Eclampsia case study
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Transcript of Eclampsia case study
![Page 1: Eclampsia case study](https://reader033.fdocuments.net/reader033/viewer/2022042723/587b19951a28ab736c8b4cad/html5/thumbnails/1.jpg)
Obstetric Case Presentation
Nick Harper
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Ms X
• 17 yo• G1 P0• 38 weeks gestation
• Admitted in early labor• Discharged
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4X tonic-clonic seizures
Presenting Complaint
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History of Presenting Complaint
• 8/10 pain headache
• 8/10 pain abdo pain
• 4X tonic-clonic seizures
• Witnessed by boyfriend and sister
• Admission via Ambulance
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Obstetric History
• 38/40
• 1+ protein seen from 28/40
•BP 92/50 @ 25 weeks
•BP 130/80 @ 37 weeks
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Differential Diagnosis
• Eclampsia
• Epilepsy– 1/3 have inc. seizures– Decreased drug levels
• Severe hypoglycaemia
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Initial management
Diazepam 10mg IV (ambulance)
MgSO4 (St Michaels)
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Investigations
• BP 200/120 (<140/90)
• Creatinine 123 (60-100)
• Uric Acid 0.66 (0.19-0.36)
• ALT 145 (5-40)
• Platelets 435 (150-400)
• Hb 11.0 (12-16)
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•“Shining Forth”
•One or more convulsions superimposed on pre-eclampsiaEclampsia
Diagnosis
•Severe pre eclampsia5:1000•Eclampsia 5:10,000
•14 deaths (2000-2002)
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Risk Factors
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Signs & Symptoms
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Management - BP
• BP >160/110
• Hydralazine 5mg IV unless pulse >120
• Labetolol 20mg IV (total 200mg)
• Restrict fluids 90mL/h
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Management - Seizures
• Magnesium sulphate 4g IVI 5 min• Magnesium sulphate 1g/h IVI 24 hrs
•Magnesium sulphate 2g IVI 5 min•Diazepam 5mg IV
•Stop MgSO4 if RR <14 or lose tendon reflex•Calcium Gluconate
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Ms X
• MgSO4 commenced• MgSO4 maintenance infusion• 190mg Labetolol given in 25mg boluses
• Into theatre• Spinal• Forceps delivery, 2nd degree tear• Healthy baby
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Important points
• BP not a good measure
• Do not ignore 1+ of protein
• Delivery is only cure
• 44% of fits are post partum
• Inform intensive care facilities early