Immediate action - first aid for eclampsia - must be carried out clearly and consistently to prevent irreversible consequences of the pathology. Eclampsia is a complication of the last months of pregnancy with severe toxic manifestations. Health problems manifest themselves in the form of increased blood pressure, convulsive seizures, and coma. It can occur before, during and in the first days after childbirth. First aid is based on symptom relief.
Causes and symptoms of pathology
The main causes of eclampsia include existing pathologies of the cardiovascular system associated with increased blood pressure and kidney disease.
Risk factors that increase the possibility of complications:
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- age of the first pregnant woman before 20 and after 35 years;
- general diseases: arterial hypertension, diabetes mellitus, systemic lupus erythematosus, rheumatoid arthritis, colitis, gastritis;
- conditions of preeclampsia and eclampsia in close relatives;
multiple pregnancy;
The course of pregnancy is influenced by a woman’s compliance with medical prescriptions. The basic rules are developing the correct daily routine, balanced nutrition, being in the fresh air, maintaining a stable psycho-emotional background and giving up bad habits. Violation of norms increases the risk of complications of toxicosis.
- Before an attack of eclampsia, preeclampsia occurs. appear:
- nausea, vomiting, stomach pain;
- headaches;
- the appearance of swelling of the body;
- beginning visual disturbances;
- coordination disorders;
increased excitability. At the first symptoms of eclampsia, you need to consult a doctor, as this threatens the life of the child and mother.
- An attack of eclampsia is accompanied by:
- increased blood pressure;
- dizziness;
- increased temperature;
- spasms of the facial muscles;
- increased coordination and visual impairment;
- convulsions, cramps, numbness of the limbs;
- increased nausea, vomiting and foaming at the mouth;
With pathology, disorders of the entire body occur. The central nervous system is characterized by increased excitability, which can provoke seizures. To remove possible irritants, it is necessary to avoid bright light, pain, sharp and loud sounds, and nervous shock.
Stages and forms of eclampsia
In the development of an attack of eclampsia in pregnant women, four stages are distinguished, which are characterized by a gradual increase in symptoms and manifestations, followed by their decrease and restoration of the body’s vital functions. A description of the development of eclampsia is presented in the table:
| Stage | Duration | Characteristic | |
| Preconvulsant | 20-30 seconds | Small contractions of the facial muscles, drooping of the corners of the mouth, rolling of the eyes. | |
| Tonic convulsions | 10-30 seconds | Tension, contraction, spasm of body muscles. Difficulty, cessation of breathing. Bluishness of the face. | |
| Clonic seizures | 20-90 seconds | Severe cramps of the whole body. Lack of breathing, pulse. | |
| Seizure resolution | – | The appearance of hoarse breathing, pulse, foam mixed with blood from the mouth. The face returns to normal color. Gaining consciousness or falling into a coma. | |
Forms of manifestation and clinical signs are presented in the table:
Severe eclampsia can be fatal. The severity of seizures is determined by their duration, number, time intervals between them and the patient’s well-being. If a woman does not regain consciousness for a long time, damage to vital organs, especially the brain, is possible, followed by death for the pregnant woman and the fetus.
Complications of the pathology are manifested by the following disorders:
- pneumonia, pulmonary edema;
- deterioration of brain activity;
- renal failure;
- suffocation;
- premature placental abruption;
- hypoxia, fetal death;
- cerebral hemorrhage, cerebral edema.
Algorithm of actions for symptoms of pathology
Emergency care must be provided strictly in a certain order. Since the pathology gives serious complications and poses a threat to the mother and fetus, at the first signs of seizures, call an ambulance. Before doctors arrive, you must:
- Place the patient on a pillow with her left side and cover her with blankets.
- Open your mouth and fix the position of your tongue, preventing it from swallowing and choking.
- Wipe your mouth to remove vomit, foam and mucus.
- If necessary, perform a heart massage.
The main focus in treating the disease is to eliminate seizures. Next, the patient is transported to the intensive care unit. The room should be soundproof, with darkened windows and dim lighting. Diagnostic measures are carried out under anesthesia to eliminate additional irritating factors. Ensuring the vital functions of the body during convulsive seizures is ensured by the following resuscitation measures:
- artificial ventilation to maintain breathing;
- administration of intravenous diuretics;
- catheterization of the bladder to ensure the excretory functions of the body;
- intravenous administration of glucose to lower intracranial pressure and stabilize cardiac activity;
- drip or intravenous administration of drugs to improve the activity of the hematopoietic system;
- the use of sedatives to relieve stimulation of the central nervous system.
Emergency care for pathology is aimed at maintaining the functioning of all organs and systems of the body, especially the kidneys, liver, heart and brain. When providing first aid, the following indicators are constantly monitored:
- blood pressure;
- heart rate;
- completeness of breathing;
- functioning of the urinary system.
Pregnant women preeclampsia or eclampsia, must be hospitalized in the obstetrics and gynecology department.
Before transport to hospital Convulsive readiness is stopped on the spot. For this purpose, intravenous administration of 1-2 ml of 0.1% rausedil solution, 2-4 ml of 0.5% seduxen solution (Sibazon), 2-4 ml of 0.25% droperidol solution or I is used. ml 2% promedol solution. To maintain the functioning of the heart, cardiac glycosides such as corglucon are administered intravenously in physiological solution in generally accepted dosages. High blood pressure is relieved by intramuscular injection of ganglion blockers such as pentamine. Along the way, if necessary, the patient is given preventive treatment for convulsive readiness.
Upon admission to hospital In the emergency department, all necessary manipulations should be performed under anesthesia with nitrous oxide mixed with oxygen.
A patient in the intensive care unit placed in an individual ward, exclude the possibility of exposure to external stimuli (loud sound, pain, bright light) and, depending on the type of gestosis, carry out specific therapy.
1. Sedative therapy for gestosis. The optimal drug for influencing the central nervous system is rausedil, which has a sedative and hypotensive effect (1 ml ampoules of 0.1% or 0.25% solution); it is administered 1-2.5 mg IV slowly. Rausedil can be successfully replaced with the tranquilizer sibazon (synonyms: seduxen, relanium). The drug is administered slowly, intravenously, diluted in 10-20 ml of physiological solution in an amount of 10-20 mg (2-4 ml). The neuroleptic droperidol has a good effect. It is also administered intravenously slowly, in dilution, in a dose of 5-10 mg (2-4 ml of 0.25% solution). These drugs reduce the excitability of brain centers and help stabilize blood pressure. To enhance the effect of sedatives, in order to desensitize and obtain an antihistamine effect, the use of drugs such as diphenhydramine (1-2 ml of 1% solution) is indicated. In case of high convulsive readiness and the need for emergency manipulations, oxygen-nitrous oxide anesthesia is indicated. If it is necessary to quickly put the patient under anesthesia, fluorotane can be used as an induction anesthesia, followed by a transition to another anesthetic.
2. Antispasmodic and antihypertensive therapy for preeclampsia, eclampsia. When carrying out antihypertensive therapy, it is necessary to combine the use of powerful, fast-acting, but with a short clinical effect, drugs such as ganglion blockers, with constant background administration of drugs that have a less powerful effect, but a longer duration of action (dibazol, no-spa, aminophylline).
Treatment for preeclampsia, eclampsia should begin with a slow intravenous injection of 3-4 ml of 1% dibazole solution (see also the topic HYPERTENSION CRISES), and then 10-20 ml of 2.4% aminophylline solution. Background medications may be antispasmodics such as no-shpa in standard doses. In the absence of the desired effect from the above antihypertensive therapy, you can try using ganglion blockers such as benzohexonium in the form of 1 ml of 1% solution IV or IM or arfonade (250 mg diluted in 150-200 ml of saline, slowly IV , drip, under constant blood pressure monitoring).
Good multilateral effect has magnesium sulfate. V. N. Serov (1989) recommends adhering to the following principles for the selection and rate of administration of this drug depending on the value of average blood pressure: up to 120 mm Hg. Art. - 30 ml of 25% magnesium sulfate solution; from 121 to 130 mm Hg. Art. - 40 ml of 25% solution, above 130 mmHg. Art. - 50 ml in 400 ml of rheopolyglucin. The recommended rate of administration is about 100 ml/hour, therefore the entire infusion will take 4 hours.
3. Infusion therapy for preeclampsia, eclampsia. In the pathogenetic therapy of eclampsia, one of the first places is occupied by infusion therapy (IT), the purpose of which is to replenish the volume of blood volume, restore normal tissue perfusion and organ blood flow, eliminate hemoconcentration and hyperproteinemia, and correct acid-base balance. They are carried out under the control of Ht and diuresis. It is not recommended to reduce the hematocrit below 30%. The total amount of fluid administered during IT should not exceed 1200-1400 ml/day, and the rate of administration should be 20-40 drops/min. Correction of hypoproteinemia is carried out by intravenous drip administration of blood replacement solutions, 100-200 ml of albumin or 150-200 ml of dry plasma. To normalize blood rheology, 400 ml of rheopolyglucin is administered intravenously. 4. Other types of therapy. To normalize vascular permeability, 5-8 ml of 5% ascorbic acid solution and hormones such as prednisolone in a dose of 60-100 mg are prescribed. To normalize the rheological and coagulation properties of blood, heparin is used at a dose of 350 units/kg/day, trental, and chimes. Dehydration therapy includes intravenous administration of 40-60 mg of Lasix. To relieve intoxication, use intravenous administration of 200-400 ml of hemodez and 200-400 ml of glucose-novocaine mixture (200 ml of 20% glucose solution, 200 ml of 0.5% novocaine solution, insulin 14-16 units). At the same time, intrauterine fetal hypoxia is prevented: oxygen inhalation, intravenous administration of glucose solutions, Riboxin, etc.
82. Eclampsia. Emergency help.
Eclampsia– clinical stage late gestosis, which is characterized by clinically pronounced multiple organ failure syndrome, against the background of which one or more attacks occur.
Clinic
Each attack lasts 1-2 minutes and has several phases that gradually replace each other.
Preconvulsant phase– characterized by small twitching of the facial muscles, closing of the eyelids, lowering of the corners of the mouth. Lasts 20-30 s.
Tonic convulsions phase characterized by tension in the muscles of the torso, the body arches, the head falls back, breathing stops, the face turns blue, loss of consciousness occurs, and the pulse is not detected. Lasts 20-30 s.
Clonic phase lasts 20-30 s and is manifested by violent chaotic contraction of the muscles of the face, torso and limbs. Then the convulsions weaken, heavy, hoarse breathing appears, foam is released from the mouth, which, due to biting the tongue, is colored with blood.
Seizure resolution phase- the convulsions stop, the patient may remain in a comatose state for some time, gradually comes to her senses, but does not remember anything that happened to her. Sometimes the coma lasts several hours, in other cases it can turn into a new attack of convulsions, which can be provoked by any irritation (pain, noise, bright light, medical manipulation, etc.). The number of attacks can range from 1-2 to 10 or more. If an attack of convulsions lasts more than 30 minutes, this condition is considered as eclamptic status.
First aid during seizures
1. Call a doctor immediately.
2. Start treatment on the spot. Place the patient on a flat surface in a lying position on the left side, avoiding injury.
3. While holding the woman, quickly clear the airway. To do this, carefully open your mouth, inserting a mouth dilator or placing a spatula (spoon) wrapped in gauze or a twisted cloth between the molars.
4. Grab the tongue with a tongue holder and bring it out to prevent it from retracting (when the tongue retracts, the root blocks the airways), insert the airway. If spontaneous breathing is still possible, administer oxygen inhalation if possible.
5. During clonic convulsions, to prevent injury from blows, cover the patient with blankets, place a pillow under her head and hold it carefully.
6. After the end of the attack of convulsions, use a gauze cloth, clamped on a forceps and moistened with a furatsilin solution, free the upper respiratory tract from foam, mucus, vomit (or using an electric suction) and, if possible, inhale oxygen.
7. For a long time apnea begin forced ventilation immediately.
8. In case of cessation of cardiac activity, perform closed cardiac massage in parallel with mechanical ventilation.
9. To prevent the next attack of seizures, as prescribed by the doctor, administer 16 ml of a 25% solution magnesium sulfate intravenously for 5 minutes under the control of blood pressure and heart rate (this drug has a pronounced anticonvulsant and sedative effect, and also gives a diuretic and hypotensive effect). If attacks continue, another 2 g of magnesium sulfate (8 ml of 25% solution) is administered over 3-5 minutes. Instead of an additional bolus of magnesium sulfate, use diazepam intravenously (10 mg) or sodium thiopental(450-500 mg) for 3 minutes.
After emergency care is provided, the patient is transported on a stretcher with the upper body slightly elevated by a specialized machine to the anesthesiology and intensive care department. In the department, the patient is placed in a separate darkened room or in the intensive care unit, where medical-protective regime, she is constantly supervised. All manipulations and examinations are carried out under the guise of anesthesia (nitrous oxide with oxygen, hexenal, sodium thiopental). Be sure to mobilize the main veins, carry out catheterization of the bladder to account for enuresis, and, if necessary, aspiration of the stomach contents with a probe to prevent regurgitation.
Complex drug treatment is carried out for 3-6 hours in order to stabilize the pregnant woman’s condition and prepare for emergency delivery.
Preeclampsia and eclampsia are severe stages of gestosis and represent a serious complication of pregnancy. According to statistics, the percentage of preeclampsia is 5-10%, and eclampsia 0.5% among the total number of women in labor, pregnant women and postpartum women.
Preeclampsia is a preconvulsive condition that is characterized by a significant rise in blood pressure, high protein content in the urine and severe edema (not the main prognostic sign).
Eclampsia is a seizure that either resolves or progresses to a coma.
Kinds
Preeclampsia and eclampsia are classified according to the period associated with pregnancy:
- preeclampsia and eclampsia in pregnancy;
- preeclampsia and eclampsia of the mother;
- preeclampsia and eclampsia of the postpartum mother.
Preeclampsia has 2 degrees of severity: moderate and severe.
Eclampsia, depending on the prevailing manifestations, is divided into cerebral, comatose, hepatic and renal.
Causes
The causes of preeclampsia and eclampsia have not yet been precisely established. There are 30 or more theories that explain the causes and mechanisms of development of preeclampsia and eclampsia. But the general opinion of all doctors is that there is a pathology of the placenta, the formation of which is disrupted in the early stages of pregnancy.
If the placental attachment is disrupted (superficially implanted placenta) or there is a deficiency of receptors for placental proteins, the placenta begins to synthesize substances that cause vasoconstriction (vasoconstrictors), which leads to a generalized spasm of all blood vessels in the body to increase pressure in them and increase the supply of oxygen and nutrients substances to the fetus. This leads to arterial hypertension and multiple organ damage (primarily the brain, liver, and kidneys are affected).
Heredity and chronic diseases play an important role in the development of preeclampsia and eclampsia.
Symptoms of eclampsia and preeclampsia
Signs of preeclampsia
Preeclampsia is just a short interval between nephropathy and a seizure. Preeclampsia is a dysfunction of the vital organs of the body, the leading syndrome of which is damage to the central nervous system:
- the appearance of spots before the eyes, flickering, blurriness of objects;
- tinnitus, headache, feeling of heaviness in the back of the head;
- nasal congestion;
- memory disorders, drowsiness or insomnia, irritability or apathy.
Preeclampsia is also characterized by pain in the upper abdomen (“in the pit of the stomach”), in the right hypochondrium, nausea, and vomiting.
An unfavorable prognostic sign is increased tendon reflexes (this symptom indicates convulsive readiness and a high probability of developing eclampsia).
With preeclampsia, swelling increases, sometimes for several hours, but the severity of edema does not matter in assessing the severity of the pregnant woman's condition. The severity of preeclampsia is determined based on complaints, proteinuria and arterial hypertension (an increase in blood pressure for normotensive patients above 140/90 mm Hg should be alarming). If arterial hypertension is 160/110 or more, they speak of severe preeclampsia.
Kidney damage manifests itself in the form of a decrease in the amount of urine excreted (oliguria and anuria), as well as a high protein content in the urine (0.3 grams in the daily amount of urine).
Signs of eclampsia
Eclampsia is an attack of convulsions that consists of several phases:
- First phase. The duration of the first (introductory) phase is 30 seconds. At this stage, small contractions of the facial muscles appear.
- Second phase. Tonic cramps are a generalized spasm of all muscles of the body, including the respiratory muscles. The second phase lasts 10-20 seconds and is the most dangerous (the woman may die).
- Third phase. The third phase is the stage of clonic seizures. The motionless and tense patient (“like a string”) begins to beat in a convulsive seizure. The convulsions go from top to bottom. The woman is without a pulse or breathing. The third stage lasts 30-90 seconds and is resolved by taking a deep breath. Then breathing becomes rare and deep.
- Fourth phase. The seizure resolves. Characteristic is the release of foam mixed with blood from the mouth, a pulse appears, the face loses its cyanosis, returning to normal color. The patient either regains consciousness or falls into a coma.
Diagnostics
Differential diagnosis of preeclampsia and eclampsia must first be carried out with an epileptic seizure (“aura” before the attack, convulsions). Also, these complications should be distinguished from uremia and brain diseases (meningitis, encephalitis, hemorrhages, neoplasms).
The diagnosis of preeclampsia and eclampsia is established based on a combination of instrumental and laboratory data:
- Blood pressure measurement. Increasing blood pressure to 140/90 and maintaining these numbers for 6 hours, increasing systolic pressure by 30 units and diastolic by 15.
- Proteinuria. Detection of 3 or more grams of protein in the daily amount of urine.
- Blood chemistry. An increase in nitrogen, creatinine, urea (kidney damage), an increase in bilirubin (decomposition of red blood cells and liver damage), an increase in liver enzymes (AST, ALT) - impaired liver function.
- General blood analysis. An increase in hemoglobin (a decrease in the volume of fluid in the vascular bed, that is, blood thickening), an increase in hematocrit (viscous, “stringent” blood), a decrease in platelets.
- General urine analysis . Detection of protein in urine in large quantities (normally absent), detection of albumin (severe preeclampsia).
Treatment of eclampsia and preeclampsia
A patient with preeclampsia and eclampsia must be hospitalized in a hospital. Treatment should be started immediately, on the spot (in the emergency room, at home in case of calling an ambulance, in the department).
An obstetrician-gynecologist and a resuscitator are involved in the treatment of these pregnancy complications. The woman is hospitalized in the intensive care ward, where a therapeutic-protective syndrome is created (a sharp sound, light, touch can provoke a convulsive attack). Additionally, sedatives are prescribed.
The gold standard for treating these forms of gestosis is the intravenous administration of a solution of magnesium sulfate (under the control of blood pressure, respiratory rate and heart rate). Also, to prevent seizures, droperidol and relanium are prescribed intravenously, possibly in combination with diphenhydramine and promedol.
At the same time, the volume of circulating blood is replenished (intravenous infusions of colloids, blood products and saline solutions: plasma, rheopolyglucin, infucol, glucose solution, isotonic solution, etc.).
Blood pressure is controlled by prescribing antihypertensive drugs (clonidine, dopegit, corinfar, atenolol).
During pregnancy up to 34 weeks, therapy aimed at maturing the fetal lungs (corticosteroids) is carried out.
Emergency delivery is indicated in the absence of a positive effect from therapy within 2-4 hours, with the development of eclampsia and its complications, with placental abruption or suspicion of it, with acute oxygen deficiency (hypoxia) of the fetus.
First aid for an attack of eclampsia:
Turn the woman on her left side (to prevent aspiration of the respiratory tract), create conditions that reduce trauma to the patient, do not use physical force to stop convulsions, and after an attack, clear the oral cavity of vomit, blood and mucus. Call an ambulance.
Medication relief of an attack of eclampsia:
Intravenous administration of 2.0 ml of droperidol, 2.0 ml of relanium and 1.0 ml of promedol. After the end of the attack, the lungs are ventilated with a mask (oxygen), and in the case of a coma, the trachea is intubated with further mechanical ventilation.
Complications and prognosis
The prognosis after an attack (coma) of eclampsia and preeclampsia depends on the severity of the patient’s condition, the presence of extragenital diseases, age and complications.
Complications:
- placental abruption;
- acute intrauterine fetal hypoxia;
- hemorrhages in the brain (paresis, paralysis);
- acute liver and kidney failure;
- HELLP syndrome (hemolysis, increased liver enzymes, decreased platelets);
- pulmonary edema, cerebral edema;
- heart failure;
- coma;
- death of a woman and/or fetus.
Some studies during pregnancy
Target: evaluate the graduate’s practical skills in providing emergency care for eclampsia
Indications– attack of convulsions during eclampsia
Contraindications- No
Possible complications– repeated attack of convulsions, eclamptic coma.
Resources– dummy of a woman, 25% magnesium sulfate solution, spatula, tongue holder, 20 ml syringe, 500 ml saline solution, intravenous infusion system, alcohol, cotton wool, tourniquet
Action algorithm:
1. In case of seizures, call all available personnel and the resuscitation team without leaving the patient.
2. Carry out the following activities at the same time:
· clear the airways by opening your mouth with a spatula or spoon wrapped in gauze, and stretch out your tongue with a tongue holder.
· remove saliva from the mouth; as soon as you inhale, ensure free access of air.
· after stopping the seizures, administer a starting dose of magnesium sulfate intravenously – 25%-20 ml over 10-15 minutes.
3. Start an intravenous infusion of 320 ml of saline with 80 ml - 25% magnesium sulfate solution
4. Under blood pressure control and ongoing magnesium therapy, transfer the patient to a stretcher and transport to the intensive care unit of the nearest maternity hospital.
NOTE
In case of eclampsia, delivery should occur after the patient’s condition has stabilized, but no later than 12 hours from the onset of seizures.
Standard “Providing emergency care for severe preeclampsia.”
Target: evaluate the graduate’s practical skills in providing emergency care for severe preeclampsia
Indications– severe preeclampsia
Contraindications- during an attack of convulsions
Possible complications– attack of convulsions, eclamptic coma.
Resources– dummy of a woman, 25% magnesium sulfate solution, 20 ml syringe, 500 ml saline solution, intravenous infusion system, alcohol, cotton wool, tourniquet
Action algorithm:
1. Make a diagnosis: “Severe preeclampsia” if one of these symptoms is present: headache, pain in the epigastric region, blurred vision, flashing spots before the eyes, nausea, vomiting, against the background of arterial hypertension (140/90 mm Hg and above) and proteinuria.
2. Call all available personnel and resuscitation team without leaving the patient.
3. Carry out the following activities at the same time:
· Place the pregnant woman on a flat surface, avoiding injury, and turn the patient’s head to the side.
· intravenously administer a starting dose of magnesium sulfate – 25%-20 ml over 10-15 minutes.
4. Start an intravenous infusion of 320 ml of saline with 80 ml of 25% magnesium sulfate solution.
5. When blood pressure is equal to or higher than 160/100 mmHg. regulate blood pressure by prescribing 10 mg of nifedipine sublingually, again after 30 minutes 10 mg under blood pressure monitoring (maintain blood pressure at 130/90-140/95 mmHg).
6. Under blood pressure control and ongoing magnesium therapy, transfer the patient to a stretcher and transport to the intensive care unit of the nearest maternity hospital.
NOTE If signs of magnesium sulfate overdose appear, administer 10 ml of a 10% Ca gluconate solution intravenously over 10 minutes.
Standard "Amniotomy".
Target- opening of the amniotic sac.
Indications– before labor induction, labor stimulation, weakness of labor Contraindications– threatening conditions of the mother or fetus
Possible complications– loss of small parts of the fetus, ascending infection, injury to the vessels of the amniotic sac, abruption of a normally located placenta
Resources– gynecological chair, individual diaper, sterile gloves, antiseptic for treating a woman’s external genitalia, branch of bullet forceps.
Action algorithm:
1. Introduce yourself.
2. Explain to the woman the need for this operation.
3. Take the patient’s informed consent for the procedure
4. Place the woman on the gynecological chair, placing a disposable
5. Treat the woman’s external genitalia with an antiseptic solution and place a sterile diaper on the woman’s stomach.
6. Carry out hygienic hand disinfection.
7. Wear disposable gloves on both hands.
8. Using the fingers of your left hand, spread the labia, sequentially insert into the vagina
index, then middle finger of the right hand.
9. Insert the jaw of the bullet forceps into the vagina between the index and middle
fingers.
10. Puncture the amniotic sac.
11. Insert your index finger into the resulting hole in the amniotic sac, and then your middle finger, gradually widen the hole, and remove the membranes from the head. Release amniotic fluid slowly, under the control of your fingers (prevention of loss of small parts, abruption of a normally located placenta).
13. Pull your fingers out.
14. Remove gloves and place in safe disposal box.
15. Wash your hands with soap.
16. Write down the data in the birth history.
NOTE.
For polyhydramnios, make a small hole and slowly release the water. It is necessary to control the rate of outflow of water, since if it is released quickly and abruptly, small parts of the fetus may fall out. After the water breaks, the woman is recommended to lie down for 30 minutes.
Eclampsia is the most severe stage of late toxicosis (preeclampsia). Unlike early toxicosis, eclampsia syndrome poses a huge danger not only to the health of the fetus and the expectant mother, but also to the lives of both of them.
The pathology is spontaneous and sudden, develops very quickly, so it is very difficult to predict its consequences. The occurrence of eclampsia is preceded by the appearance of edema, the presence of protein in the urine, and an increase in blood pressure.
The condition does not belong to an independent disease and occurs only during pregnancy, during delivery, and in the postpartum period. It is usually associated with severe disturbances in the pregnant woman - placenta - fetus system and is a combination of severe damage to the central nervous system, which in the most severe cases is manifested by the development of seizures and coma.
In more than 90% of cases, eclampsia occurs after the 28th week of pregnancy, very rarely (no more than 1%) before the 20th week. Diagnosis is not difficult, so modern medicine rarely reports severe complications after an attack.
Causes
It is impossible to unambiguously determine why eclampsia occurs in pregnant women. There are many theories, but none of them are 100% reliable. Doctors identify a number of predisposing factors, ignoring which can lead to the development of pathology. These include:
- hypertensive conditions;
- the presence of similar attacks in previous pregnancies;
- chronic diseases of internal organs (severe kidney damage, pathologies of the heart and blood vessels, diabetes mellitus, severe obesity);
- first birth at an early (before 18 years) or late (after 35 years) age;
- poor uterine blood flow;
- disturbances in the placenta;
- eclampsia in close relatives.
The risk of developing a pathological condition increases if the time interval between pregnancies exceeds ten years. Eclampsia is most often observed during pregnancy (up to 70% of cases). During childbirth, the rate is about 25%, after childbirth - no more than 2-3%.
Symptoms
The occurrence of pathology is preceded by a condition. It is characterized by the following symptoms: protein in the urine, hypertension, edema. Eclampsia syndrome can develop in the presence of even one or two of the above factors.
The most common manifestation of late toxicosis is edema. They usually occur on the legs and arms, subsequently spreading to the face and neck, as well as the entire body. Edema is pathological in nature; it not only does not decrease after a night's rest, but also leads to rapid weight gain (more than 500 g per week).
Normally, a person does not have protein in their urine. In pregnant women, the acceptable level may be 0.333 g/l per day. If the indicators exceed this norm, we are talking about proteinuria; in this case, the woman should be under the strict supervision of a doctor.
Protein is present in the urine in more than half of women with symptoms of preeclampsia. However, in 14% of pregnant women, the urine test results are normal.
The risk of developing pathology increases with blood pressure 140/90 mm. rt. Art. (moderate form of the disease), 160/110 mm. rt. Art. (severe form).
Other threatening factors are:
- severe headache, dizziness;
- nausea and vomiting;
- pain in the stomach and liver;
- problems with urination;
- severe swelling of the whole body;
- blurred vision, appearance of spots before the eyes
There is a pathological change in the composition of the blood - a decrease in the number of platelets, destruction of red blood cells. The presence of edema, high blood pressure and increased protein concentration in the urine allows a diagnosis of “moderate eclampsia”. In severe cases, convulsive seizures and fetal death may develop.
The main symptoms are convulsive seizures, which end in fainting and, in severe cases, coma. Eclampsia is characterized by increased headaches, chronic sleep disturbances, and a sharp jump in blood pressure. Deep lesions of the nervous system organs increase the excitability of the brain. External stimuli of varying intensity can trigger seizures: bright light, sudden movements, loud noise.
There are several stages in a seizure:
- Tension and slight trembling of the facial muscles, the general condition worsens sharply.
- Stretching of the entire torso, unnatural curvature of the spine, contraction of muscles. Convulsions, rolling of the eyes, changes in pulse, and breathing problems are noted. This stage of a seizure is the most dangerous because it leads to the risk of complete respiratory arrest, brain hemorrhage and possible death.
- The pregnant woman's body is subjected to strong convulsions that replace each other. A seizure lasts about a minute. Characterized by sudden disturbances in breathing and pulse, the appearance of foam at the mouth, and bleeding from biting the tongue. Gradually, the cramps weaken, breathing normalizes, and the skin acquires its natural color.
- Return of consciousness. Within a few minutes, the woman comes to her senses, her pulse and breathing normalize, and her pupils narrow. Memories of the experience are not retained.
After a seizure, the condition gradually stabilizes, but there are often cases when seizures end in coma. This condition can last from several hours to several days. It poses a real threat to the health of the mother and fetus.
Classification of the disease depending on the main symptoms and their severity includes:
- The typical form is characterized by high blood pressure, swelling of the skin, and a high amount of protein in the urine.
- Atypical form - symptoms most often appear during prolonged labor. In this form of the disease, cerebral edema is diagnosed, while other symptoms are mild or absent.
- Renal form - occurs with severe kidney pathologies.
With glomerulonephritis, an acute inflammatory process in the kidneys, swelling of the skin may be insignificant with excessive accumulation of fluid in the abdominal cavity and fetal bladder.
Diagnosis and treatment
As already noted, the disease is pronounced in nature, so its diagnosis does not present much difficulty. The situation is often aggravated by the fact that a seizure occurs suddenly and does not leave time for a gynecological examination or ultrasound. Typical signs help distinguish eclampsia from an epileptic seizure, as well as from a diabetic coma.
Doctors are faced with the task of identifying the precursors of late toxicosis in time and preventing their transition to the most severe form.
Preliminary diagnostic and preventive measures include:
- asking the patient about the time of onset of the first symptoms, such as swelling, headache, pressure surges;
- analysis of possible diseases of internal organs that occurred both before and during pregnancy;
- general blood and urine tests;
- fetus and condition of internal organs;
- regular blood pressure monitoring;
- identification of edema, assessment of its severity and location;
- electrocardiogram.
Timely implementation of diagnostic measures at the stage of preeclampsia will not allow the condition of the expectant mother to develop into eclampsia itself. Failure to do so increases the risk of complications such as severe heart failure, stroke or paralysis, mental disorders, coma and sudden death.
Very often, an attack of eclampsia occurs when a woman is away from a medical facility where she will receive immediate help. First of all, you must immediately call an ambulance. While waiting for doctors, first aid should be provided.
Pre-hospital and emergency care
The pregnant woman should be placed on her left side to prevent ingestion of vomit and blood. It is better if it is on a soft surface, which will help avoid additional injuries. There is no need to restrain the patient during convulsions.
After a seizure, it is necessary to clear your mouth and nose of mucus, foam, vomit and blood. When the woman comes to her senses, every effort will be made to calm her down and prevent additional emotional stress.
Emergency care for eclampsia is, first of all, anticonvulsant therapy. The patient is given intravenous magnesium sulfate (magnesia). After the first main dose, a maintenance dosage is prescribed in the form of a solution of magnesia and saline. Such therapy is necessary as long as the risk of eclampsia remains.
Therapy
Treatment of eclampsia should be aimed at normalizing blood pressure, correcting brain function, restoring blood circulation and clotting. Drug therapy is prescribed, the purpose of which is to normalize blood pressure. The drugs Nifedipine, Sodium Nitroprusside, Dopegit are indicated. The exact dosage is determined by the doctor.
Drugs used in the treatment of eclampsia
To relieve severe edema, diuretics are prescribed, and glucose is prescribed to improve brain metabolism. Since after an attack the patient may experience a severe psychological state, she is prescribed sedatives (calming) drugs. Treatment of eclampsia involves the involvement of a neurologist and neurosurgeon.
A convulsive state is also dangerous for the unborn child. There is a risk of premature placental abruption and lack of oxygen supply to the fetus. The prognosis of the disease is not always favorable and depends on several factors: the severity of the seizure, the duration of pregnancy, and the timeliness of providing qualified medical care.
Delivery
After the convulsions end, doctors decide on delivery. With a moderate form of pathology, it is possible to maintain pregnancy until 37 weeks. Severe forms pose a threat to the life of the woman and child, so delivery is carried out regardless of the period during the day.
There is a misconception that eclampsia syndrome requires exclusively delivery with the help. However, unless the condition is complicated by certain other medical conditions, there is no need for a caesarean section. On the contrary, natural childbirth in this condition is more preferable. It is necessary to accelerate labor by using gentle methods: opening the amniotic sac, rotating the fetus.
Although the typical period for the development of eclampsia is during pregnancy, rapid eclampsia is sometimes observed during childbirth. This condition occurs with prolonged contractions, inadequate pain relief, strong labor, when the process of dilation of the cervix and expulsion of the fetus occur too quickly. The symptoms of the syndrome are similar to those that occur during pregnancy.
Eclampsia after childbirth develops, as a rule, in the first two days after the birth of the child (there are cases of late eclampsia that occurred several weeks after birth) and is quite rare. Treatment of the pathological condition is carried out using the same therapeutic methods as during pregnancy.
Treatment according to Stroganov
For successful treatment of eclampsia, Stroganov’s principles are used. Thanks to the use of these methods, mortality decreased by 5-6 times.
Stroganov's principles include the following measures:
- Placing the woman in a darkened room where all noise or visual stimuli are absent. Treatment (injections, catheterization) is carried out under inhalation anesthesia.
- Relief from seizures with the help of morphine hydrochloride and chloral hydrate, the administration of which was carried out according to a specially developed scheme.
- Delivery using obstetric forceps, rupture of membranes.
- Drug therapy aimed at maintaining normal functioning of the lungs, heart and kidneys.
- Performing bloodletting 300-400 ml.
Over time, some of Stroganov's principles underwent certain changes. Thus, the drugs morphine and chloral hydrate, which have a depressant effect on the central nervous system, were replaced with magnesium sulfate and ether with oxygen. In order to prevent oxygen starvation of the mother and child, oxygen inhalations are performed.
Bloodletting reduces vascular spasm, which allows you to normalize blood pressure and improve the functioning of the kidneys and lungs. Bloodletting is not performed if emergency delivery is planned.
Thanks to the optimal combination of traditional and modern treatment methods, the condition is now classified as a rare pathology, and maternal mortality and fetal death occur only in the most extreme cases.
Women who have experienced eclampsia during pregnancy or childbirth should be under close medical supervision throughout the postpartum period. Regular blood pressure measurements and a urinalysis every two to three days are necessary to monitor the presence of protein. Particular attention is paid to monitoring the activities of the cardiovascular system, respiratory system and reproductive system.
Children also need very careful care. Such babies are prone to infectious and viral diseases, allergic reactions, diseases of the nervous system and other pathologies.
Prevention
Preventive measures aimed at minimizing the risk of developing pathology are as follows:
- Registration for pregnancy no later than 12 weeks.
- Regular monitoring by a gynecologist, visiting a consultation monthly in the first half of pregnancy and every two weeks in the second.
- Treatment of chronic diseases of internal organs at the stage of pregnancy planning.
- Monitoring your blood pressure.
- Taking a general urine test at least once a month in the first 20 weeks of pregnancy and twice a month thereafter.
- Timely identification and elimination of the first signs, fight against edema.
- Compliance with the principles of proper nutrition (inclusion in the diet of non-spicy foods rich in vitamins, fresh vegetables, fruits and herbs, limiting fatty foods and salt).
- Elimination of excessive physical activity, psychological peace.
- Sufficient stay in the fresh air, regular walks in the fresh air, moderate sports activity, sleep at least 8-9 hours a day.
Preventing the development of eclampsia is helped by taking small doses of Aspirin from the moment of detection until the 20th week of gestation and calcium supplements throughout the entire period of gestation. Taking these medications should become the norm for those women who are at risk. Iron supplements, folic acid, magnesium, vitamins E and C are also recommended for prevention.
