eclampsia

Question 1

ethiopathogenesis of eclampsia

Answer 1

• predisposing factor :
  1. nervous stress
  2. socioeconomical problems
  3. malnutrition
  4. sleeplessness
  5. climate
• these predisposing factor causes hyperexcitability n hyperflexia of brain
• gen vasospasm occur at :
  1. eye : art constricts, Vn dilates, edema of retina, small hemorr
  2. lungs : pulm edema → fibrosis → pulm insufficiency
  3. kidneys : ↓ b flow → glomerular perfusion n renal perfusion ↓ → ↓ clearance of uric
  acid → Na+ n H20 retention → edema
• ↓ b flow → hypoxia of glomerulus → high permeability → proteinuria, cylinduria
• ↓ b flow → renal cortical necrosis → renal insufficiency
  4. liver : hepatocellular damage → protein formation disorder, disintoxication, coagulation disorder → thrombocytopenia → HELPP synd, DIC
  5. brain : microcirculation disorder, circulatory hypoxia, edema of brain, cerebral hemorrh → brain compression → convulsion

Question 2

definition of “eclamptic status”

Answer 2

• def = convulsive disorder of preg associated w clinical pict of severe pre-eclampsia

Question 3

phases of “eclamptic status”

Answer 3

1. stage 1 / aura phase
   - prodromal sympt
   o Disturbed vision
   o Flashes of lights
   o Headache
   o Vomiting
   o Epigastric pain
2. stage 2 / tonic phase
   o Restlessness
   o Twitching n rolling of eyeball
   o Rigid body
   o Head thrown back
   o Eyes turned up to the side
   o Respiration is stopped
3. stage 3 / clonic phase
   - marked by alternate contraction n relaxation of m
   - thus need to fixate ptt to prevent injury of ptt
   o Twitching in the face
   o Violent contraction of limb
   o Tongue severely bitten ( possible )
4. stage 4 / coma phase
   - outcome is death or survival

Question 4

management

Answer 4

• immediate initiate
  1. analgesia
  2. antiHT drugs
  3. CV monitoring
  4. b/p n pulse monitoring
  5. CTG to monitor fetal heart activity n uterine contraction
  6. management of coagulation abN ( hemostasiogram )
  7. fluid therapy → treat oliguria
  8. control convulsion
  9. decide when to deliver

Question 5

indication to cesarean section in eclampsia

Answer 5

● Uncontrolled fits inspite of therapy.
● Unconscious patient & poor prospect of vaginal delivery.
● Obstetric indications (malpresentation)

Question 6

clinical picture

Answer 6

• usually no aura preceding the seizure; ptt may have 1 or more seizures
• unconsciousness period may vary
• ptt in hyperventilation after tonic-clonic seizure to compensate resp and lactic acidosis that develop during apneic phase ( no breathing )
• fever is rare but poor prognosis sign
• seizure induced complication include tongue bitting, broken bones, head trauma, or aspiration
• pulmonary oedema and retinal detachment may follow seizure
• proteinurea may not present

Question 7

diagnosis

Answer 7

• features preceding convulsion are noticed; eg. severe headache, irritability, visual disturbance, epigastric pain, oliguria, tachycardia dt severe vasoconstriction
• pregnant women with pre-eclampsia
• causes for coma and convulsion in 1/5 cases not related to HT

Question 8

differential diagnosis

Answer 8

• Hypertensive states of pregnancy other than preeclampsia-eclampsia
  ● Chronic Essential HT
  ● Chronic HT dt renal disease
  ⮚ Interstitial nephritis
  ⮚ acute and chronic glomerulonephritis
  ⮚ systemic lupus erythematosus
  ⮚ diabetic glomerulosclerosis
  ⮚ Sclerodema
  ⮚ Polyarthritis nodosa
  ⮚ Polycystic kidney disease
  ⮚ renovascular stenosis
  ⮚ chronic renal failure with Tx by dialysis
  ⮚ renal transplant
  ● Chronic HT dt endocrine disease
  ⮚ Cushing’s syndrome and disease
  ⮚ primary hyperaldosteronism
  ⮚ thryotoxicosis
  ⮚ pheochromocytoma
  ⮚ acromegaly

Question 9

complications

Answer 9

• cerebral hemorrhage, aspiration pneumonia, hypoxic encephalopathy, thromboembolism, dev of disseminated intravascular coagulation, hepatic rupture, renal failure, anesthetic accident may lead to death
• iatrogenic complications when multiple drugs are given
• multipara eclampsia had much higher incidence of subsequent HT and deaths dt CVD and other causes
• dt risk of reoccurrence of eclampsia, subsequent pregnancy is not advisable