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Eclampsia


- A severe form of late toxicosis of pregnancy, usually occurring on the background of preeclampsia and nephropathy.
Nephropathy is characterized by the presence of edema, protein in the urine, hypertension. Typically, these symptoms increase as nephropathy goes into preeclampsin), and new signs associated with impaired function of the central nervous system, impaired cerebral circulation, increased intracranial pressure and cerebral edema join them. Patients are inhibited or agitated. They suffer from a headache, sometimes in the stomach, a feeling of heaviness in the forehead and occiput, visual disturbances - a veil before the eyes, flickering flies, etc., associated with changes in the retina of the eye (swelling, hemorrhage, detachment). Preeclampsia at any time can turn into eclampsia. In addition, hemorrhages in the brain and other vital organs, premature detachment of the placenta and other complications dangerous to the pregnant woman and the fetus are possible. Often there is asphyxia of the fetus, which can cause his death before birth or during birth.
Treatment:
Based on the principles adopted for the treatment of eclampsia (see below).
An urgent hospitalization is required in a hospital, where the patient is placed in a special ward and permanent duty is established (they do not leave one for one minute!). Eliminate all stimuli - noise, bright light, exciting moments. During the first day, give only fruit juices in small quantities (up to 300 ml) or fruit, other food is not allowed. Usually it is possible to prevent the transition to eclampsia, and the woman's condition improves to the point that she can carry the pregnancy. In the absence of the effect of treatment for 4-5 days, indicated abortion.
Eclampsia is the highest stage of late toxicosis. Severe state indicates a violation of the activities of all major systems and organs. The most significant symptom is muscle cramps, accompanied by loss of consciousness (coma).
Eclampsia usually occurs during childbirth, less frequently after and during pregnancy. It is more common in nulliparous, especially the elderly, as well as in women, burdened with diseases of the liver, kidneys, cardiovascular, neuroendocrine and other systems.
Symptoms and course:
Seizures of convulsions build up on the existing symptoms of preeclampsia or nephropathy. Before they begin, there is an increase in headache, blurred vision, insomnia, anxiety, increased blood pressure and protein in the urine. Each seizure of eclampsia lasts 1-2 minutes and consists of the following successive periods: 1) the pre-convulsive period lasts 20-30 seconds. Small twitching of the facial muscles appear, the eyelids close, only the whites of the eyes are visible, the corners of the mouth are lowered; 2) the period of tonic convulsions, duration - 20-30 seconds, the most dangerous for the mother and fetus. Tetanic contraction of the muscles of the whole body occurs, the body becomes tense, breathing stops, the face turns blue; 3) period of clonic convulsions, 20-30 seconds. Stormy convulsive twitching of the muscles of the face, torso and extremities, which gradually weaken, wheezing appears, froth comes out of the mouth, stained with blood due to biting of the tongue; 4) the period of resolution of the seizure, its duration is different, sometimes lasts for hours. The patient is in a coma, the consciousness returns slowly, she does not remember anything that happened. Attacks are often accompanied by fever, slow pulse, a further rise in blood pressure. Sometimes convulsions begin again in a coma. It happens and non-convulsive form (rare), in which the patient immediately falls into a coma, and the prognosis is unfavorable. Because of the deep disturbances of the most important vital functions, including the central nervous system, the excitability of the organism rises sharply, therefore all stimuli (pain, noise, bright light, etc.) can provoke a new attack. Cerebral edema caused by impaired cerebral circulation, bleeding in the brain and its membranes are the main causes of death. Without appropriate assistance during seizure damage may occur: biting the tongue, bruises, fractures.
Treatment:
Modern methods are aimed at the following:
1. Ensuring the strictest peace, elimination of visual, auditory, tactile and pain sensations. A special darkened, well-ventilated ward is necessary for the patient, where noise and unnecessary movements of the medical staff are not allowed. A midwife should always be at the bedside, under the guidance of a doctor, carrying out a set of medical and hygienic measures.
2. Elimination of vascular spasm leading to arterial hypertension (magnesium sulfate, aminazine, aminophylline, dibazol, papaverine, etc.).
3. Dehydration therapy, contributing to increased diuresis and preventing brain swelling and hypertension (mannitol, lasix, furosemide).
4. Intravenous drip administration of protein preparations for their correction (albumin, protein, dry plasma solutions); to improve blood flow and detoxification - glucose-novocaine mixture, reopolyglukine, hemodez.
5. Oxygenotherapy - inhalation of oxygen.
With insufficient efficiency of all methods, early delivery or cesarean section is indicated. Pregnant women who have had eclampsia need special monitoring. After childbirth, blood pressure is measured daily, urine analysis is done every 2-3 days, and the general state of the puerperal, cardiovascular activity, airway and genital involution processes are monitored. It must be remembered about the possibility of septic postpartum diseases, pneumonia and other complications. Children born to mothers who have undergone toxemia often have a reduced resistance to infection, cooling, etc., so they need careful care from their relatives and pediatricians.