ECLAMPSIA

BY WIKA R. ROSEFA, S.Kep., Ns

Description
Preeclampsia and eclampsia are

hypertensive disorders of pregnancy that occur in 5% of pregnancies. In developing countries, hypertensive disorders of pregnancy are the single most common cause of death in childbirth. Among the most fatal part of pregnancyinduced hypertension is eclampsia. The status of having an eclampsia is an introductory phase for having convulsions when the case is not managed properly. Eclampsia is also called toxaemia.

Definition
Preeclampsia is defined by the presence

of three elements: hypertension, proteinuria (protein in the urine), and edema (fluid retention). If seizures develop following the appearance of the first three factors, the condition is called eclampsia.

In diagnosing pregnant mothers in the pre-eclamptic stage, a triad of signs and symptoms are observed:
Intense Vasospasm Local or disseminated intravascular

coagulation Plasma volume contraction

Eclampsia can only be squared down when the following signs and symptoms are present:
hypertension proteinuria edema

Pathophysiology
During pre-eclampsia, there is constriction of

the muscles around the small arteries that then damages the internal lining of the arteries (endothelium) and the red cells in the blood as they try to squeeze through the constrictions. Ultimately the constrictions cause high blood pressure and reduced blood flow to the liver, kidneys, eyes and brain. When the internal lining of the blood vessels is damaged, fluid can leak out into the tissues,

Symptoms
High blood pressure, the risk of eclampsia

rises as blood pressure increases above 160/110 mm Hg. The kidneys are unable to efficiently filter the blood (as they normally do). This may cause an increase in protein to be present in the urine. Nervous system changes can include blurred vision, seeing spots, severe headaches, convulsions, and even occasionally blindness.

Symptoms
Changes that affect the liver can cause

pain in the upper part of the abdomen. Changes that can affect the baby can result from problems with blood flow to the placenta and therefore result in the baby not getting proper nutrients. As a result, the baby may not grow properly and may be smaller than expected, or worse the baby will appear sluggish or seem to decrease the frequency and

 Pre-eclampsia can be mild or severe.

It is called eclampsia if a seizure

occurs. One severe form of the disease is called HELLP syndrome if a particular combination of problems develops (Haemolysis, Elevated Liver enzymes, Low Platelets).

 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.

Eclampsia Causes
No one knows what exactly causes

preeclampsia or eclampsia, although abnormalities in the endothelial system (the lining cells of blood vessels) have been described as a potential cause. Obese women also have a higher risk of preeclampsia and eclampsia than women of normal weight. Preeclampsia may run in families, although the reason for this is unknown.

Predisposing factors:
Multiparity

Being pregnant under 20 years old

Being pregnant more than 30 years

old Being in a low socio-economic status Previous diagnosed illness such as heart disease, diabetes mellitus and

MANAGEMENT OF ECLAMPSIA 1. Resuscitation Resuscitation requires institution of intravenous access, oxygen by mask, assuring a patent airway and removing regurgitated stomach contents from the mouth/pharynx. Occasionally, recurrent seizures require additional treatment with a short-acting barbiturate such as sodium amobarbital. Other medications including diazepam (Valium) or phenytoin (Dilantin) have been used to treat eclampsia; however,

2. Magnesium sulfate
While magnesium is given they will be

observed closely, receive intravenous fluids A Foley catheter placed in the bladder (to measure urine output). Magnesium sulfate 4-g to 6-g loading dose diluted in 100 mL fluid administered intravenously over 15 minutes, followed by continuous intravenous infusion at 1 to 2 g per hour.

2. Control hypertension Patients may require medication to treat high blood pressure during labor or after delivery (Hydralazine, labetolol and nifedipine) 3. Delivery 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

Intensive Care
Frequent nursing and medical

observations are required to ensure control of the blood pressure and reduce the risk of seizures. A bedside monitor will be used to closely monitor blood pressure and an indwelling

Intensive Care
The mothers blood and urine

are tested frequently to check liver and kidney function, platelet count and for red cell destruction (haemolysis). Depending upon the condition of the baby and the mother efforts will be made to bring the

Intensive Care The baby will be kept in a nursery appropriate for their condition. In most cases the father and other relatives will be encouraged to be involved with the care of the baby by maternity staff.

Eclampsia Nursing Care Plan

Nursing Diagnosis:
Ineffective Cerebral Tissue Perfusion related to decreased

cardiac output secondary to vascular vasopasme. Impaired Gas Exchange related to accumulation of fluid in the lungs: pulmonary edema. Decreased Cardiac Output related to decreased venous return, cardiac trouble. Excess Fluid Volume related to glomerular function impairment secondary to the decrease of cardiac output. Activity Intolerance related to weakness. Impaired Urinary Elimination related to impaired glomerular filtration: anuria and oliguria. Imbalanced Nutrition Less Than Body Requirements related to inadequate intake. Acute Pain related to injury of biological agents: Hydrogen ion accumulation and an increase in HCl. Risk for Injury: the mother related to diplopia, increased intracranial: seizures.

(Cerebral, peripheral and renal) Defining characteristics: (Evidenced by)

Elevated blood
Epigastric pain Fetal status

pressure Edema, especially of the hands and face Sudden weight gain Proteinuria (1+ up to 4+) Hyperreflexia Headache Visual disturbances

Decreased urine

output Rales, if pulmonary edema is present Elevated BUN, creatinine, uric acid Decreased hematocrit and haemoglobin

Possible Etiologies (Related to):

Arterial vasospam/ constriction of blood

vessels Decreased prostaglandin levels Sensitivity to angiotensin II Impaired glomerular perfusion Decreased uteroplacental perfusion Increased cardiac workload Vascular damage Red blood cell damage

ng Actio ns

Monitor vital signs, palpate peripheral pulses

and note capillary refill, assess urinary output, weigh client daily and evaluate changes in mentation. Place client on left recumbent position.Monitor maternal well- being periodically. Administer oxygen as prescribed. Ensure safety by putting the side rails always up and monitor client for tonic- clonic convulsions. Insert foley catheter as indicated by the physician and monitor urine output. Administer Magnesium Sulfate as ordered by

Thank You