Eclampsia- Midwifery Emergencies

1-Intro

  • Recognise time-critical emergency- Eclampsia
  • Definition: One or more convulsions associated with pre-eclampsiaI (NICE,2010). Recognise that seizure may be the first presentation- In the postnatal period most common in the first 12 hours post birth.
  • Call for help-emergency buzzer -SOAPS
  • Senior midwife (Co-ordinate, keep theatre free, aware of workload on D/S)
  • Obstetrician (Prescribe and administer drugs/ plan of care for birth/expedite birth)
  • Anaesthetist (Manage airway, IV access, if transfer to theatre)
  • Paed/Neonatologist (Infant risk morbidity/mortality/ compromised/hypoxia)
  • Scribe (Document time of events/ seizure/ personnel, drugs etc)
  • DRUGS/ECLAMPSIA BOX
  • Record time and length of seizure (normally less than 90 seconds- self-limiting)
  • DO NOT LEAVE WOMAN ALONE 
  • Begin ABCDE approach
1 of 9

2-Airway and Breathing

A=Airway

  • Left lateral position- To open airway and reduce aorta-caval compression (if pregnant)

B=Breathing

  • Give high-flow oxygen via mask with reservoir (12-15l/min)
  • Due to seizures- hypoxic episode
  • To improve oxygenation to vital organs i.e. brain
2 of 9

3- Circulation and Disability

C=Circulation

  • Site 2x large bore IV cannulas 
  • Take bloods for:
    Full Blood Count- RBCs- haemolysing. Platelet count.
    U&E- To check renal function.
    Liver Function Test- Possible liver damage? Increased liver enzymes.
    Coagulation Screen-Damage to capillaries-thrombi produced.
    Group and Save- Crossmatch blood? Incase of theatre. Risk of DIC (Disseminated intravascular coagulation=formation of blood clots in the small blood vessels throughout body).
  • Catheter- Strict input/output. Monitor uirne output-at least 100mls in 4 hours OR 0.5ml/kg/hr.

D=Disability

  • During seizure protect from injury
  • Do not attempt to restrain/put anything in mouth
  • Use cot sides
  • Following seizure remain in left lateral position to maintain open airway
  • Maintain communication
3 of 9

4-Drugs

  • Control seizures- drug of choice- Magnesium Sulphate (MgSO4-)
  • Loading dose- 4g Mag Sulph over 5 minutes. IV Bolus.
    8ml 50% MgSO4 (4g)
    in 12ml 0.9% NaCl (normal saline)
    into 20ml syringe
  • Maintenance dose- 1g/hr
    20ml 50% MgSO4 (10g)
    in 30ml 0.9% NaCl (normal saline)
    into 50ml syringe
    Place into a syringe driver and set the pump to run IV at 5ml/hr- SAFE
  • Continue for 24 hours following birth or last seizure (whichever was most recent)
  • Side effects: Flushes, burning sensation up arm
  • Toxicity suspected? Call for help. Stop Mag Sulph, administer O2, administer calcium glutonate IV 1g (100mls 10%), start BLS
4 of 9

5-Following Seizure-Monitor-Obs

  • Blood Pressure (Need to treat hypertension to keep BP <150/100mmHg
  • Pulse
  • Respiratory Rate
  • Patellar reflexes- Hourly- to monitor for magnesium toxicity
  • Oxygen saturations
  • Level of consciousness- AVPU
  • Rationale for observations: Risk of respiratory depression, cardiac arrest
  • Identify immediate aftercare will require level 2 critical care obstetric HDU
  • Strict fluid balance- fluid restriction

If pregnant...

  • Ensure left lateral, use wedge to avoid aorto-caval compression
  • Monitor FHR immediately post-seizure- compare with mat pulse
  • Commence continuous CTG
  • Maternal condition must be stabilised prior to planning birth
  • Involve paediatricians 
5 of 9

6-Documentation, Debrief, Datex (Incident Report)

  • One-to-one care
  • Women, family and staff - psychological care
  • MEWS, HDU chart, Drug Wardex, Fluid Balance chart
  • Incident report form

Identify possible complications (Maternal and fetal) associated with this scenario

  • Physical injuries: tongue biting, head injury
  • Recurrent fits
  • Maternal- Complications of PE, HELLP syndrome, coagulopathy, intracerebral bleeding, CVA, aspiration, perinatal morbidity and mortality
  • Fetus- prematurity, hypoxia, compromised fetus

 

6 of 9

7- Additional Info

  • Relationship to pre-eclampsia (ref)
  • Incidence
  • Research
  • Magpie Trial
  • Risk factors
  • Other references
7 of 9

Exposure

E=Exposure

  • Respect dignity
  • Minimise exposure and heat loss
  • If pregnant, CTG (Risk of abruption/hypoxic episode/bradycardia common/mode of birth/birth plan) Obstetric review-timing of birth etc.
  • Injuries (biting tongue/banged head etc).
8 of 9

Breathing

B=Breathing

  • Give high-flow oxygen via mask with reservoir (12-15l/min)
  • Due to seizures- hypoxic episode
  • To improve oxygenation to vital organs i.e. brain
9 of 9

Comments

No comments have yet been made

Similar Other resources:

See all Other resources »See all Eclampsia resources »