Eclampsia

- a severe form of late toxicosis of pregnant women, usually arising on the background of pre-eclampsia and nephropathy.
Nephropathy is characterized by the presence of edema, protein in the urine, hypertension. Usually these symptoms during the transition of nephropathy to preeclampsin) increase and they are joined by new signs associated with impaired central nervous system function, cerebral circulation disorder, increased intracranial pressure and brain edema. Patients are hindered or agitated. They are tormented by a headache, sometimes under a spoon, a feeling of heaviness in the forehead and occiput, a vision disorder - a veil before your eyes, flickering of flies, etc., associated with changes in the retina (swelling, hemorrhage, detachment). Pre-eclampsia at any time can go to eclampsia. In addition, hemorrhages to the brain and other vital organs, premature detachment of the placenta and other complications dangerous to the pregnant and fetus are possible. Often observed asphyxia of the fetus, which can lead to its death before birth or during childbirth.
It is based on the principles adopted for the therapy of eclampsia (see below).
An urgent hospitalization is necessary in the hospital, where the patient is placed in a special ward and fixed on duty (they do not leave one for one minute!). Eliminate all the stimuli - noise, bright light, exciting moments. During the first day, only fruit juices are given in small amounts (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 bring the pregnancy. In the absence of the effect of treatment for 4-5 days, the termination of pregnancy is indicated.
Eclampsia is the highest stage of late toxicosis. A serious condition indicates a disruption in the activities of all the most important systems and organs. The most significant symptom is muscle cramps of the body, accompanied by loss of consciousness (coma).
Eclampsia, as a rule, occurs at the time of delivery, rarely after and during pregnancy. More common in primiparous, especially the elderly, as well as in women, burdened with diseases of the liver, kidneys, cardiovascular, neuroendocrine and other systems.
Seizure attacks are layered on existing symptoms of pre-eclampsia or nephropathy. Before they start, 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 is composed of the following successively changing periods: 1) the pre-convulsive period lasts 20-30 seconds. There are minor twitches in the muscles of the face, eyelids are closed, only the whites of the eyes are visible, the corners of the mouth drop; 2) period of tonic convulsions, duration - 20-30 seconds, the most dangerous for the mother and fetus. There is a tetanic contraction of the muscles of the whole body, the torso strains, the breath 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 extremities, which are gradually weakening, wheezing appears, a foam colored from the mouth due to the biting of the tongue emerges from the mouth; 4) the period of resolution of the seizure, the duration of it is different, sometimes lasts for hours. The patient is in a coma, the mind returns slowly, she does not remember anything. Attacks are often accompanied by an increase in temperature, slowing of the pulse, a further rise in blood pressure. Sometimes even in a coma, convulsions begin again. There is also an unconvulsive form (rare), in which the patient immediately falls into a coma, and the forecast is unfavorable at the same time. Because of deep violations of vital vital functions, including the central nervous system, the organism's excitability sharply increases, therefore all stimuli (pain, noise, bright light, etc.) can trigger a new attack. Cerebral edema, cerebral hemorrhages and its membranes are the main causes of death. Without appropriate care during a fit, damage can occur: biting of the tongue, bruises, fractures.
Modern methods are aimed at the following:
1. Provision of the strictest rest, elimination of visual, auditory, tactile and painful sensations. For the patient, a special darkened, well ventilated room is necessary, where noisy and unnecessary movements of the medical staff are allowed. A midwife should 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, euphyllin, dibazol, papaverine, etc.).
3. Dehydration therapy, which contributes to diuresis and preventive edema of the brain and hypertension (mannitol, lasix, furosemide).
4. Intravenous drip introduction of protein preparations for their correction (albumin, protein, solutions of dry plasma); To improve blood flow and detoxification - glucose-novocaine mixture, rheopolyglucin, gemodez.
5. Oxygenotherapy - inhaling oxygen.
With insufficient effectiveness of all methods, early delivery or cesarean section is indicated. Pregnant women who have undergone eclampsia need special supervision. After giving birth every day, blood pressure is measured, every 2-3 days urine is analyzed, the general condition of the parturient is monitored, the cardiovascular system is functioning, the condition of the respiratory tract and the processes of involution of the genital organs. It is necessary to remember the possibility of the occurrence of septic postpartum diseases, pneumonia and other complications. Children born to mothers who have had toxicoses often have reduced resistance to infection, cooling, etc., so they need careful care of relatives and the pediatrician.