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Prevention Identification And Management of Pre-Eclampsia And Eclampsia PowerPoint Presentation

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This medical PowerPoint presentation is about pre-eclampsia and eclampsia, serious complications that can occur during pregnancy. Pre-eclampsia is characterized by high blood pressure and damage to organs, such as the liver and kidneys, while eclampsia is marked by seizures in women with pre-eclampsia. These conditions can be life-threatening for both the mother and the baby. This presentation lists some ways to prevent, identify, and manage pre-eclampsia and eclampsia.

Tags : Pre-eclampsia, Eclampsia, pregnancy, Obstetrics and Gynecology, Obstetrics and Gynecology PowerPoint presentation

Published on : Jun 20, 2023 | Views : 1330 | Downloads : 5

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Slide 1-

Prevention, Identification and Management of Pre-eclampsia and Eclampsia
Slide 2-

2 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 Learning Objectives
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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 MgSO₄ in all mothers having Severe pre-eclampsia and Eclampsia 3
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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.
Slide 5-

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
Slide 6-

Management of Severe PE/E 6
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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
Slide 8-

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
Slide 9-

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
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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
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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.
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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
Slide 13-

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 MgSO4 & do needful Admit and give MgSO4 & 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
Slide 14-

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
Slide 15-

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 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. Calcium Supplementation for Prevention of Pre-Eclampsia/Eclampsia (PE/E)
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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. Key Messages 16