Pre-eclampsia and Eclampsia: Prevention and Management
Prevention, Identification and Management of
Pre-eclampsia and Eclampsia
2
B
y
t
he
end
o
f
t
h
i
s
s
e
ss
i
on,
t
he
l
ea
r
n
e
r
s
w
il
l be
ab
l
e
t
o
:
•
D
e
f
i
ne
v
a
r
i
ous
t
e
rm
s
i
n
h
y
pe
rt
ens
i
v
e
d
i
so
r
de
r
s
o
f
p
r
e
g
nancy
•
D
esc
r
i
be
suppo
r
t
i
v
e
ca
r
e
o
f
w
o
m
an
w
i
t
h
ec
l
a
m
ps
i
a
du
r
i
n
g
a
f
i
t
•
D
esc
r
i
be
t
he
dose
and
r
ou
t
e
o
f
a
d
m
i
n
i
s
tr
a
t
i
on
o
f
in
j
ec
t
i
on
m
a
g
nes
i
um su
l
ph
a
t
e
f
or
t
he
m
an
a
g
e
m
e
n
t
o
f p
r
e
-
ec
l
a
m
ps
i
a
and
ec
l
a
m
ps
i
a
Learning Objectives
Pre-eclampsia/Eclampsia is the Second Leading Cause of
Maternal Mortality – Globally and in India
Pre-eclampsia/Eclampsia can
be prevented and managed
by:
•
Recording and monitoring of
BP and urine protein
examination of all labouring
women
•
Timely identification of
danger signs
•
Giving inj MgSO
₄ in all
mothers having
Severe pre-
eclampsia and Eclampsia
3
Definitions- Hypertensive disorders of
pregnancy
Hypertension:
BP >=140/90 TWO consecutive readings 4 hours apart
Chronic Hypertension:
Hypertension before 20 weeks of pregnancy
Pregnancy Induced Hypertension (PIH):
Hypertension after 20 weeks
Pre-eclampsia (PE):
>=140/90 but <160/110 with proteinuria trace, 1+ or
2+
Severe pre-eclampsia (Severe PE):
>= 160/110 with proteinuria 3+ or 4+
PE with presence of any symptoms like headache, blurring of vision,
epigastric pain or oliguria and abnormal oedema over face, hands,
abdomen and vulva
Eclampsia
(E):
Convulsions with >=140/90 and proteinuria more than
trace
NOTE-
Convulsions in pregnancy, labour and postpartum
period should be considered ‘Eclampsia’ unless proved
otherwise.
Need for MgSO4
Management with Inj. MgSO4 should be given in
following conditions:
Eclampsia
Severe PE:
>= 160/110 with proteinuria 3+ or 4+
PE with presence of any symptoms like headache,
blurring of vision, epigastric pain or oliguria and
abnormal edema over face, hands, abdomen and
vulva
5
Management of Severe PE/E
6
•
Anti - Hypertensive need to be given if Diastolic BP > 100
mm Hg (as per GoI protocol poster on Pre-Eclampsia)
•
Tab Alpha-Methyl Dopa or tab Labetalol can be used for
controlling BP
•
Target should be to maintain diastolic BP between 90-100
mm Hg
•
In case of severe Pre eclampsia, use of tab Nifedipine or Inj.
labetalol is recommended for initial control of BP
Role of Anti-hypertensive
7
Administration of MgSO4
First dose (at Non-FRU level):
Total
10
grams
5 g (10mL) magnesium sulphate deep IM in each buttock
Patient should reach FRU in 2 hours for further
management
Loading dose (at FRU level):
Total
14
grams
4 g (8mL) magnesium sulphate diluted with 12 ml NS or
distilled water in 20 ml syringe i.e. 20%, and given slow IV in
5-10 minutes
5 g (10mL) magnesium sulphate
with 1 ml 2% lignocaine
deep IM in each buttock
8
Administration of MgSO4- Maintenance Dose
5 g (10mL) magnesium sulphate
with 1 ml 2%
lignocaine
deep IM in alternate buttock every 4
hours
To be given for 24 hours after last convulsion or
delivery- whichever occurs later
9
10
Watch for toxicity signs before every maintenance dose
Urine output:
< 25-30 ml/hour
Deep Tendon Reflex (knee jerk):
Absent
Respiratory rate:
< 16/minute
Administration of MgSO4- Toxicity Signs
NOTE-
With hold the next dose in case of presence of any
toxicity sign
Give antidote
Inj Calcium gluconate
(10 ml 10 % in 10
minutes) slow IV for respiratory toxicity
We can administer 2 gm MgSO4 20% IV dose only once
Then we continue giving four
hourly maintenance doses for 24
hrs
Give diazepam, 5-10mg IV stat may be
repeated every 10-15 minutes upto maximum
of 30mg dose
If convulsions still
not controlled
If convulsions
controlled
Send patient for C-
section
If convulsions still not controlled =
status eclampticus
Administration of MgSO4-
Recurrent Episode
11
Additional Dose:
2 g (4mL) magnesium sulfate diluted in 6mL
of NS/distilled water in 10mL syringe i.e. 20%, given slow IV over
5-10 minutes.
12
•
GoI recommends use of magnesium sulphate by nurses in cases of
severe pre eclampsia and
eclampsia (first dose)
•
Magnesium sulphate is a very safe drug and can be easily used with
monitoring of toxicity signs
•
Even in case where any sign of toxicity is seen, generally
withholding the next dose is sufficient to address it
•
Antidote may only be needed in case of respiratory toxicity which is
very rare at the usual recommended doses with close monitoring
•
Give antidote – Inj. Calcium gluconate 10 ml 10 % in 10 minutes slow
IV for respiratory toxicity.
Magnesium Sulphate is a Safe Drug to Use
GESTATIONAL
HYPERTENSION
PRE-ECLAMPSIA
SEVERE PRE-ECLAMPSIA
ECLAMPSIA
Presenting in
Labour
Presenting
Without Labour
Presenting in
Labour
Presenting in
Labour
Presenting in
Labour
Presenting
Without Labour
Presenting
Without Labour
Presenting
Without Labour
Admit and treat as per
progress of labour
Follow up in OPD
once a week
Admit and treat as per
Progress of labour
Follow up in OPD
twice a week
Admit and give
MgSO
4
& do needful
Admit and give
MgSO
4
& do needful
Stabilize convulsions, position
in left lateral, Mouth gag, Do
suctioning, clear secretion,
Start oxygen, catheterize, give
MgSO4 & terminate
pregnancy within 12 hrs
To Identify What Nursing Care Needed
GESTATIONAL
HYPERTENSION
PRE-ECLAMPSIA
SEVERE PRE-
ECLAMPSIA
ECLAMPSIA
If unstable, give
antenatal
corticosteroids and
terminate within 24hrs
If stable
If she is already in labour, let her progress in labour
If unstable, do not give
antenatal corticosteroids
and terminate within
24hrs
If stable
In all cases of eclampsia terminate pregnancy within 12 hrs
To Terminate the Pregnancy or Not
14
15
•
WHO recommends calcium supplementation for prevention of PE/E
in populations whose diets are deficient in calcium
GoI recommendations
•
Every woman would be given calcium supplementation for 6
months during ANC period after 1
st
trimester and for 6 months
during lactation.
•
Two calcium tablets would be given daily
•
Each tablet shall contain 500mg elemental Calcium and 250 IU
Vitamin D3
•
To be implemented at all levels of contact of the pregnant women
with the health system.
Calcium Supplementation for Prevention of
Pre-Eclampsia/Eclampsia (PE/E)
•
P
r
e
-
ec
l
a
m
ps
i
a
/E
c
l
a
m
ps
i
a
i
s
t
he
m
a
j
o
r
k
ill
e
r
, dea
t
hs
fr
om
w
h
i
ch
can
be
p
r
e
v
en
t
ed
t
h
r
o
u
g
h p
r
oper
AN
C and
i
f
t
h
i
s
h
appens
can
be
m
an
a
g
ed
w
i
t
h
t
i
m
e
l
y
ad
m
i
n
i
s
tr
a
t
i
on
o
f
i
n
j
.
M
g
S
O
4
•
P
r
oper
n
u
r
s
i
n
g
c
a
r
e
and
t
i
m
e
l
y
i
n
j
.
M
g
S
O
4
a
d
m
i
n
i
s
tr
a
t
i
on
i
s
k
ey
i
n
m
an
a
g
e
m
ent
o
f eclampsia
c
ase
•
M
g
S
O
4
i
s
a
s
a
f
e
d
r
u
g
f
o
r
m
o
t
her and
c
a
n
be
g
i
v
e
n
w
i
t
hout
hes
i
t
a
t
i
on.
T
o
x
i
c
i
t
y
of
M
g
S
O
4
i
s
v
e
r
y
r
a
r
e.
•
A
t
sub Centre
AN
M
can
s
a
f
e
l
y
g
i
v
e
f
i
r
s
t
dose
o
f
5
-
5
g
m
s
deep
I
M
on
each
bu
t
t
o
c
k
and
r
e
f
e
r
t
o h
i
g
her
f
ac
ili
t
y
f
o
r
f
u
r
t
her
m
an
a
g
e
m
e
n
t
.
Key Messages
16
Learn about the prevention, identification, and management of pre-eclampsia and eclampsia, which are significant causes of maternal mortality globally. This session covers definitions of hypertensive disorders of pregnancy, supportive care for women with eclampsia, and the administration of injection magnesium sulfate for effective management. Discover key learning objectives and the importance of timely intervention in these conditions to improve maternal outcomes.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
E N D
Presentation Transcript
Prevention, Identification and Management of Pre-eclampsia and Eclampsia
Learning Objectives By the end of this session, the learners will be able to: Define various terms in hypertensive disorders of pregnancy Describe supportive care of woman with eclampsia during a fit Describe the dose and route of administration of injection magnesium sulphate for the management of pre-eclampsia and eclampsia 2
Pre-eclampsia/Eclampsia is the Second Leading Cause of Maternal Mortality Globally and in India Pre-eclampsia/Eclampsia can be prevented and managed by: Haemorrhage 27% Others 31% Recording and monitoring of BP and urine protein examination of all labouring women Sepsis 11% Abortion 8% Timely identification of danger signs Obstructed labour 9% Hypertensive disorders 14% Giving inj MgSO in all mothers having Severe pre- eclampsia and Eclampsia Source- WHO 2014 3
Definitions- Hypertensive disorders of pregnancy Hypertension: BP >=140/90 TWO consecutive readings 4 hours apart Chronic Hypertension: Hypertension before 20 weeks of pregnancy Pregnancy Induced Hypertension (PIH): Hypertension after 20 weeks Pre-eclampsia (PE): >=140/90 but <160/110 with proteinuria trace, 1+ or 2+ Severe pre-eclampsia (Severe PE): >= 160/110 with proteinuria 3+ or 4+ PE with presence of any symptoms like headache, blurring of vision, epigastric pain or oliguria and abnormal oedema over face, hands, abdomen and vulva Eclampsia(E): Convulsions with >=140/90 and proteinuria more than trace NOTE- Convulsions in pregnancy, labour and postpartum period should be considered Eclampsia unless proved otherwise.
Need for MgSO4 Management with Inj. MgSO4 should be given in following conditions: Eclampsia Severe PE: >= 160/110 with proteinuria 3+ or 4+ PE with presence of any symptoms like headache, blurring of vision, epigastric pain or oliguria and abnormal edema over face, hands, abdomen and vulva 5
Management of Severe PE/E Role of anti- hypertensive Management of severe PE/E Role of MgSO4 Nursing care Termination of pregnancy 6
Role of Anti-hypertensive Anti - Hypertensive need to be given if Diastolic BP > 100 mm Hg (as per GoI protocol poster on Pre-Eclampsia) Tab Alpha-Methyl Dopa or tab Labetalol can be used for controlling BP Target should be to maintain diastolic BP between 90-100 mm Hg In case of severe Pre eclampsia, use of tab Nifedipine or Inj. labetalol is recommended for initial control of BP 7
Administration of MgSO4 First dose (at Non-FRU level): Total 10 grams 5 g (10mL) magnesium sulphate deep IM in each buttock Patient should reach FRU in 2 hours for further management Loading dose (at FRU level): Total 14 grams 4 g (8mL) magnesium sulphate diluted with 12 ml NS or distilled water in 20 ml syringe i.e. 20%, and given slow IV in 5-10 minutes 5 g (10mL) magnesium sulphate with 1 ml 2% lignocaine deep IM in each buttock 8
Administration of MgSO4- Maintenance Dose 5 g (10mL) magnesium sulphate with 1 ml 2% lignocaine deep IM in alternate buttock every 4 hours To be given for 24 hours after last convulsion or delivery- whichever occurs later 9
Administration of MgSO4- Toxicity Signs Watch for toxicity signs before every maintenance dose Urine output: < 25-30 ml/hour Deep Tendon Reflex (knee jerk): Absent Respiratory rate: < 16/minute NOTE- With hold the next dose in case of presence of any toxicity sign Give antidote Inj Calcium gluconate (10 ml 10 % in 10 minutes) slow IV for respiratory toxicity 10
Magnesium Sulphate is a Safe Drug to Use GoI recommends use of magnesium sulphate by nurses in cases of severe pre eclampsia and eclampsia (first dose) Magnesium sulphate is a very safe drug and can be easily used with monitoring of toxicity signs Even in case where any sign of toxicity is seen, generally withholding the next dose is sufficient to address it Antidote may only be needed in case of respiratory toxicity which is very rare at the usual recommended doses with close monitoring Give antidote Inj. Calcium gluconate 10 ml 10 % in 10 minutes slow IV for respiratory toxicity. 12
To Identify What Nursing Care Needed Pregnant Women Scenario (Irrespective of gestational age) Presenting in Labour Presenting Without Labour Presenting in Labour Presenting Without Labour Nursing Care require DIAGNOSIS Description Admit and treat as per progress of labour Follow up in OPD once a week Admit and treat as per Progress of labour Follow up in OPD twice a week Admit and give MgSO4 & do needful Admit and give MgSO4 & do needful GESTATIONAL HYPERTENSION PRE-ECLAMPSIA Presenting in Labour Presenting Without Labour SEVERE PRE-ECLAMPSIA Presenting in Labour Stabilize convulsions, position in left lateral, Mouth gag, Do suctioning, clear secretion, Start oxygen, catheterize, give MgSO4 & terminate pregnancy within 12 hrs ECLAMPSIA Presenting Without Labour
To Terminate the Pregnancy or Not If she is already in labour, let her progress in labour Pregnancy of >37 Weeks Pregnancy of <23 Weeks Pregnancy of 24- 34 Weeks Pregnancy of 35- 36 Weeks DIAGNOSIS GESTATIONAL HYPERTENSION PRE-ECLAMPSIA If unstable, give antenatal corticosteroids and terminate within 24hrs If unstable, do not give antenatal corticosteroids and terminate within 24hrs SEVERE PRE- ECLAMPSIA If stable If stable ECLAMPSIA In all cases of eclampsia terminate pregnancy within 12 hrs 14
Calcium Supplementation for Prevention of Pre-Eclampsia/Eclampsia (PE/E) WHO recommends calcium supplementation for prevention of PE/E in populations whose diets are deficient in calcium GoI recommendations Every woman would be given calcium supplementation for 6 months during ANC period after 1st trimester and for 6 months during lactation. Two calcium tablets would be given daily Each tablet shall contain 500mg elemental Calcium and 250 IU Vitamin D3 To be implemented at all levels of contact of the pregnant women with the health system. 15
Key Messages Pre-eclampsia/Eclampsia is the major killer, deaths from which can be prevented through proper ANC and if this happens can be managed with timely administration of inj. MgSO4 Proper nursing care and timely inj. MgSO4 administration is key in management of eclampsia case MgSO4 is a safe drug for mother and can be given without hesitation. Toxicity of MgSO4 is very rare. At sub Centre ANM can safely give first dose of 5-5 gms deep IM on each buttock and refer to higher facility for further management. 16
