1. IN PARTNERSHIP WITH
Liverpool School of Tropical Medicine
LiverpoolAssociates in Tropical Health
Eclampsia and severe
preeclampsia
Eclampsia and Severe
Pre-eclampsia

2. Aims
 To recognise eclampsia and severe pre-
eclampsia
 To practise an effective response to a
woman with eclampsia (fit) or severe
pre-eclampsia
 To achieve competence in those skills

3. Principles of management
 Stabilise mother and then deliver fetus
 Treat and prevent fits
 Treat blood pressure
 Attention to fluid balance
 Be aware of and prevent complications

4. Signs and Symptoms of Pre-Eclampsia
• Headache
• Blurred vision
• Upper epigastric pain
• Hyperreflexia/clonus
Diagnosis:
BP > 140/90
Urine protien +

5. Eclampsia - recognition
 Fitting or unconscious

6. Management of fits

7. Fitting or unconscious
 Call for help
 Recovery position
 Open and maintain airway
 iv access and give magnesium sulphate
 1 litre Ringer’s lactate to be given very
slowly iv

8. Magnesium sulphate
 The anticonvulsant of choice
 Loading dose is given IV and IM
 4g given IV (dilutent N/S!)
 10g IM (diluent 2% Lignocaine)
 Give 5g to each buttock
 If unable to give IV loading dose give IM
loading dose only

9. Magnesium Sulphate: Maintenance
dose
IV route
 Magnesium sulphate (10g) in 1000 ml normal
Saline IV infusion at rate of 1g/hour
OR
IM route
 After loading dose continue with 5 g IM every 4
hours
Continue maintenance dose until 24 hours
after birth or 24 hours after last convulsion

10. Magnesium caution!
 Do not give the next dose of magnesium if
 Absent knee jerk
 Urine output less than 100 mls in last 4
hours
 Respiratory rate less than 16 breaths per
minute

11. • If respiratory rate less than 16 breaths /
minute stop magnesium and give
calcium gluconate 1 g iv over 10
minutes

12. Magnesium Sulphate
 If convulsions recur give an additional
2-4g iv over 10-15 minutes
 Consider giving lower dose (2g) if
patient is small and/ or weight is less
than 70kgs

13.  Magnesium sulphate has various
concentrations
 For IV injection concentration of
magnesium should not exceed 20%
 20% solution=200mg/ml

14. Diazepam
 Only use if magnesium not available or
magnesium toxicity develops

15. Blood pressure
 Uncontrolled blood pressure leads to
intracranial haemorrhage and death
 Monitor
 Treat if BP diastolic >110 mm Hg or
systolic >160 mmHg
 Nifedipine, hydralazine, labetalol
according to local protocol

16. Delivery
 Assess fetal heart, gestational age, lie of the
baby and assess cervix
 Vaginal delivery or CS?
 Vaginal if no maternal or fetal distress, no
obstetric contraindication and cervix
favourable
 CS if repeated fits, fetal distress or
unfavourable cervix

17. Fluid
 Careful fluid balance required
 Capillaries are ‘leaky’ therefore control fluid
input to prevent pulmonary oedema
 Monitor closely via fluid in and output chart
 Restrict iv fluids to 30 drops per minute

18. Complications of (pre) eclampsia
 Brain
 Lung
 Liver
 Clotting (abruption, DIC)
 Heart
 Kidney
 Eye
 Fetal
 Death

19. Monitor!
 HR
 BP
 Urine Output
 RR
 Reflexes
 Fluid in and output
 Temperature
 Fundi
 Bloods (platelets, clotting, Hb,
renal function)

20. After delivery
 Monitor, monitor, monitor
 Remember (pre-)eclampsia get worse or
first fit can occur in post partum period
 Continue magnesium for 24 hours after
delivery or after last fit – no need to “tail
off”

21. IN PARTNERSHIP WITH
Liverpool School of Tropical Medicine
LiverpoolAssociates in Tropical Health
??

22. IN PARTNERSHIP WITH
Liverpool School of Tropical Medicine
LiverpoolAssociates in Tropical Health
RECAP
Recognition of Eclampsia and Severe pre-
eclampsia
Management of fits and blood pressure
Decision on delivery
Monitoring of patient
Complications