eclampsia case M&M

1. ECLAMPSIA
M&M

2. PREGNANCY
OUR CASE
• 38 years PG , 41+1.
• Fit and Healthy
• No allergies
• BMI booking 24.
• VTE risk : law
• Gestational Hypertension on Labetalol.
• No support at home

3. LABOUR
OUR CASE
• Labour onset: induced with Propess. 21/6/18 @ 0915AM
• Reason of induction : GH on Oral Labetalol “controlled” and slow
progress.
• ROM: 0635 PM
• Pain relief in labour : Diamorphine , Entonox , meptid ,paracetamol.

4. THE INCIDENT
OUR CASE
• 22.30 : Call for Grade 2 CS .
• Reason : failure to progress and not reassuring CTG.
• Anaesthetic assessment : BP 140/80 , no abnormalities in pregnancy ,
normal FBC, KFT, LFT and coagulation studies , Plan: spinal
anaesthesia (all concerns and plans explained to her ).
• On arrival to theatres : BP: 140/90 , HR 110/min , on entonox,
• 22,50 pm :Spinal anaesthesia : setting up the patient , drugs
preparation , spraying , LA infiltration with first 3 ml lidocaine 1%
…….. seizures

5. MANAGEMENT
OUR CASE
• Immediate oxygenation
• Left uterine placement
• Call for help.
• Seizures termination , suctioning and immediate intubation and proceeding
with GA …
• 23.06: Grade 1 CS and placental delivery 23,07.
• Magnesium sulphate loading and maintenance doses start and arrival of
backup help from ITU consultant ….
• Baby : APGAR 1/9. 5/10 no resuscitation required

6. • Oxytocin infusion and fentanyl and paracetamol.
• Reversal: using suggamedex.
• Full regain of motor power and consciousness, extubated, and sent
for recovery in main theatres ….
• Continue magnesium sulphate infusion and monitoring of
Magnesium level according to protocol .
• Patient returned to ward after two hours in recovery .

10. GASTATIONAL HYPERTENSIN
• hypertension presenting after 20 weeks' gestation without significant proteinuria.
• affects 6% of pregnancies.
• Oral labetalol is the first-line therapy if the mother can tolerate it. Alternative agents
include nifedipine and methyldopa.
•
• Renal function should be regularly monitored with quantification of any proteinuria
using spot protein:creatinine ratio.

16. ECLAMPSIA
• Eclamptic seizures are a significant cause of mortality in pre-
eclampsia, and complicate 1-2% of pre-eclamptic pregnancies.
• Intracerebral haemorrhage and cardiac arrest are complications
• Magnesium sulphate is first-line therapy for treatment .

17. • PATHOPHYSIOLOGY?

21. • COMPLICATIONS …..?

22. MANAGEMENT
• The patient should be turned to the left lateral position
• Call for help
• Assess and support Airway, Breathing and Circulation
• High flow oxygen by face mask
• Obtain IV access
• Treat with IV magnesium sulphate.
• Monitor ECG, BP, respiratory rate and oxygen saturations ανδ χheck blood sugar .
• Repeated seizures not responding to magnesium sulphate, consultant obstetrician and anaesthetist decide intubation and transfer
to intensive care .
• consider CT scan to exclude other causes

23. Collaborative Eclampsia Trial regimen
• 4g bolus over 10 min followed by 1g/hr infusion
until 24 hours after delivery.
• This maintenance dose is stopped or decreased to
0.5g/hr if the patient is oliguric or if the serum
magnesium levels are higher than the therapeutic
range. In the event of recurrent seizures,
• a further bolus of 2-4g over 10 min is given.

26. GA OR REGIONAL

27. REFLECTION AND FEEDBACK
• What went well?
1. The all team members did all we could, and all skills used and all
worked in harmony….
2. At the time of the incident there was a reflection in action …
3. Excellent support from ITU consultant (onsite )…
4. Compliance with literature

28. • Areas of discussions and review :
1. Drugs to be drawn ?
2. PCR to be done IN GH?
3. ITU admission and invasive lines ?
4. Other lines of management ?
5. Review of the local guidelines
6. Communication with other team members .
7. Atypical features should be anticipated ..

29. THANKS
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