The patient if at home or in peripheral health centres, should be shifted urgently to the referral hospital. The aim of immediate management in the hospital are :
General management -
- The patient should be placed in a railed cot in an isolated room, protected from
noxious stimuli which might provoke further fits.
- Detailed history is to be taken from the relatives, relevant to the diagnosis of
eclampsia, duration of pregnancy and number of fits.
- When the patient is properly stabilized, general abdominal and vaginal examination
are done.
- If the patient is unconscious, catheter is introduced and urine is tested for protein.
- Pulse, respiration and BP should be recorded half hourly.
- Fluid balance- Ringer's solution is started.
Total fluids = Previously 24 hours urinary output + 1000 ml (insensible loss through
lungs and skin).
Specific treatment -
1. Antibiotic drugs - Ampicillin 500 gm I.M. or I.V. six hourly is administered.
2. Anticonvulsant and sedatives -
Magnesium sulphate 10 mg I.M. (5 mg in each buttock).
Phenytoin 200 mg is given orally after 12 hours.
Diazepam 40 mg I.V.
3. Antihypertensive drugs - Labetalol, hydralazine.
4. Diuretics drugs - Frusemide (lasix).
Management during a fit -
- In the premonitory stage, a mouth gag is placed in between the teeth to prevent
tongue bite and should be removed after the clonic phage is over.
- The air passage is to be cleared off the mucous with a mucous sucker after
convulsion.
- The patient's head is to be turned to one side and the pillow is taken off.
- Oxygen is given until cyanosis disappear.
Obstetric management -
A. Fits controlled during pregnancy -
i) Baby mature - Termination of pregnancy should be done.
- If the cervix is favourable and there is no contraindicated of vaginal delivery then
done vaginal delivery.
- If the cervix is unfavourable and vaginal delivery is contraindicated then
caesarean section is performed.
ii) Baby premature - Continuation of pregnancy at 37th week of pregnancy.
iii) Baby dead - Expell the dead baby as soon as possible.
B. Fits not controlled -
If the fits are not controlled with anticonvulsant within a reasonable period (6-8 hours) termination of pregnancy should be done.
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- Clear and maintain the airway.
- Prevent injuries.
- Prevent hypoxia.
- Arrest convulsions.
General management -
- The patient should be placed in a railed cot in an isolated room, protected from
noxious stimuli which might provoke further fits.
- Detailed history is to be taken from the relatives, relevant to the diagnosis of
eclampsia, duration of pregnancy and number of fits.
- When the patient is properly stabilized, general abdominal and vaginal examination
are done.
- If the patient is unconscious, catheter is introduced and urine is tested for protein.
- Pulse, respiration and BP should be recorded half hourly.
- Fluid balance- Ringer's solution is started.
Total fluids = Previously 24 hours urinary output + 1000 ml (insensible loss through
lungs and skin).
Specific treatment -
1. Antibiotic drugs - Ampicillin 500 gm I.M. or I.V. six hourly is administered.
2. Anticonvulsant and sedatives -
Magnesium sulphate 10 mg I.M. (5 mg in each buttock).
Phenytoin 200 mg is given orally after 12 hours.
Diazepam 40 mg I.V.
3. Antihypertensive drugs - Labetalol, hydralazine.
4. Diuretics drugs - Frusemide (lasix).
Management during a fit -
- In the premonitory stage, a mouth gag is placed in between the teeth to prevent
tongue bite and should be removed after the clonic phage is over.
- The air passage is to be cleared off the mucous with a mucous sucker after
convulsion.
- The patient's head is to be turned to one side and the pillow is taken off.
- Oxygen is given until cyanosis disappear.
Obstetric management -
A. Fits controlled during pregnancy -
i) Baby mature - Termination of pregnancy should be done.
- If the cervix is favourable and there is no contraindicated of vaginal delivery then
done vaginal delivery.
- If the cervix is unfavourable and vaginal delivery is contraindicated then
caesarean section is performed.
ii) Baby premature - Continuation of pregnancy at 37th week of pregnancy.
iii) Baby dead - Expell the dead baby as soon as possible.
B. Fits not controlled -
If the fits are not controlled with anticonvulsant within a reasonable period (6-8 hours) termination of pregnancy should be done.
Related articles :
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