Eclampsia

Description:

Eclampsia — the greatest severity of a gestosis; the main clinical implication — the spasms with a loss of consciousness which are not connected with what - or other cerebral pathology (for example, epilepsy or hemorrhage in a brain). The eclampsia is followed by consciousness disturbance, arterial hypertension, hypostases, a proteinuria. Usually the eclampsia develops in the III trimester of pregnancy or during 24 h in a delivery effect. If spasms developed more than in 48 h in an effect of childbirth, the eclampsia is improbable (it will be necessary to exclude TsNS pathology). The prevailing age. Arises at young primapara more often and primapara 40 years are more senior.

Eclampsia symptoms:

Clinical picture:
- Spasms (local and generzlizovanny)
- Harbingers of spasms: steady increase in the diastolic ABP, a headache, vision disorders, pain in epigastric area or the right verkhnem.kvadrant of a stomach. See Preeklampsya
- Each attack of an eclampsia proceeds 1 — 2 min. and consists of four periods: preconvulsive, tonic spasms, clonic spasms and permission of an attack
- Spasms against the background of the normal ABP are possible.
- Loss of consciousness, cyanosis (not always).
- Proteinuria (80%), hypostases (70%), arterial hypertension.
- DVS, thrombocytopenia, disturbance of functions of a liver, a renal failure are possible.
- Predisposition to a fluid lungs and a brain when performing infusional therapy. Increase in volume of the extracellular liquid which is inadequately distributed in extracellular spaces and reduction of OTsK (pachemia).

Eclampsia reasons:

The etiology and pathogeny are up to the end not studied. There are more than 30 theories of emergence of an eclampsia, to the most widespread of them concern:

    * Genetic factors (defects of genes: 7q36 — eNOS, 7q23-ACE, HLA, AT2R1, C677T-polymorphism)
    * Thrombophilias (mutation ф the V Leiden, AFS)
    * Extragenital pathology
    * Infection

There is no test allowing with sufficient reliability to predict an eclampsia.

The main releaser of a preeclampsia — fetoplacental insufficiency in combination with other maternal risk factors.
Maternal risk factors:

    * A heavy preeclampsia / eclampsia during the previous pregnancies;
    * A heavy preeclampsia / eclampsia in the family anamnesis;
    * Polycarpous pregnancy
    * Chronic somatopathies:
          - Arterial hypertension;
          - Diseases of kidneys;
          - Diseases of cardiovascular system;
          - Diabetes mellitus;
    * Obesity (IMT> 35);
    * First pregnancy;
    * Anti-phospholipidic syndrome;
    * The age is more senior than 40 years;
    * Interval between childbirth more than 10 years.

Treatment of the Eclampsia:

- Diet. Electrolyte-deficient diet. At serious condition — parenteral food. Tactics vedeniyakupirovaniye of spasms. At a loss of consciousness and coma consultation of the neuropathologist is necessary.
- Constant observation of hemodynamic indicators of mother and a fruit, a respiration rate, expressiveness of reflexes (definition in 15 min.); definition of an hourly diuresis.
- Immediate delivery! In the absence of conditions for its carrying out — Cesarean section. In in posledstviidovy and in posledstviirodovy the periods it will be necessary to fill blood loss completely.
- Infusional therapy — Ringer's solution with a lactate and 5% glucose solution with a speed of 60 — 120 ml/h under constant control of OTsK and Ht. The volume of infusional therapy — 300 — 1 500 ml, at delivery by operation of Cesarean section — to 2 500 — 3 000 ml.
- Glucocorticoids, and also the means improving cerebral circulation (Cavintonum, nootropil, etc.).
- The intensive care of a gestosis is continued up to three days.
- Anti-hypertensive therapy at it is necessary budetst of a prodolzh - ют to the woman in childbirth extract.
- Prevention of pyoinflammatory complications. Observation at the therapist during 1 year. Stopping of spasms
- The fixed position of the patient in order to avoid injuries, attributings and retractions of language.
- Aspiration of slime from a mouth and upper respiratory tracts.
- The moistened oxygen or IVL. Indications to IVL:
      - inefficiency of the held events (the attack of an eclampsia proceeds)
      - disturbance of consciousness out of an attack
      - convulsive readiness
      - the stop of cordial activity — in this case is necessary IVL combination with cardioresuscitation actions.
Medicinal therapy:
- Magnesium sulfate of 20 ml of 25% of solution in/in
- Then through in 4 h 50% solution (5 g) in oil
- Administration of magnesium sulfate safely under following conditions (check before each introduction): the knee jerk is kept, breath is not oppressed, the diuresis is not less than 25 ml/h
- Diazepam (Sibazonum) of 2 ml of 0,5% of solution in/in (2 mg/min.) before stopping of symptoms or achievement of a cumulative dose of 20 mg
- Promedolum — 1 ml of 2% of solution in/in
- Isopromethazine - 0,025 g
Prediscretion measures:
- At decrease in OTsK diuretics are contraindicated
- Giperosmolyarny products can cause transuding of a liquid part of blood through capillaries
- Medicinal interaction. Combinations of the appointed products can cause respiratory depression. At development of this complication apply Calcii chloridum (10 ml of 10% of solution in/in slowly).