[19] Eclampsia

Question 1

What is eclampsia?

Answer 1

Onset of seizures in a woman with pre-eclampsia

Question 2

When can eclampsia occur?

Answer 2

Before, during or after delivery

Question 3

What type of seizures are seen in eclampsia?

Answer 3

Tonic-clonic

Question 4

How long do eclampsia seizures generally last?

Answer 4

1 minute

Question 5

What are the features of the postictal period in eclampsia?

Answer 5

Confusion or coma

Question 6

What are the main management points of eclampsia?

Answer 6

• Resuscitation
• Treatment and prophylaxis of seizures
• Treatment of hypertension
• Fluid therapy
• Delivery care
• After-delivery care

Question 7

How should a patient with eclampsia be resuscitated?

Answer 7

• Place in left lateral position
• Secure airway
• Oxygen

Question 8

What is the anti-convulsant drug of choice in eclampsia seizures?

Answer 8

Magnesium sulphate

Question 9

What is the initial dose of magnesium sulphate in eclampsia?

Answer 9

4g bolus over 20 minutes as 20ml of a 20% solution

Question 10

How are blood levels of magnesium maintained in treating eclampsia seizures?

Answer 10

1g/hour

Question 11

When should blood levels of magnesium be measured in treating eclampsia seizures with magnesium sulphate?

Answer 11

Only if significant renal failure or seizures recur

Question 12

Why is severe hypertension in eclampsia managed?

Answer 12

To reduce the risk of cerebrovascular accident

Question 13

What are the most commonly used drugs to treat hypertension in eclampsia?

Answer 13

• Hydralazine

- IV labetalol

Question 14

What are the risks of using hydralazine or IV labetalol in eclampsia?

Answer 14

They may cause fetal distress

Question 15

What monitoring is necessary when using hydralazine or labetalol for eclampsia?

Answer 15

Fetal heart rate monitoring

Question 16

What diastolic pressure must not be gone below during pregnancy?

Answer 16

90 mmHg

Question 17

Why is it important to maintain a diastolic pressure of 90 mmHg in pregnancy?

Answer 17

To maintain perfusion of the placenta

Question 18

How should fluid therapy be given in eclampsia?

Answer 18

• Monitor intake and output
• Input restricted to 100ml/hour
• If urine falls below 30ml/hour consider central venous pressure monitoring

Question 19

What can fluid overload in women with eclampsia lead to?

Answer 19

• Pulmonary oedema

- ARDS

Question 20

What is the definitive treatment for eclampsia?

Answer 20

Delivery

Question 21

Should a baby be delivered of the mother is unstable?

Answer 21

No, even in fetal distress

Question 22

When should delivery be performed in eclampsia?

Answer 22

After seizures, severe hypertension and hypoxia are controlled

Question 23

What delivery options should be considered in eclampsia?

Answer 23

• Vaginal

- C-section

Question 24

Which delivery method is more likely in eclampsia?

Answer 24

C-section

Question 25

When is a c-section required in eclampsia?

Answer 25

• Primigravidae
• Well before term
• Unfavourable cervix

Question 26

How should the patient be managed after delivery in eclampsia?

Answer 26

• Quiet environment under constant observation
• Appropriate levels of sedation
• Continue magnesium sulfate for 24 hours after last seizure
• Continue anti hypertensives until BP normal

Question 27

How long may hypertension continue in eclampsia after delivery?

Answer 27

6 weeks

Question 28

What are the potential complications of eclampsia?

Answer 28

• Aspiration
• Pneumonia
• Cerebral haemorrhage
• Kidney failure
• Cardiac arrest