GROUP 5

• YUSUF SELAWIJAYA

• DHADHANG SETYA

• COKORDA GEDE ARI .D

• GUNGDE INDRA

• GABRIEL RENATA HANDOYO

• VERA SILVIANA

• NUR FARIDA

• NI PUTU INTAN YUSTIKA RINI DEWI

ECLAMPSIA

• Is a life threatening complications of preeclampsia, defined as tonic, clonic convulsions in a pregnant woman in the absence of any other neurological or metabolic causes. It is an obstetric emergency.

• It occurs antenatal,intrapartum,postpartum

(after delivery 24-48hs)

RISK FACTORS

• Low socioeconomic class

• Multiple foetuses or hydatid

• Maternal age <20 or >35 yrs

• Primip

• Gestational or pre-gestational DM

• Renal disease

• Afro caribbean- twice as likely

• Family history- four times the risk

What Causes Eclampsia?

Eclampsia often follows preeclampsia, which is characterized by the appearance of high blood pressure after the 20th week of pregnancy. If your preeclampsia worsens and affects your brain, causing seizures or a coma, you have developed eclampsia.

SYMPTOMS

• Headache

• Oedema

• Visual disturbance

• Focal neurology , fits , anxiety , amnesia

• Abdo pain

• SOBOE

• Decreased urine output

Eclampsia Diagnosis

• If you experience any of the above symptoms call your doctor immediately and expect to come to the office or hospital. If you have your own blood pressure device at home, report this reading to your health care professional. However, do not substitute your home blood pressure reading for a doctor visit.

• Be sure to review all of your signs, symptoms, and concerns with your health care professional. Your health care professional should check your blood pressure, weight, and urine at every office visit.

• If your health care professional suspects that you have preeclampsia, he or she will order blood tests to check your platelet count, liver function, and kidney function. They will also check a urine sample in the office or possibly order a 24-hour urine collection to check for protein in the urine. The results of these blood tests should be available within 24 hours (if sent out), or within several hours if performed at a hospital.

• The well-being of your baby should be checked by placing you on a fetal monitor. Further tests may include non-stress testing, biophysical profile (ultrasound), and an ultrasound to measure the growth of the baby (if it has not been done within the previous 2-3 weeks). • Ancillary studies may include ultrasound and CT or MRI

scan of the head to help include or exclude diagnoses.

COMPLICATIONS

• Permanent neuro demage

• Renal insufficiency

• Abruption

• 25% of eclamptics will be so in future pregnancies

• Increased risk of essential hypertension

Eclampsia Medications

• Patients may require medication to treat high blood pressure during labor or after delivery. Hydralazine, labetolol and nifedipine are commonly used medications used to reduce blood pressure slowly to systolic levels below 160 mm Hg. It is unusual to require medication for high blood pressure after six weeks following delivery (unless the person has a problem with high blood pressure that is unrelated to pregnancy).

• During labor (and for 24 to 48 hours after delivery) patients will be given a medication called magnesium sulfate. This is to decrease the chances of having a recurrent seizure. Secondary medications for seizures include benzodiazepines and phenytoin.

• Medications such as oxytocin (Pitocin) or prostaglandins may be given to induce labor and/or ripen the cervix. A Foley catheter is sometimes placed in the cervix to mechanically "speed" the dilation process. • Some patients may be given steroids IV if the fetal

gestational age is less than 32 weeks.

Eclampsia Treatment

• Once eclampsia develops, the only treatment is delivery of the baby (if eclampsia occurs prior to delivery). Eclampsia can also occur after delivery (up to 24 hours postpartum, typically). Rarely, eclampsia can be delayed and occur up to one week following delivery. There is no cure for eclampsia.

• Magnesium sulfate (given intravenously) is the treatment of choice once eclampsia develops. This treatment decreases the chances of having recurrent seizures. Magnesium treatment is continued for a total of 24 to 48 hours after the last seizure. Patients may receive magnesium in an intensive care unit or a labor and delivery unit. While magnesium is given they will be observed closely, receive intravenous fluids, and have a Foley catheter placed in the bladder (to measure urine output).

• Occasionally, recurrent seizures require additional treatment with a short-acting barbiturate such as sodium amobarbital. Other medications including diazepam or phenytoin have been used to treat eclampsia; however, they are not as effective as magnesium sulfate.

• Patients may also receive treatment for elevated blood pressure while being treated for eclampsia. Common blood pressure medications (for women with eclampsia) include hydralazine or labetalol.

• Once the mother's condition is stabilized following a seizure, the doctor will prepare to deliver the baby. This can occur either by cesarean delivery or induction of labor and vaginal delivery. If the patient is already in labor, labor can be allowed to progress provided there is no evidence that the baby has become "distressed" or compromised by the seizure.

• The closer the person is to the due date, the more likely the cervix will be ripe (ready for delivery), and that induction of labor will be successful. Sometimes medications, such as oxytocin, are given to help induce labor.

• The earlier in pregnancy (24 to 34 weeks), the less chance of a successful induction (although induction is still possible). It is more common to have a cesarean delivery when eclampsia necessitates delivery early in pregnancy. • If the baby shows signs of compromise, such as decreased

fetal heart rate, an immediate cesarean delivery will be performed.

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