Pre- & Eclampsia
Background Eclampsia
re-Eclampsia Diagnosis
Triad of :
- Hypertension
- Proteinuria
- Oedema. (usually insidious onset, asymptomatic)
Eclampsia usually occurs in first pregnancy unless change of partner.
- Systolic BP > 160
- Diastolic BP > 110 or (>15 mmHg above booking)
- Proteinuria > "+" / 500 mg/24
Some present with symptoms
- Neurological - headache, visual disturbance and convulsions
- Epigastric pain and tenderness
- HELLP (Haemolysis, Elevated Liver enzymes and Low Platelets)
- Pre-eclampsia as a syndrome specific to pregnancy
- Disorder of endothelial function (placental / maternal vascular trees)
- 20% of maternal mortality
- Commonest recognised cause of fetal growth retardation
- Fitting due to pregnancy induced hypertension
- May be atypical
- May occur post partum
- Progress halted only by delivery of the fetus (and placenta).
Approach
- Upper abdominal pain in pregnancy may indicate pre-eclampsia
- All women
who present with upper abdominal pain and tenderness in pregnancy (usually after 20 weeks'
gestation):
- 1. Measure B.P. If > 140/90 mmHg seek advice from the obstetric unit in which the woman is booked
- 2. Test for proteinuria. If proteinuria (i.e., more than a trace) is present in an MSU and especially if hypertension is detected refer immediately for admission to the maternity unit. (Don't take "No" for an answer
- 3. Once admitted, blood should be analysed for, among other things, thrombocytopaenia and hepatic dysfunction.
- 4. If you remain concerned about the epigastric pain and tenderness in the absence of hypertension or proteinuria review the following day.
Treatment of Eclampsia
- High flow oxygen
- Place in left lateral; position, suction available
- i.v. access (large bolus)
- Diazemuls 5 - 10 mg then
- Magnesium
Magnesium Sulphate
Magnesium toxicity
| >5 | loss of reflexes, flushing, diplopia, slurred speech |
| 6 - 7.5 | muscle paralysis, respiratory arrest |
| >12 | cardiac arrest |
Recurrent seizures after Mg
- Treat with a further bolus of 2g
- RSI with Thiopentone/ventilation
- Treat hypertension(MgSO4may reduce BP otherwise, give Hydralazine)
- (contra-indications: neuromuscular disease, myasthenia gravis, renal failure, cardiac disease)
- MgSO4 Loading dose - 4 grams (8 mls 50% w/v) i.v. over 5 mins
- Causes nausea, vomiting and flushing (use Maxolon)
- Maintenance infusion of 1g/h for at least 24 hours after the last seizure
- Recurrent seizures should be treated by a further bolus of 2g
- Can cause respiratory arrest
- Reduce maintenance dose in oliguria or renal failure
- Antidote: Calcium Gluconate 1 gram over 10 mins
- Monitor: reflexes, resps (>16/min), SpO2, ECG for first hour
