ECLAMPSIA/ECLAMPTIC FITS

 Eclampsia is a condition of convulsions or coma occurring in pregnancy (in Between the 20 w of pregnancy and the end of the 1st week after delivery) Associated with Hypertension edema and protein uses”

Or

Eclampsia is a complicated state of pre-eclsmpsia with coma & convulsion

Note:- Convulsion/coma accused due to epilepsy cerebral haemorrhage or any other pathological condition of brain are not considered in eclampsia”

Causes of eclampsia:- Convulsion are caused by cerebral irritation following conditions leads to irritation

(i) Anoxic:- Anoxic is caused by spasm of the cerebral vessels due to hypertension

(ii) Cerebral oedema:- Oedema of the brain parenchyma also contribute to the irritation of brain

(iii) Cerebral dysrhythmia:- Dysrhythmia is caused by reduced blood supply to brain due to edema and spasm of vessels of brain

Clinical Features of eclampsia:-

Sed BP, Albumin & urine out put

Convulsions & coma

Headache

Epigastric pain

Vomiting

Stages of clinical Features:-

(1) Pre-Monitory stage:- (It lasts for about 30 sec)

Pt becomes unconscious

Face tongue and limbs muscle are twitched

Eye balls turn one side

(2) Tonic stage:- (It also last for 30 sec.)

Limbs are flexed

Hands cleanched

Tongue protrudes b/w teeth

Respiration become shallow

Cyanosis’ occurs

Eye balls are become fixe

(3) Clonic stage:- (It becomes last 1-4 min)

Rhythmical contraction of voluntary muscles occur

Twitching occurs in face limbs and even in whole body

Tongue biting occurs

Breathing become Sertorous

Blood stained secretions occurs from mouth

Cyanosis’ disappears gradually

(4) Coma stage:-

Pt become confused

Coma may occur without prior convulsions

Temp 

Pulse and Resp. also increases

B.P increase

Urinary output diminished

Diagnosis eclampsia:-

Eclampsia must be differentiate from f. pathological condition

Epilepsy

Hysterias

Poisoning

Encephalitis

Cerebral Malarias

Intra cranial tumor

Enen cephalopathy

Complication of eclampsia:-

Tongue bite

Pulmonary Oedema

Hyper pyrexia

Cardiac failure

Renal failure

Cerebral edema and Haemorrhage

Disseminated Intravascular Coagulopathy (DIC)

Shock, Sepsis, Psychosis

Management of eclampsia (elamptic fits)

Principle of Hospital Management:-

Maintaining the airway open

Oxygen administration

Maintain Haemodynsic stabilization (Control B.P)

Maintain fluid & electrolyte balance

Control the convulsions

Ventilator support (if needed)

Delivery by 6-3 hrs.

(1) During Pregnancy:-  If labor doesn’t start Management depends on

(a) Fit controlled/not

(b) Maturity of fetus

(1) Fits controlled – baby mature

Induction of labour & vaginal delivery

Or C.S

Baby Premature -  Continues preg. Till term

Continues monitoring of fetal well being

(2) During labour:-

Adm. Antihypertensive & anti consultant

Improve progress of labour by ARM

Monitor for PPH shock

Record vital signs & urine out put

ECLAMPSIA

           Anti convulsant, Antihypertensive, Diuretics’ & sedatives

Labour Absent Labour

Fits are controlled Fits are not controlled AROM C.S

Dead       Pre-mature  Matured Favorable    Unfavorable

Wait for Continues it Part AROM C.S

Spontaneous Condition is under Oxytocin

Expulsion Control in Hospital

For few days

Termination

Induction PGE E2 gel C.S

AROM oxytocin