Q.10. Define pre eclampsia and eclamp sia. How you will manage a case of eelampsia.
pre eclampsia--> pre eclampsia is a syndrome complex characterized by development of hypertension to the extent of 140/90 mm of hg or more with oedema of proteinuria of both induced by pregnant after the 20th weeks.
Pre eclampsia is defined as the development of hypertension in pregnancy together with proteinuria and/on generalized by the occurrence of major epilepfiform convulsions in women who usually have the sings and symptoms of imminent eelampsia.
OR
The occurrence of convulsion in a patient with pre eclampsia with no coincident neurological disease.
mange a case of eclampsia ;
1.clinical features
a. Symptoms-
1. swelling of feet
2. alarming symptoms ;
i. headache
ii. disturbed sleep
iii. diminished urinary output
iv. epigastric pain with or with out vomiting
v. blurring of vision
b. sings;
eclamptic convulsion on fit -4stages
1. premonitoring stage –seeing of after has of light and sport before has (auna ) twiching of muscles rolling of the eye ball.
2. tonic stage > the whole body become rigid (generalized muscular spasm)
3. colonics stage> all voluntary muscles under go alternet contnetion and relaxtion tongue biting occurs.
4. stage of –coma >following fit patient passes on to the stage of come
2.Investigation
1.unine for R/M/E.
2.12 hours urinary protein.
3.Speeial investigations to exclude.complication.
i.opthalmoscopy.
ii.blood urea.serumcretinine;serum uric acid level.
iii.serum sgpt(ALT);total platelet count and blood flim (to exclude HELL syndrome)
iv.ultrasonognaphy to see total. condition(IUGR)
3. Diagnosis:-
preeclampsia a (hypertension to edema proteinuria) plus convulsion and on come.
4.Management of eclamlasia-principales of management-
1.Control of convulsion
2. control of stabilisation of preeclamptic menifestion
3. prevention and treatment of complication
4. quick and safe deliveryof the baby
A. General management
1. Absolute bed rest in an isolated room (eclampsia room) in lift lateral position is
to be taken.
2. Detail history from relatives.
3. Quick examination of the patient.
4. catheterisation by self retaining catheter.
5. Parenteral nutrition.
6. Maintenance of intake output chart.
7. Parenteral antibiotices.
B. Specific management
1. Inj—Diazepam
Initial dose 10-20mg slowly
-Maintenance done 40my in 500 cc 51.DA at a rate of 10-15d/min for 24 hour.
ii.megnisium done sulphate (Mgso4) regime
Pegimens of Mgso4 for the management of severe pre eclampsia and pre eelamlia
Regimen
Loading dose
Maintenance dose
I/M Pritchard
Pamk over3-smin followed by 10gm deep (5gm. In each buttock)
5gm m4 hour in alternative buttock
f/v (zuspan of sibai)
4-6 gm over 15-20 min
1-2 gm/hour infusion
iii) Lytic cocktail regime (chlor-promazint+promethazine+pethidine)
a) Initial dose-
Chloropramazine 25 mg+petlsi dine 100 mg stal in 20 ml of 5% dextrose.
b) Maintenance dose-
Pethidine 100mg in 500 ml 10% DA at a of 20-30d/min.
Promethazine (phenergan) 25 mg and chlorpromazine 50 mg alternatively at 4 hourly up to 24 hours following last convulsion.
2. Antihypertensive and diuretics Inj-Hydralazine 5 mg slowly it na response repeat after 20 minutes 10mg. Drugs commonly used are parenteral hydralazine, labetalol, calcium, channel blockers or nitroglycerine.
C. Treatment of complication.D.Obstructive management.