Mom Life

Topic 4 Preeclampsia

    Preeclampsia and eclampsia are severe stages of gestosis and represent a formidable complication of pregnancy. According to statistics, the percentage of preeclampsia is 5-10%, and eclampsia is 0.5% among the total number of women in labor, pregnant women and maternity women. Preeclampsia is a pre-seizure condition that is characterized by a significant rise in blood pressure, high protein content in the urine, and pronounced edema (not the main prognostic sign). Eclampsia is a convulsive attack that either resolves or goes into a coma. Signs of preeclampsia Preeclampsia is only a short interval between nephropathy and a convulsive attack. Preeclampsia is a violation of the functions of vital organs of the body, the leading syndrome of which is a lesion of the Central nervous system: * appearance of flies before the eyes, flickering, blurring of objects; * tinnitus, headache, feeling of heaviness in the back of the head; • nasal congestion; * memory disorders, sleepiness or insomnia, irritability or apathy. Also, preeclampsia is characterized by pain in the upper abdomen ('under the stomach'), in the right hypochondrium, nausea, vomiting. An unfavorable prognostic sign is an increase in tendon reflexes (this symptom indicates convulsive readiness and a high probability of developing eclampsia). In preeclampsia, edema increases, sometimes within a few hours, but the severity of edema in assessing the severity of the pregnant woman's condition does not matter. The severity of preeclampsia is determined on the basis of complaints, proteinuria and arterial hypertension (an increase in blood pressure for normotonics above 140/90 mm Hg. this should be alarming). If arterial hypertension is 160/110 or more, they say about severe preeclampsia. Kidney damage is manifested as a decrease in the amount of urine released (oliguria and anuria), as well as a high protein content in the urine (0.3 grams in the daily amount of urine). Signs of eclampsia Eclampsia is an attack of convulsions that consists of several phases: • Frst phase. The duration of the first (introductory) phase is 30 seconds. At this stage, there are small contractions of the facial muscles. • Second phase. Tonic convulsions – a generalized spasm of all the muscles of the body, including the respiratory muscles. The second phase lasts 10-20 seconds and is the most dangerous (a woman may die). • Third phase. The third phase is the stage of clonic convulsions. The patient, motionless and tense ('like a string'), begins to beat in a convulsive fit. The cramps go from top to bottom. The woman is without a pulse or breathing. The third stage continues for 30-90 seconds and is resolved with a deep breath. Then the breath becomes rare and deep. • Fourth phase. The seizure is resolved. It is characterized by the release of foam with an admixture of blood from the mouth, a pulse appears, the face loses its blueness, returning to normal color. The patient either regains consciousness or falls into a comatose state. Treatment A patient with preeclampsia and eclampsia must be admitted to a hospital. Treatment should be started immediately, on the spot (in the emergency room, at home if an ambulance team is called, in the Department). In the treatment of these pregnancy complications, an obstetrician – gynecologist and a resuscitator are involved. A woman is hospitalized in an intensive care unit, where a therapeutic and protective syndrome is created (a sharp sound, light, or touch can provoke a convulsive attack). Additionally, sedatives are prescribed. The gold standard of treatment for these forms of gestosis is intravenous administration of magnesia sulphate solution (under the control of blood PRESSURE, respiratory rate and heart rate). Also, to prevent seizures, droperidol and Relanium are prescribed intravenously, possibly in combination with Dimedrol and promedol. At the same time, the volume of circulating blood is replenished (intravenous infusions of colloids, blood products and salt solutions: plasma, reopoliglyukin, infucol, glucose solution, isotonic solution, and so on). Management of blood pressure is exercised in the appointment of antihypertensive drugs (clonidine, dopegit, corinfar, atenolol). In pregnancy up to 34 weeks, therapy aimed at the maturation of the fetal lungs (corticosteroids) is performed. Emergency delivery is indicated in the absence of a positive effect from therapy for 2-4 hours, with the development of eclampsia and its complications, with placental detachment or suspicion of it, with acute oxygen insufficiency (hypoxia) of the fetus. Pre-medical care for an eclampsia attack: Turn the woman to the left side (to prevent aspiration of the respiratory tract), create conditions that reduce the patient's injuries, do not use physical force to stop convulsions, after an attack, clear the oral cavity of vomit, blood and mucus. Call an ambulance. Medication relief of an eclampsia attack: Intravenous administration of 2.0 ml of droperidol, 2.0 ml of Relanium and 1.0 ml of promedol. After the end of the attack, the lungs are ventilated with a mask (oxygen), and in the case of a comatose state, the trachea is intubated with a further ventilator device.