment has sedative, anticonvulsant & hypotensive effects . Regimen: An initial loading dose of 4-6 grams is slowly I.V followed by slow intravenous infusion 1gm/hour. Magnesium sulphate therapy should be continued for 24 hours after delivery. Magnesium sulphate intoxication should be checked and cancelled in presence of any of the followings: 1. Absent knee jerk 2. respiratory rate < 16/minute 3. urine output < 30 ml/hour. Intravenous calcium gluconate or chloride (one gram in 10 ml) is the specific antidote for magnesium sulphate intoxication.

4-Hypotensive drugs: Hydralazine: effective vasodilator drug. Nifedipine: Calcium channel blocker 5-Plasma volume expanders: should be carefully monitored to avoid overload and cardiac failure. 6-Diuretics: should be avoided However, recommended in cases of cerebral edema or cardiac failure. Termination of pregnancy: should be performed as soon as blood pressure is controlled.

HELLP Syndrome
HELLP Syndrome is a series of symptoms that make up a

syndrome that can affect pregnant women. HELLP syndrome is thought to be a variant of preeclampsia, but it may be an entity all on its own.
The name HELLP stands for:

H- hemolysis ( breakdown of red blood cells) EL- elevated liver enzymes (liver function) LP- low platelets counts (platelets help the blood clot)

Causes:
still unclear. Although it is more common in women who

have preeclampsia or pregnancy induced hypertension, there are still a number of women who get it without previously showing signs of preeclampsia

Risk factors

Previous pregnancy with HELLP Syndrome (19-27% chance of recurrence in each pregnancy)
Preeclampsia or pregnancy induced hypertension

Women over the age of 25

Caucasian Multiparous (given birth two or more times)

Symptoms:
The most common symptoms of HELLP syndrome include:

Headaches Nausea and vomiting that continue to get worse (this may also feel like a serious case of the flu.) Upper right abdominal pain or tenderness Fatigue or malaise

other symptoms :

Visual disturbances

High blood pressure

Protein in urine Edema (swelling)

Severe headaches
Bleeding

Diagnosis:
Hemolysis -Red blood bells

Abnormal peripheral smear Lacatate dehydrogenase >600 U/L

Bilirubin > 1.2 mg/dl

Elevated liver Enzyme levels

Serum aspartate amniotransferase >70 U/L Lacatate dehydrogenase >600 U/L

Low Platelets count

Complications

Placental Abruption
Pulmonary Edema ( fluid buildup in the lungs) DICblood clotting problems that result in hemorrhage Respiratory distress syndrome (lung failure) Ruptured liver hematoma

Acute renal failure

IUGR.

management
The treatment of HELLP Syndrome is primarily based on the

gestation of the pregnancy, but delivery of the baby is the best way to stop this condition from causing any serious complications for mom and baby

 Treatments that may be used until baby is delivered :

Bed rest and admission into a medical facility to be monitored closely

Corticosteroid ( to help babies lungs develop more rapidly)

Magnesium Sulfate ( to help prevent seizures)

Blood transfusion if platelet count gets too low

Blood pressure medication Fetal monitoring and tests including biophysical tests, sonograms, non stress tests and fetal movement evaluation