MANAGEMENT OF

ECLAMPSIA

DR. OKAGUA
 LEVELS OF PREVENTION
Pre-conception care
Prediction of those at risk
Preventive measures for those at risk
Early diagnosis/appropriate management
of pre-eclampsia
 PRE-CONCEPTION CARE
Advice early antenatal care
Pre-pregnancy hypertension control
Pre-pregnancy diabetic control
Good nutrition for those at risk
 PREDICTION
Family/Personal History→ DM, HT, PE
Age/Parity
Multiple pregnancy
Roll-over test
Uterine artery Doppler waveforms
Angiotensin infusion test
Urine Kallikrein to Creatinine ratio
Plasma Fibronectin
Serum inhibin
Serum Urate
 PREDICTION (cont.)
Urinary calcium
Serum AFP/hCG
Haematocrit
Antithrombin III
Plasminogen activator inhibitors (1&2)
 INTERVENTIONS TO
PREVENT PE

Calcium
Aspirin
Magnesium
Fish oils
Anti-hypertensive drugs
 EARLY DIAGNOSIS OF PE
Good antenatal care
Early booking
Routine BP, Urine Protein, Weight checks
Early recognition of Pre-eclampsia &
appropriate management of severe Pre-
eclampsia
 FEATURES OF IMPENDING
ECLAMPSIA
Epigastric pain → right hypogastric
tenderness
Headache → Papilloedema on
Fundoscopy
Visual symptoms
Nausea/vomiting
Hyperreflexia, excessive clonus, twitching
and/or tremor
Benefit from prophylactic anticonvulsants
especially in presence of diastolic BP ≥
 DIAGNOSTIC
CLINICAL CRITERIA
Usually occurs between 20wks gestation and 10
days post-partum
Any fit which does not appear to be of epileptic
origin, metabolic or other known causes should
be classified as eclamptic convulsion
The convulsions should have features of grand
mal convulsions including aura, tonic and clonic
movements, involuntary activity and a post-ictal
state
BRITISH ECLAMPSIA SURVEY
TEAM (BEST)
Defined eclampsia using the above clinical
criteria with at least 2 of the following
 Hypertension
 Proteinuria
 Thrombocytopenia
 Liver enzyme elevation
 PRINCIPLES OF
MANAGEMENT
Ensure ventilation and correction of
hypoxia/ fluid/electrolyte derangement
Control/prevent convulsions
Control blood pressure
Expeditious delivery of the fetus &
placenta (for antepartum/ intrapartum
eclampsia)
 ANTI-CONVULSANTS
Magnesium Sulphate: better seizure
control, no sedation, no significant neonatal
effect, cheap?
Diazepam
Lytic Cocktail
Phenytoin
Paraldehyde
Sodium Aminobarbitone
Bromethol
 MAGNESIUM SULPHATE
ADMINISTRATION

Intravenous or intramuscular regimen

Intramuscular regimen used in this
centre
→ Loading dose of 14g
→ Maintenance dose of 5g 4hrly for
24hrs after
last fit, provided,
Respiratory rate > 16/min
Knee jerk present
Urine output > 100mls in last 4 hrs
BLOOD PRESSURE CONTROL
Hydrallazine
Nifedipine (sublingual)
Labetalol
Sodium nitroprusside
Nitroglycerine
Monitor BP ¼ hrly then ½ hrly when stable
 GENERAL CARE

Resuscitate with cautious correction of

fluid & electrolyte imbalance
Maintain strict imput/output chart
Maintain airway
Nurse semi-prone
Give oxygen
Patient must be stable before attempts
at delivery
 DELIVERY
Mode of delivery will depend on maternal
status and fetal viability
Vaginal delivery preferred were feasible
Continuous FHR monitoring
Avoid prolonged labor
Assisted second stage
Active management of 3rd stage (No
ergometrine)
replace blood loss, volume for volume
INDICATIONS FOR CESAREAN
SECTION
All deeply unconscious patients (unless
delivery is imminent)
All unco-operative patients due to
restlessness
If vaginal delivery is unlikely in 6-8hrs from
the 1st eclamptic seizure
There is obstetric indication for C/S
including fetal distress
 POST-NATAL CARE
Nurse in intensive care unit for 24-48hrs
Stop anticonvulsants after 24hrs fit free
Oliguric patients unresponsive to fluid challenge will
benefit from low dose Dopamine
Continue IV antihypertensives & change to oral
when oral intake commenced then tail off
Counsel about risk of recurrence; advice on
contraception and early booking before discharge
Those with persistent hypertension on discharge
should be seen weekly and referred to the
physicians after 6 weeks for full work-up
Long term follow-up for neurological assessment.
 COMPLICATIONS
MATERNAL
Severe bleeding from abruptio placenta with
its resultant coagulopathy
Pulmonary oedema
Aspiration pneumonia
Acute renal failure
Cerebrovascular haemorrhage
Liver rupture
Retinal detachment
Increased operative delivery
Maternal death
 COMPLICATIONS
FETAL
Prematurity
Birth asphyxia
↑ MTCT of HIV 1 due to depletion of
vitamin A
Fetal wastage
 CONCLUSION
Evidence from developed and developing
countries suggest that of the 3 major causes
of maternal mortality, death from
hypertensive disorders of pregnancy are the
most difficult to prevent (Duley, 1992)
However with effective implementation of the
above prevention strategies and appropriate
treatment based on the best available
evidence, we can continue the march
towards a zero maternal mortality for the
benefit of our mothers, our babies and the
nation.
THANK YOU