MyCpdZw - Protocols Details

ECLAMPSIA

a condition in which one or more convulsions occur in a pregnant woman suffering from high blood pressure, often followed by coma and posing a threat to the health of mother and baby.

Diagnosis

A multisystem disorder of pregnancy usually associated with raised blood pressure & proteinuria.

Generally considered severe if SBP>140 or DBP>90 & significant proteinuria (>+).

Generally occurs after 20/40 up to 1/52 post-partum.

Rarely occurs after 20/40 in multiple pregnancy, hydatidiform moles, antiphospholipid syndrome or

severe renal disease.

Complications include pulmonary, cerebral & peripheral oedema, hepatic rupture & subcapsular

haematoma, renal failure, thrombocytopaenia, DIC, foetal growth retardation & adruptio placentae.

Treatment is ultimately delivery! Anti-hypertensives reduce the risk of stroke but don’t treat the

eclampsia.

Management

1. ABC’s & resuscitation as indicated, continuous monitoring,

2. Inform medical officer at earliest juncture,

3. Nurse in left lateral position,

4. IV access x 2 large bore cannulae,

5. FBC, U& E’s LFT’s, Uric Acid, Coag studies,

6. Catheterize & urinalysis,

7. ECG,

8. Cardiotocography as indicated,

9. CXR as indicated,

10. Prompt treatment of complications especially seizures & hypertension,

11. Treatment & prophylaxis or seizures:

· Magnesium suphate,

· Loading dose 4 g over 5 mins,

· Then infuse at 1 g/hr for 24 hours,

· Give further 2-4 g over 5 mins if convulsions occur,

· Side effects: flushing, nausea, decreased reflexes followed by respiratory depression

(reversible with Ca Gluconate 10 ml 10% at 5 ml/min – give when reflexes disappear

not breathing stops!),

· IV Clonazepam 1-2 mg if above fails.

12. Anti-hypertensives:

· Do not reduce BP too quickly,

· Hydralazine 10 mg by slow IV injection, repeated every 20 minutes up to total of 60

mg if required,

· Consider Hydralazine infusion: 40 mgs in 500 mLs N.Saline infused at 25-250 mls/hr

with rate determined by response,

· GTN infusion may be useful especially if complicated by pulmonary oedema

13. Consider Betamethasone 11.5 mg if delivery expected & 28-34/40,

14. Indications for immediate delivery:

· Eclampsia at > 37/40,

· Inability to control BP,

· Abnormal Cardiotocography,

· Placental abruption,

· Deteriorating liver or renal function,

Progressive thrombocytopaenia.

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