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Eclampsia - Coggle Diagram
Eclampsia
Epidemiology
Maternal mortality rate of 1.8%
Affecting approximately 5/10,000 pregnancies
Foetal mortality rate of up to 30%
Majority of seizures occur in the post-natal period [within 4 days] (44%), but they can also occur in the antepartum (38%) or intrapartum (18%) settings
Clinical Features
Post-ictal phase
Signs and sx relating to end organ dysfunction
Hyper reflexia
N and V
Headache (frontal)
Generalised oedema
RUQ pain +/- jaundice
Visual disturbance e.g. flashing lights, blurred or double vision
Change in mental stage
Seizures typically last around 60 to 75 seconds
New onset tonic-clonic type seizure, in the presence of pre-eclampsia (new onset hypertension and proteinuria after 20 weeks’ gestation)
Risk factors of pre-eclampsia
Moderate
Nulparity
Maternal age >40yrs
Maternal BMI>35 at initial presentation
Family Hx
Pregnancy interval >10yrs
Multiple pregnancies
High
Chronic HTN
HTN, pre-eclampsia or eclampsia in a previus pregnancy
Pre-existing CKD
DM
Autoimmune diseases (e.g. SLE, APLS)
Complications
Foetal
Distress
Bradycardia
IUGR
Prematurity
Infant respiratory distress syndrome
Intrauterine foetal death
Placental abruption
Maternal
HELLP syndrome (3%)
DIC (3%)
AKI (4%)
ARDS (3%)
Cerebrovascular haemorrhage (<2%)
Permanent CNS damage
Death
Management
Assess for other causes of seizures including hypoglycaemia, head trauma, brain tumour, medication SE, stroke, meningitis, pre-existing epilepsy, septic shock, cerebral aneurysm, etc.
5 principles
Resuscitation
ABCDE
Left lateral position
Blood pressure control
MAP <120
Continue CTG monitoring to assess foetal heart rate
labetalol or hydralazine
Cessation of seizures: Magnesium sulfate (Assess for signs of hypermagnesia: hyperreflexia, resp depression) and monitor CTG
MgSO4 should be continued for 24 hours alfter delivery/last seizure (whichever is later)
Recurrent: 2g bolus
Maintenance: 1g hourly for 24 hours
1st seizure: 4g in 100ml 0.9% NaCL
Prophylaxis: 4g in 100ml 0.9% NaCL
Prompt delivery of baby and placenta
C-section is ideal
HDU is required post delivery until patient stable with aadequate BP, UO abd discontinuation of MgSO4
Monitoring
Fluid balance to prevent APO and AKI
Compliationm fo eclampsia: plt, transaminases, creatinine
Investigations
To exclude other causes
BSL
CTB/MRI
To assess for complications
FBC (decreased Hb, plt)
Clotting studies
EUC (increased urea, creatinine, urate; decreased UO)
Abdominal US: estimate gestational age, rule out placental abruption)
CTG
Post natal care and follow up
Inpatient care
Regular sx review: headaches, epigastric pain
Bloods 72 hours post partum: FBC, LFT's, creatinine
Pre-conceptual counselling: minimise risk factors + prophylaxis for future pregnancies
Step down care to community: when reached target BP and asymptomatic
Outpatient care
Consider CT head: persisting neuro deficit
Measure BP
6 week follow up: BP, proteinuria, creatinine, FBC, LFT
Definition: the occurrence of one or more convulsions in a pre-eclamptic woman in the absence of any other neurological or metabolic causes