Treatment of eclampsia

Treatment of eclampsia includes a range of the following therapeutic measures:

• assess the degree of airway patency and eliminate any identified disorders;
• catheterize a vein, preferably a central one;
• introduce magnesium sulfate.

How does eclampsia manifest itself?

• Approximately 33% of seizures develop before delivery, 33% during delivery, and 33% in the postpartum period.
• Cramps can develop even a week after birth.

Emergency treatment of eclampsia

• Call for help.
• Respiratory tract - breathing - circulation.
• Position on the left side (position for awakening).
• High flow oxygen - do not attempt to insert an airway or ventilate manually.
• If before birth, assess the condition of the fetus as soon as the most urgent situation has passed.
• Magnesium sulfate intravenously 4 g over 15 minutes, then infusion 1 g/h.
• If seizures recur, re-administer magnesium 2 g bolus - it may be necessary to monitor its plasma level.
• Do not administer Diazemuls during the first attack.

NB: The average duration of a seizure in eclampsia is 90 sec. If seizures persist, diazemuls, thiopental or propofol may be used - in the presence of an anesthesiologist. Consider the possibility of another cause of seizures, such as intracranial hemorrhage.

Treatment of eclampsia involves the administration of:

Magnesium sulfate, 25% solution, intravenously 6 g (25 ml) for 15-20 min, then intravenously by drip (or through an infusion pump) 2 g/h (8 ml/h), including the period of delivery. If convulsions recur or previous measures are unsuccessful, barbiturates and muscle relaxants are used and the patient is transferred to artificial ventilation:

Hexobarbital intravenously 250-500 mg,

+

Suxamethonium chloride intravenously 1.5 mg/kg.

Infusion treatment of eclampsia is carried out under the control of central venous pressure (CVP) indices and diuresis level. It is necessary to refrain from infusion of low- and medium-molecular dextrans, albumin (capillary leak syndrome), starch solutions are indicated.

According to indications - controlled normotension (always against the background of infusion - control of preload) with triphosadenine (ATP), hydralazine, sodium nitroprusside (remember the possible toxic effect of cyanides on the pregnant woman and fetus), nimodipine (remember the analgesic and anti-ischemic effect of the drug):

Nimodipine IV 0.02-0.06 mg/kg/h, or Trifosadenine IV 5 mg/kg/h.

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Further management

• Once the patient's condition has stabilized, she must give birth.
• Severe hypertension (> 160/110 mmHg) should be controlled with intravenous labetapol or hydrapazine according to the clinical protocol.
• The possibility that the seizures are caused by intracranial hemorrhage should be considered - a full neurological examination is mandatory. CT/MRI may be required.
• The type of delivery may vary.
• In all cases, it is imperative to inform the senior anesthesiologist and senior obstetrician.
• In case of severe fetal distress and lack of effect of intrauterine resuscitation, emergency delivery should be considered, but it can be dangerous for the mother.