Eclampsia-Midwifery Emergencies
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- Created by: MarthaTyson
- Created on: 17-05-19 09:50
1- Introduction
- Recognise time-critical emergency- Eclampsia
- Definition: One or more convulsions associated with pre-eclampsia (NICE, 2010).
- Recognise that seizure may be the first presentation. In the postnatal period, most common in the first 24 hours following birth.
- Call for help- SOAPS
- Senior Midwife- Aware of workload on delivery suite, can keep theatre free/make theatre team aware, knowledge and expertise
- Obstetrician- Prescribe and administer drugs, Plan of care, expedite birth (if pregnant)
- Anaesthetist- Manage airway, IV access, analgesia
- Paediatrician/Neonatologist- (if pregnant) Hypoxic episode- fetal compromise
- Scribe- Document time of events such as drug administration, personelle in room, time and length of seizures.
- Drug/Eclampsia box
- Record time and length of seizure- Normally less than 90 seconds, self-limiting
- DO NOT LEAVE WOMAN ALONE AT ANY POINT
- Begin ABCDE approach
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2-Airway
- Left lateral position
- To open airway
- To reduce aorta-caval compression (If pregnant)
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2-Breathing
- High-flow Oxygen via mask with reservoir (12-15L/min)
- Due to seizures- hypoxic episode
- To improve oxygenated blood to vital organs i.e. brain
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3- Circulation
- 2x Large bore cannulas (14-16 gauge)- Fluids, drugs, transfer to theatre
- Bloods
- Full Blood Count-RBC's-haemolysing/clotting? Platelet count
- Urea and Electrolytes- Kidney function- Detects creatinine clearance
- Liver Function test- possible liver damage. Elevated liver enzymes.
- Coagulation screen- Damage to capillaries- thrombi produced.
- Group and Save- Crossmatch blood incase of transfer to theatre. At risk of DIC (Disseminated intravascular coagulation-formation of blood clots in the small blood vessels throughout the body).
- Catheter
- Strict fluid balance
- Leaky blood vessels could cause pulmonary oedema
- 100ml in 4 hours OR 0.5ml/kg/hr
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3-Disability
- During the seizure, protect from injury
- Use cot sides
- Do not attempt to restrain or put anything in the mouth
- Following seizure remain in L lateral to maintain an open airway
- Maintain communication
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3-Exposure
- Respect dignity
- Minimise heat loss/exposure
- Any injuries? Banged head, biting tongue
- Obstetric Review
- If pregnant, CTG
- Hypoxic episode- risk of bradycardia or placental abruption
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4-Drugs
- Drug used to control seizures= Magnesium Sulphate
- Magpie trial- Inhibits cerebral NMDA receptors and causes cerebral vasodilation
- Loading Dose (administered by obstetrician- out of scope of practice of midwife)
- 4g Magnesium Sulphate over 5 minutes
- 8ml 50% Magnesium Sulphate in 12ml 0.9% normal saline
- In 20ml syringe
- Maintenance Dose (In syringe driver for safety. Set up to pump 5ml/hr)
- 1g/hr
- 20ml 50% Magnesium Sulphate in 30ml 0.9% normal saline
- In 50ml syringe
- Continue for 24 hours following birth or last seizure (whichever most recent)
- Side Effects: Flushing, burning sensation up arm
- Toxicity suspected? Call for help. Stop infusion. Administer oxygen and calcium glutonate IV 1g (100mls, 10%), start BLS
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5-Following Seizure
- Monitor maternal observations- MAGNESIUM SULPHATE TOXICITY AND RISK OF RESPIRATORY DEPRESSION, RISK OF CARDIAC ARREST
- Blood Pressure - Treat hypertension to keep BP <150/100mmHg
- Maternal Pulse
- Respiratory Rate- Risk of respiratory depression
- Patellar reflexes- Hourly-to monitor for magnesium toxicity
- Oxygen saturations
- Level of consciousness- AVPU- Alert, Voice, Pain, Unresponsive- Risk of respiratory depression, magnesium toxicity
- Level 2 critical care
- Obstetric HDU chart (High dependency unit)
- Fluid Balance Chart
- Modified Early Warning Score (MEWS)
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5- Following seizure- if pregnant
- 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 before transfer/ planning birth
- Involve paediatricians
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6- Documentation, Debrief, Incident Report Form
- Documentation- accurate record keeping, accountability (NMC, 2015)
- Incident Report Form
- Debrief: woman, family, staff. Psychological care- traumatic effect.
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6- Potential complications of eclampsia
- Maternal:
- Recurrent fits
- Physical injury
- More likely to develop HELLP syndrome- haemolysis, elevated liver enzymes, low platelet count
- Fetal
- Hypoxia
- Prematurity
- Compromised fetus
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Additional Information
- Incidence: 2.7 per 10,000 births (Knight, 2007)
Risk Factors
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