Download to read offline
Uploaded bySREEVIDYA UMMADISETTI
ECLAMPSIA.pptx PREGNANCY INDUCED HYPERTENSION
DESCRIBES ECLAMPSIA IN DETAIL
More Related Content
Similar to ECLAMPSIA.pptx PREGNANCY INDUCED HYPERTENSION
More from SREEVIDYA UMMADISETTI
ECLAMPSIA.pptx PREGNANCY INDUCED HYPERTENSION
- 1.
- 4. INTRODUCTION Eclampsia is asevere complication of preeclampsia. It’s a rare but serious condition, where high blood pressure results in seizures during pregnancy. Seizures are periods of disturbed brain activity that can cause episodes of staring, decreased alertness, and convulsions (violent shaking). Eclampsia affects about 1 in every 200 women with preeclampsia. It can develop even if it doesn’t have a history of seizures.
- 6. Definition 1. Eclampsia isthe progression of a more severe form of preeclampsia in which generalized seizures or coma occurs. - Reeder’ s Martin 2. Pre-eclampsia when complicated with convulsion and / or coma is called eclampsia. 3. Eclampsia may occur abruptly without any warning manifestation. – W.H.O 4. Eclampsia includes hypertension, proteinuria & oedema with convulsions. - Sandeep Kaur 5. Pre-eclampsia when complicated with generalized tonic–clonic convulsions and/or coma is called eclampsia. -D.C.Dutta
- 9. ONSET OF FITS Fitsoccur more commonly in the third trimester (more than 50%). On rare occasions, convulsion may occur in early months as in hydatidiform mole. Antepartum (50%): Fits occur before the onset of labor. More often, labor starts soon after and at times, it is impossible to differentiate it from intrapartum ones. Intrapartum (30%): Fits occur for the first time during labor. Postpartum (20%): Fits occur for the first time in puerperium, usually within 48 hours of delivery. Fits occurring beyond 48 hours but less than 4 weeks after delivery is accepted as late postpartum eclampsia.
- 12. CAUSE OF CONVULSION Thecause of cerebral irritation leading to convulsion is not clear. The irritation may be provoked by: (1) Anoxia — spasm of the cerebral vessels → increased cerebral vascular resistance → fall in cerebral oxygen consumption → anoxia, (2) Cerebral edema — may contribute to irritation, (3) Cerebral dysrhythmia — increases following anoxia or edema. There is excessive release of excitatory neurotransmitters (glutamate).
- 14.
- 15. CLINICAL FEATURES OFECLAMPSIA Except on rare occasions, an eclamptic patient always shows previous manifestations of acute fulminating pre-eclampsia — called premonitory symptoms. Eclamptic convulsion or fit: The fits are epileptiform and consist of four stages. Premonitory stage: Becomes unconscious. There is twitching of the muscles of the face, tongue, and limbs. Eyeballs roll or turned to one side and become fixed. This stage lasts for about 30 seconds. Tonic stage: The whole body goes into a tonic spasm — the trunk- opisthotonus, limbs are flexed and hands clenched. Respiration ceases and the tongue protrudes between the teeth. Cyanosis appears. Eyeballs become fixed. This stage lasts for about 30 seconds.
- 16. Cont. Clonic stage: Allthe voluntary muscles undergo alternate contraction and relaxation. The twitching's start in the face then involve one side of the extremities and ultimately the whole body is involved in the convulsion. Biting of the tongue occurs. Blood stained frothy secretions fill the mouth; cyanosis gradually disappears. This stage lasts for 1–4 minutes. Stage of coma: Following the fit, the patient passes on to the stage of coma. It may last for a brief period or in others deep coma persists till another convulsion. On occasion, the patient appears to be in a confused state following the fit and fails to remember the happenings. Rarely, the coma occurs without prior convulsion.
- 17. Cont. Following the convulsions,the temperature usually rises; pulse and respiration rates are increased and so also the blood pressure. The urinary output is markedly diminished; proteinuria is pronounced, and the blood uric acid is raised.
- 20. Diagnostic Findings ⁑Complete historycollection ⁑Physical examination of the mother ⁑Blood tests: like red blood cell count or platelet count (It may show abnormal factors) ⁑Urine tests: Urine tests typically show large amounts of protein in urine. ⁑Creatinine tests: Creatinine is a waste product that’s typically filtered out of blood by kidneys. Abnormally high levels of creatinine could be a sign of kidney failure. ⁑Monitor the fetus and check its heart rate, movement, size and other factors through ultrasound to ensure it’s tolerating pregnancy well.
- 26. Regimens of MgSO4 forthe management of severe pre-eclampsia and eclampsia Regimen Loading dose Maintenance dose Intramuscular (Pritchard) 4 gm IV over 3–5 min followed by 10 gm deep IM (5 gm in each buttock) 5 gm IM 4 hourly in alternate buttock Intravenous (Zuspan) 4–6 gm IV over 15–20 min 1–2 gm/hrs. IV infusion
- 31. Cont. Other regimens are:(1) Lytic cocktail (Menon 1961) using chlorpromazine, promethazine and pethidine. (2) Diazepam (Lean) and (3) Phenytoin. Compared to other regimes Magnesium sulfate has got the following benefits: (i) it controls fits effectively without any depression effect to the mother or the infant. (ii) Reduced risk of recurrent convulsions (iii) Significantly reduced maternal death rate (3%) and (iv) Reduced perinatal mortality rate.
- 42. MATERNAL COMPLICATIONS OFECLAMPSIA Injuries: Tongue bite, injuries due to fall from bed, bed sore. Pulmonary complications: Oedema—due to leaky blood capillaries Pneumonia—due to aspiration, hypostatic or infective Adult respiratory distress syndrome Embolism • Hyperpyrexia • Cardiac—Acute left ventricular failure • Renal failure • Hepatic—necrosis, Subcapsular hematoma • Cerebral: Edema (vasogenic) hemorrhage • Neurological deficits
- 43. Cont. Disturbed vision: Dueto retinal detachment or occipital lobe ischemia. • Haematological – Thrombocytopenia – Disseminated Intravascular Coagulopathy (DIC) • Postpartum – Shock – Sepsis – Psychosis