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Mother Care
through Drills:
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2. Each Gynaecologist – master it yourself
& Teach to every one in labor room
2012-13 “Drills” to - Gynaecologists
2014 -15 - Doctors & Nurses in the LR
- Our MMR & Global standing
- Focus on Faculty
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-Future perfect – Safe Motherhood

3. Eclampsia Drill AOGD

4. CONTRIBUTORS
DR. SHARDA JAIN
DR. MANJU PURI
DR. ILA GUPTA
DR. SHARDA PATRA

5. Eclampsia DrillEclampsia Drill
Eclampsia is an important obstetric
emergency which if not managed
promptly can lead to life-threatening
complications like cerebral
haemorrhage, pulmonary edema, abruptio
placentae maternal and fetal death
Any pregnant woman presenting
with CONVULSIONS in later
half of pregnancy should be treated
as eclampsia until proved otherwise

6. The management of eclampsiaThe management of eclampsia
involvesinvolves
Immediate management
Subsequent management
One should remember that first few
minutes following a fit are very crucial
and should be handled very fast due to risk
of cerebral hypoxia and aspiration which
can have serious consequences.
.

7. Immediate managementImmediate management….….
PrinciplesPrinciples
Speed
Skills
Priorities

8. Immediate management …..Immediate management …..
Stabilize the woman
Call for Help
Remember A; B; C of
resuscitation
Control convulsion
Control blood pressure

9. Initial ResuscitationInitial Resuscitation
Airway
 Place the woman on her left side to reduce the
risk of aspiration of secretions, vomit and blood
Put an airway in between the tongue and palate
to prevent tongue bite and falling of tongue
Suction of the secretions is done through this
airway by connecting it to a suction machine.
Give oxygen (if available15 l /min ) and continue
longer if cyanosis persists
Stay with the patient to ensure that her airway is
clear

10. Initial ResuscitationInitial Resuscitation
Breathing Assess – count respiratory rate
.Look, Listen, Feel. Ventilate if necessary
Circulation
Assess pulse , BP. CPR if necessary
Secure intravenous access with a cannula (16G )
Send blood for BG, CBC, platelets, clotting screen,
KFT, LFT, Uric acid, Serum electrolytes
Catheterize the patient to empty the bladder ,
record output and monitor output subsequently
Do a urine examination for proteins

11. Treat and prevent further fitsTreat and prevent further fits
Administer Magnesium Sulphate
(MgS04)
Regimes: Pritchard or Zuspan

12. Loading dose Maintenance dose
4g IV 20% solution over 5
to 10min plus 10g IM
(5 g 50% solution deep
I/M in each buttock)
5g I/M every 4h in
alternate buttock till 24
hrs after the last seizure
or delivery which ever is
later
Loading dose Maintenance dose
Loading dose 4g IV 20%
solution over 5 to
10min
1 to 2 g / h by controlled
infusion pump x 24h
after the last seizure
Pritchard
Zuspan

13. Mg So4 :Preparation and AdministrationMg So4 :Preparation and Administration
MagSo4 available in 25%, 50% strength
Initial loading dose 14gms
14gms
4gm IV 10 gms IM

14. Preparation and administrationPreparation and administration
IV 4gms
Take 8amps (16ml)
dilute with 4ml saline
to make it 20ml
50% amps (2ml)
contains 1gm of
magso4
25% ampoules
(2ml) contains
0.5 gm magso4
20ml solution contains 4gms
Magso4
( 4gm/20ml 20% Sol)
Take 4amps (8ml)
dilute with 12ml
saline to make it
20ml
IV 4gm
20ml is given slow IV
over 5-10mins
Keep an eye on
respiratory rate ,
facial flushing ,

15. Preparation and AdministrationPreparation and Administration
5gms deep
IM(10ml) in each
buttock
50% amps (2ml)
contains 1gm of
magso4
Take 5amps
(10ml)
undiluted
10gms IM

16. If convulsion recursIf convulsion recurs
Give 2gm IV 20% solution over 5-10mins
and continue the maintenance dose

17. Monitoring during magnesium sulphateMonitoring during magnesium sulphate
TherapyTherapy
Respiratory rate >14/ min
Presence of patellar reflexes (knee jerk)
Urinary output- 25ml/hr or 100ml/4hrs
Repeat doses of magnesium sulphate
must be withheld or delayed if:
The respiratory rate is less than 14 per
minute
Patellar reflexes are absent
Urinary output is less than 100 ml over
preceding 4 hours

18. Antidote:Antidote:
In case of respiratory depression or
arrest:
Give calcium gluconate 1 g (10 ml of 10%
solution) IV slowly
Assisted ventilation using mask and bag,
anesthetic apparatus or intubation

19. CAUTIONCAUTION
Magnesium sulfate should be used with
caution in women with
Impaired renal function.
Patients with a heart block or myocardial
damage including a history of cardiac
ischaemia

20. Controlling blood pressureControlling blood pressure
Antihypertensive drugs should be given if
the diastolic blood pressure is 110
mmHg or more.
The aim is to keep the diastolic blood
pressure between 90–100 mmHg to
prevent cerebral haemorrhage
Drug of choice- Labetolol, Nifedepin

21. Labetolol
1. 20 mg I.V over 2mins
wait for 10 mins if no response
40 mg iv
80 mg iv
(can be increased upto 220 mg)
2. 10 mg IV 20 mg iv
40 mg iv
Target : 40 mg iv
Decrease in diastolic BP
To 90-100 mgHg 80 mg iv

22. NifedipineNifedipine
10 mg tabs orally to repeat every 20
mins up to a maximum dose of
200 mg

23. Subsequent managementSubsequent management
Once the patient is stabilized and fits
have ceased , then a pervaginum
examination is done to assess cervical
status
Consider for termination of pregnancy if
not in labor

24. Essential careEssential care
Turning the woman two–hourly to
avoid hypostatic pneumonia
Mouth Care, (no oral fluids are given)
monitor the Urinary Output.

25. Observations:Observations:
Restlessness or twitching which may
herald the onset of another fit
Color is observed for cyanosis which
indicates the need for oxygen
Temperature four hourly. Hyperpyrexia
may occur
Pulse and respirations are recorded
hourly, or more often
Blood pressure is recorded at least hourly
earlier if >=160/110
Ut contractions and FHS is checked
Input output is recorded accurately.

26. Do not leave the patient
alone
Place in left lateral position
CALL FOR HELP
Airway
Breathing
Circulation
Assess
Maintain patency
Give oxygen
Assess
Protect Airway
Ventilate if required
Evaluate pulse and BP
Secure IV access
A
L
G
O
R
I
T
H
M

27. Control of
convulsions
Control of
Hypertension
Loading dose :
4gm IV
20ml is given slow IV over 5-10mins followed by 10gms ,
5gms deep IM (10ml) in each buttock
If fits recur- 2gms , 20% IV
Maintenance dose- 5gms IM in alternate buttocks 4 hourly
Monitor- Resp rate>16
Presence of Knee jerk
Urinary output >25ml/1hr
If Mag toxicity- Inj Calcium Gluconate , 10% 10ml , 10mins
IV
Labetolol
10mg IV , give 20mg IV if noresponse after 10mins, then
40mg, 40mg, 80mg max 220mg
Nifedipine
10mg orally , repeat after 20mins if noresponse , max 200
mg, target BP- dbp-90-100 mmHg
Delivery

28. A DRILL …….. EclampsiaA DRILL …….. Eclampsia
The need for good clinical skills to be
able to recognize and act promptly
Be in control of the situation
Need to care for the family, who will be
extremely distressed to see the woman have
a fit;
Need for gentleness, so as not to harm
the woman if she is unconscious, or
stimulate further fits;
Need to respect the woman’s dignity at
all times;
Need for strict attention

29. ThanksThanks