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Eclampsia


- A severe form of late toxicosis of pregnant women, which usually occurs against the background of preeclampsia and nephropathy.
Nephropathy is characterized by the presence of edema, protein in the urine, and hypertension. Typically, these symptoms with the transition of nephropathy to preeclampsin) increase and new signs are associated with a violation of the central nervous system, impaired cerebral circulation, increased intracranial pressure and cerebral edema. Patients are inhibited or agitated. They are tormented by a headache, sometimes under the stomach, a feeling of heaviness in the forehead and neck, visual disturbances - a veil in front of the eyes, flickering flies, etc., associated with changes in the retina (edema, hemorrhage, detachment). Preeclampsia at any time can go into eclampsia. In addition, hemorrhages in the brain and other vital organs, premature detachment of the placenta and other complications that are dangerous for the pregnant woman and the fetus are possible. Often there is asphyxiation of the fetus, which can lead to its death before birth or during childbirth.
Treatment:
Based on the principles adopted for the treatment of eclampsia (see below).
Urgent hospitalization in a hospital is necessary, where the patient is placed in a special ward and a constant watch is established (they do not leave one for one minute!). Eliminate all irritants - noise, bright light, exciting moments. During the first day they give only fruit juices in small quantities (up to 300 ml) or fruits, other foods are not allowed. Usually, it is possible to prevent the transition to eclampsia, and the woman's condition improves so much that she can inform the pregnancy. In the absence of the effect of treatment for 4-5 days, abortion is indicated.
Eclampsia is the highest stage of late toxicosis. A serious condition indicates a violation of the activity of all the most important systems and organs. The most significant symptom is muscle cramps, accompanied by loss of consciousness (coma).
Eclampsia, as a rule, occurs at the time of childbirth, less often after and during pregnancy. It is more common in primiparous, especially the elderly, as well as in women, weighed down by diseases of the liver, kidneys, cardiovascular, neuroendocrine and other systems.
Symptoms and course:
Attacks of seizures overlap with existing symptoms of preeclampsia or nephropathy. Before they begin, there is an increase in headache, visual impairment, insomnia, anxiety, increased blood pressure and protein in the urine. Each seizure of eclampsia lasts 1-2 minutes and consists of the following successively alternating periods: 1) the preconvulsive period lasts 20-30 seconds. Small twitches of the muscles of the face appear, the eyelids close, only the whites of the eyes are visible, the corners of the mouth drop; 2) the period of tonic convulsions, duration - 20-30 seconds, the most dangerous for the mother and fetus. A tetanic contraction of the muscles of the whole body occurs, the torso tenses up, breathing stops, the face turns blue; 3) the period of clonic seizures, 20-30 seconds. There are violent convulsive twitching of the muscles of the face, trunk and limbs, which gradually weaken, hoarse-breathing appears, foam is released from the mouth, stained with blood due to biting 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, slowing of the pulse, a further rise in blood pressure. Sometimes convulsions begin again in a coma. There is a non-convulsive form (rare), in which the patient immediately falls into a coma, and the prognosis is unfavorable. Due to the deep disturbances of the most important vital functions, including the central nervous system, the excitability of the organism increases sharply, therefore all irritants (pain, noise, bright light, etc.) can provoke a new attack. Edema caused by cerebrovascular accidents, hemorrhages in the brain and its membranes are the main causes of deaths. Without appropriate help during a seizure, damage may occur: biting the tongue, bruises, fractures.
Treatment:
Modern methods are aimed at the following:
1. Providing the strictest rest, elimination of visual, auditory, tactile and pain sensations. For the patient, a special darkened, well-ventilated ward is needed, 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, chlorpromazine, aminophylline, dibazole, papaverine, etc.).
3. Dehydration therapy, which enhances diuresis and prevents cerebral edema and hypertension (mannitol, lasix, furosemide).
4. Intravenous drip of protein preparations for their correction (albumin, protein, dry plasma solutions); to improve blood flow and detoxification - glucose-novocaine mixture, reopoliglyukin, hemodesis.
5. Oxygen therapy - inhalation of oxygen.
With insufficient effectiveness of all methods, early delivery or cesarean section is indicated. Pregnant women who have experienced eclampsia need special monitoring. After childbirth, blood pressure is measured daily, urine analysis is done every 2-3 days, the general condition of the puerpera, the activity of the cardiovascular system, the state of the respiratory tract and the processes of genital involution are monitored. It is necessary to remember the possibility of septic postpartum diseases, pneumonia and other complications. Children born to mothers who have undergone toxicosis often have a reduced resistance to infection, cooling, etc., so they need careful care of relatives and the pediatrician.