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Treatment of eclampsia
Last reviewed: 23.04.2024
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Treatment of eclampsia includes a set of the following therapeutic measures:
- assess the degree of patency of the respiratory tract, identify violations to eliminate;
- catheterize a vein, preferably central;
- to introduce magnesium sulfate.
How is eclampsia manifested?
- Approximately 33% of seizures develop before delivery, 33% during labor and 33% in the postpartum period.
- Seizures can develop and a week after childbirth.
Emergency treatment of eclampsia
- Call for help.
- Respiratory tract - breathing - circulation.
- Position on the left side (position for awakening).
- Oxygen is a large stream - do not try to enter the duct or manually ventilate.
- If before delivery, assess the condition of the fetus as soon as the most urgent situation passes.
- Magnesia sulfate intravenously 4 g for 15 min, then infusion 1 g / h.
- In the case of recurrent seizures, re-enter magnesium 2 g bolus - you may need to monitor its plasma level.
- At the first attack diazemuls not enter.
NB: the average duration of a seizure attack with eclampsia is 90 s. If the convulsions persist, you can use diazemuls, thiopental or propofol - in the presence of an anesthesiologist. Consider the possibility of another cause of seizures, such as intracranial hemorrhage.
Treatment of eclampsia consists in the appointment of:
Magnesium sulfate, 25% r.p., in / in 6 g (25 ml) for 15-20 min, then in / in the drip (or through infusomate) 2 g / h (8 ml / h), including the period of delivery. When the seizures are repeated or the previous actions are unsuccessful, barbiturates, muscle relaxants are used and the patient is transferred to the ventilator:
Heckobarbital IV in the 250-500 mg,
+
Suxamethonium chloride IV / 1.5 mg / kg.
Infusion treatment of eclampsia is carried out under the control of CVP, the level of diuresis. We should refrain from infusing low- and medium-molecular dextrans, albumin (capillary leakage syndrome), starch solutions are shown.
According to the indications - controlled normotonia (always against the background of infusion - pre-loading control) with trifosadenine (ATP), hydralazine, sodium nitroprusside (remember the possible toxic effects of cyanide on the pregnant and fetus), nimodipine (remember the analgesic and anti-ischemic action of drugs):
Nimodipine iv 0.02-0.06 mg / kg / h, or Trifosadenin IV 5 mg / kg / h.
[Further management
- Once the patient's condition is stabilized, it must be given birth.
- Severe hypertension (> 160/110 mm Hg) is monitored intravenously with the introduction of labetapol or hydra-pasin according to the protocol adopted in the clinic.
- It should be analyzed the likelihood that convulsions are triggered by intracranial hemorrhage - a complete neurologic examination is mandatory. You may need CT / MRI.
- The type of delivery can be different.
- In all cases, be sure to inform the senior anesthesiologist and the senior obstetrician.
- In the case of severe fetal distress and the absence of the effect of intrauterine resuscitation, one should think about emergency delivery, but it can be dangerous for the mother.