Providing first aid for eclampsia. Emergency care for a pregnant woman with eclampsia

Target: evaluate the graduate’s practical skills in providing emergency care for eclampsia

Indications– attack of convulsions during eclampsia

Contraindications- No

Possible complications– repeated attack of convulsions, eclamptic coma.

Resources– dummy of a woman, 25% magnesium sulfate solution, spatula, tongue holder, 20 ml syringe, 500 ml saline solution, intravenous infusion system, alcohol, cotton wool, tourniquet

Action algorithm:

1. In case of seizures, call all available personnel and the resuscitation team without leaving the patient.

2. Carry out the following activities at the same time:

· clear the airways by opening your mouth with a spatula or spoon wrapped in gauze, and stretch out your tongue with a tongue holder.

· remove saliva from the mouth; as soon as you inhale, ensure free access of air.

· after stopping the seizures, administer a starting dose of magnesium sulfate intravenously – 25%-20 ml over 10-15 minutes.

3. Start an intravenous infusion of 320 ml of saline with 80 ml - 25% magnesium sulfate solution

4. Under blood pressure control and ongoing magnesium therapy, transfer the patient to a stretcher and transport to the intensive care unit of the nearest maternity hospital.

NOTE

In case of eclampsia, delivery should occur after the patient’s condition has stabilized, but no later than 12 hours from the onset of seizures.

Standard “Providing emergency care for severe preeclampsia.”

Target: evaluate the graduate’s practical skills in providing emergency care for severe preeclampsia

Indications– severe preeclampsia

Contraindications- during an attack of convulsions

Possible complications– attack of convulsions, eclamptic coma.

Resources– dummy of a woman, 25% magnesium sulfate solution, 20 ml syringe, 500 ml saline solution, intravenous infusion system, alcohol, cotton wool, tourniquet

Action algorithm:

1. Make a diagnosis: “Severe preeclampsia” if one of these symptoms is present: headache, pain in the epigastric region, blurred vision, flashing spots before the eyes, nausea, vomiting, against the background of arterial hypertension (140/90 mm Hg and above) and proteinuria.

2. Call all available personnel and resuscitation team without leaving the patient.

3. Carry out the following activities at the same time:

· Place the pregnant woman on a flat surface, avoiding injury, and turn the patient’s head to the side.

· intravenously administer a starting dose of magnesium sulfate – 25%-20 ml over 10-15 minutes.

4. Start an intravenous infusion of 320 ml of saline with 80 ml of 25% magnesium sulfate solution.

5. When blood pressure is equal to or higher than 160/100 mmHg. regulate blood pressure by prescribing 10 mg of nifedipine sublingually, again after 30 minutes 10 mg under blood pressure monitoring (maintain blood pressure at 130/90-140/95 mmHg).

6. Under blood pressure control and ongoing magnesium therapy, transfer the patient to a stretcher and transport to the intensive care unit of the nearest maternity hospital.

NOTE If signs of magnesium sulfate overdose appear, administer 10 ml of a 10% Ca gluconate solution intravenously over 10 minutes.

Standard "Amniotomy".

Target- opening of the amniotic sac.

Indications– before labor induction, labor stimulation, weakness of labor Contraindications– threatening conditions of the mother or fetus

Possible complications– loss of small parts of the fetus, ascending infection, injury to the vessels of the amniotic sac, abruption of a normally located placenta

Resources– gynecological chair, individual diaper, sterile gloves, antiseptic for treating a woman’s external genitalia, branch of bullet forceps.

Action algorithm:

1. Introduce yourself.

2. Explain to the woman the need for this operation.

3. Take the patient’s informed consent for the procedure

4. Place the woman on the gynecological chair, placing a disposable

5. Treat the woman’s external genitalia with an antiseptic solution and place a sterile diaper on the woman’s stomach.

6. Carry out hygienic hand disinfection.

7. Wear disposable gloves on both hands.

8. Using the fingers of your left hand, spread the labia, sequentially insert into the vagina

index, then middle finger of the right hand.

9. Insert the jaw of the bullet forceps into the vagina between the index and middle

fingers.

10. Puncture the amniotic sac.

11. Insert your index finger into the resulting hole in the amniotic sac, and then your middle finger, gradually widen the hole, and remove the membranes from the head. Release amniotic fluid slowly, under the control of your fingers (prevention of loss of small parts, abruption of a normally located placenta).

13. Pull your fingers out.

14. Remove gloves and place in safe disposal box.

15. Wash your hands with soap.

16. Write down the data in the birth history.

NOTE.

For polyhydramnios, make a small hole and slowly release the water. It is necessary to control the rate of outflow of water, since if it is released quickly and abruptly, small parts of the fetus may fall out. After the water breaks, the woman is recommended to lie down for 30 minutes.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Eclampsia and preeclampsia are pathological conditions that occur during pregnancy. Both conditions are not independent diseases, but are syndromes of failure of various organs, combined with various symptoms of damage to the central nervous system of varying degrees of severity. Preeclampsia and eclampsia are pathological conditions that develop exclusively during pregnancy. In principle, a non-pregnant woman or man cannot develop either preeclampsia or eclampsia, since these conditions are provoked by disturbances in the relationship between the mother-placenta-fetus system.

Since the causes and mechanisms of development of eclampsia and preeclampsia have not yet been fully elucidated, the world has not made a clear decision as to which nosology these syndromes should be classified as. According to scientists from Europe, the USA, Japan and experts from the World Health Organization, preeclampsia and eclampsia are syndromes related to the manifestations of hypertension in pregnant women. This means that eclampsia and preeclampsia are considered precisely as types of arterial hypertension in pregnant women. In Russia and some countries of the former USSR, eclampsia and preeclampsia are considered types of gestosis, that is, they are considered a variant of a completely different pathology. In this article we will use the following definitions of eclampsia and preeclampsia.

Preeclampsia is a multiple organ failure syndrome that occurs only during pregnancy. This syndrome is a condition in which a woman, after the 20th week of pregnancy, develops persistent hypertension, combined with generalized edema and the release of protein in the urine (proteinuria).

Eclampsia– these are the predominant clinical manifestations of brain damage with seizures and coma against the background of the general symptoms of preeclampsia. Seizures and coma develop due to severe damage to the central nervous system by excessively high blood pressure.

Classification of eclampsia and preeclampsia

According to the World Health Organization classification, eclampsia and preeclampsia occupy the following place in the classification of hypertension in pregnant women:
1. Chronic arterial hypertension that existed before pregnancy;
2. Gestational hypertension that occurs during pregnancy and is caused by pregnancy;
3. Preeclampsia:

• Mild preeclampsia (not severe);
• Severe preeclampsia.

4. Eclampsia.

The above classification clearly illustrates that eclampsia and preeclampsia are types of hypertension that develops in pregnant women. Preeclampsia is a condition that precedes the development of eclampsia. However, eclampsia does not necessarily develop against the background of only severe preeclampsia; it can also occur with mild preeclampsia.

In Russian practical obstetrics the following classification is often used:

• Edema of pregnant women;
• Nephropathy 1, 2 or 3 degrees;
• Preeclampsia;
• Eclampsia.

However, according to the instructions of the World Health Organization, nephropathy of any severity is classified as preeclampsia, without being classified as a separate nosological structure. It is precisely because of the presence of nephropathy in the Russian classification that obstetricians-gynecologists consider preeclampsia to be a short-term condition preceding eclampsia. And foreign obstetricians and gynecologists classify preeclampsia as nephropathy of degrees 1, 2 and 3, and therefore believe that it can last for a fairly long period of time. However, as foreign practicing obstetricians note, before an attack of eclampsia, the course of preeclampsia becomes sharply more severe for a short period of time. It is this spontaneous and abrupt deterioration in the course of preeclampsia that is considered an immediate harbinger of eclampsia, and when it occurs, it is necessary to urgently hospitalize the woman in an obstetric hospital.

Foreign experts diagnose preeclampsia if a woman has hypertension (pressure above 140/90 mm Hg), edema and proteinuria (protein content in daily urine more than 0.3 g/l). Domestic experts regard these symptoms as nephropathy. Moreover, the severity of nephropathy is determined by the severity of the three listed symptoms (volume of edema, pressure value, protein concentration in the urine, etc.). But if the three symptoms (Zantgemeister triad) are accompanied by headache, vomiting, abdominal pain, blurred vision (visible “as if in a fog,” “spots before the eyes”), and decreased urine output, then Russian obstetricians make a diagnosis of preeclampsia. Thus, from the point of view of foreign specialists, nephropathy is a serious pathology that must be classified as preeclampsia, and not wait for a sharp deterioration in the condition preceding eclampsia. In the future, we will use the term “preeclampsia”, putting into it an understanding of the essence of foreign obstetricians, since the treatment guidelines used in almost all countries, including Russia, were developed by these specialists.

To summarize, to understand the classifications, you should know that preeclampsia is hypertension in combination with proteinuria (protein in the urine in a concentration of more than 0.3 g/l). Depending on the severity of the Zantgemeister triad, mild and severe preeclampsia are distinguished.

Mild preeclampsia is hypertension in the range of 140 – 170/90 – 110 mmHg. Art. in combination with proteinuria with or without edema. Severe preeclampsia is diagnosed when blood pressure is above 170/110 mmHg. Art. combined with proteinuria. In addition, severe preeclampsia includes any hypertension in combination with proteinuria and any of the following symptoms:

• Strong headache;
• Visual impairment (veil, floaters, fog before the eyes);
• Abdominal pain in the stomach area;
• Nausea and vomiting;
• Convulsive readiness;
• Generalized swelling of the subcutaneous tissue (swelling throughout the body);
• Decreased urine output (oliguria) to less than 500 ml per day or less than 30 ml per hour;
• Pain when palpating the liver;
• The number of platelets in the blood is below 100 * 106 pieces/l;
• Increased activity of liver transaminases (AST, ALT) above 90 IU/l;
• HELLP syndrome (destruction of red blood cells, high activity of liver transaminases, platelet count below 100 * 106 pieces/l);
• IUGR (intrauterine growth retardation).

Severe and mild preeclampsia reflect different degrees of severity of damage to the internal organs of a pregnant woman. Accordingly, the more severe the preeclampsia, the greater the damage to internal organs, and the higher the risk of adverse consequences for the mother and fetus. If severe preeclampsia does not respond to drug therapy, the only treatment option is termination of pregnancy.

The classification of preeclampsia into mild and severe is generally accepted in Europe and the USA, as well as recommended by the World Health Organization. The Russian classification has a number of differences. In the Russian classification, mild preeclampsia corresponds to grades I and II nephropathy, and severe preeclampsia corresponds to grade III nephropathy. Preeclampsia in the Russian classification is actually the initial stage of eclampsia.

Depending on the moment at which eclampsia develops, it is divided into the following types:

• Eclampsia occurring during pregnancy(accounts for 75 - 85% of all cases of eclampsia);
• Eclampsia during childbirth, which occurs directly during labor (approximately 20–25% of all cases of eclampsia);
• Postpartum eclampsia, which occurs within 24 hours after delivery (accounts for approximately 2–5% of all cases of eclampsia).

All of the listed types of eclampsia develop according to exactly the same mechanisms, and therefore have the same clinical manifestations, symptoms and severity. Moreover, even the principles of treatment for any of the above types of eclampsia are the same. Therefore, the classification and distinction of eclampsia depending on the time of its occurrence is of no practical importance.

Depending on the prevailing symptoms and damage to any organ, three clinical forms of eclampsia are distinguished:

• Typical form of eclampsia characterized by severe swelling of the subcutaneous tissue of the entire surface of the body, increased intracranial pressure, severe proteinuria (protein concentration is more than 0.6 g/l in daily urine) and hypertension more than 140/90 mm Hg;
• Atypical form of eclampsia most often develops during prolonged labor in women with a labile nervous system. This form of eclampsia is characterized by cerebral edema without swelling of the subcutaneous tissue, as well as slight hypertension, increased intracranial pressure and moderate proteinuria (protein concentration in daily urine from 0.3 to 0.6 g/l);
• Renal or uremic form of eclampsia develops in women who suffered from kidney disease before pregnancy. The renal form of eclampsia is characterized by mild or completely absent swelling of the subcutaneous tissue, but the presence of a large amount of fluid in the abdominal cavity and amniotic sac, as well as moderate hypertension and intracranial pressure.

Eclampsia and preeclampsia - causes

Unfortunately, the causes of eclampsia and preeclampsia are currently not fully understood. Only one thing is known for certain - these conditions develop exclusively during pregnancy, and therefore are inextricably linked with a disruption of normal relationships in the mother-placenta-fetus system. There are more than thirty different theories of the development of eclampsia and preeclampsia, among which the most complete and prognostically significant are the following:

• Genetic mutations (gene defects eNOS, 7q23-ACE, HLA, AT2Р1, C677T);
• Antiphospholipid syndrome or other thrombophilias;
• Chronic pathologies of non-genital organs;
• Infectious diseases.

Unfortunately, there is currently no test that can determine whether eclampsia will develop in a given case with or without predisposing factors. Many modern scientists believe that preeclampsia is a genetically determined insufficiency in the processes of adaptation of the woman’s body to new conditions. However, it is known that the trigger for the development of preeclampsia is placental insufficiency and the risk factors that a woman has.

Risk factors for preeclampsia and eclampsia include the following:
1. The presence of severe preeclampsia or eclampsia during previous pregnancies;
2. The presence of severe preeclampsia or eclampsia in the mother or other blood relatives (sisters, aunts, nieces, etc.);
3. Multiple pregnancy;
4. First pregnancy (preeclampsia develops in 75–85% of cases during the first pregnancy, and only in 15–25% during subsequent ones);
5. Antiphospholipid syndrome;
6. The pregnant woman is over 40 years old;
7. The interval between the previous and current pregnancy is more than 10 years;
8. Chronic diseases of internal non-genital organs:

• Arterial hypertension;
• Kidney pathology;
• Diseases of the cardiovascular system;

Eclampsia and preeclampsia - pathogenesis

Currently, the leading theories of the pathogenesis of preeclampsia and eclampsia are neurogenic, hormonal, immunological, placental and genetic, explaining various aspects of the mechanisms of development of pathological syndromes. Thus, neurogenic, hormonal and renal theories of the pathogenesis of eclampsia and preeclampsia explain the development of pathologies at the organ level, and genetic and immunological - at the cellular and molecular level. Each theory separately cannot explain the diversity of clinical manifestations of preeclampsia and eclampsia, so they all complement each other, but do not replace.

Currently, scientists believe that the initial link in the pathogenesis of preeclampsia and eclampsia is laid at the time of migration of the cytotrophoblast of the fetal egg. The cytotrophoblast is a structure that provides nutrition and also supports the growth and development of the fetus until the formation of the placenta. It is on the basis of the cytotrophoblast that the mature placenta is formed by the 16th week of pregnancy. Before the formation of the placenta, trophoblast migration occurs. If the migration and invasion of trophoblast into the uterine wall is insufficient, then in the future this will provoke preeclampsia and eclampsia.

With incomplete invasion of the migrating trophoblast, the uterine arteries do not develop and grow, as a result of which they are unprepared to ensure further life, growth and development of the fetus. As a result, as pregnancy progresses, the uterine arteries spasm, which reduces blood flow to the placenta and, accordingly, to the fetus, creating conditions for chronic hypoxia. With severe insufficiency of blood supply to the fetus, its development may even be delayed.

Spasmed uterine vessels become inflamed, which leads to swelling of the cells that form their internal lining. Fibrin is deposited on the inflamed and swollen cells of the inner layer of blood vessels, forming blood clots. As a result, blood flow in the placenta is further disrupted. But the pathological process does not stop there, since inflammation of the cells of the inner lining of the vessels of the uterus spreads to other organs, primarily to the kidneys and liver. As a result, the organs are poorly supplied with blood and their function becomes insufficient.

Inflammation of the inner lining of the vascular wall leads to their severe spasm, which reflexively increases the woman’s blood pressure. Under the influence of inflammation of the internal lining of blood vessels, in addition to hypertension, the formation of pores, small holes in their walls, through which fluid begins to seep into the tissue, forming edema. High blood pressure increases the sweating of fluid into the tissue and the formation of edema. Therefore, the higher the hypertension, the stronger the swelling during preeclampsia in a pregnant woman.

Unfortunately, the vascular wall is damaged as a result of the inflammatory process, and therefore insensitive to various biologically active substances that relieve spasms and dilate blood vessels. Therefore, hypertension appears to be constant.

In addition, due to damage to the vascular wall, blood clotting processes are activated, which consume platelets. As a result, the supply of platelets is exhausted, and their number in the blood decreases to 100 * 106 pieces/l. After the platelet pool is depleted, a woman experiences partial hemophilia, when the blood clots poorly and slowly. Low blood clotting combined with high blood pressure creates a high risk of stroke and cerebral edema. While a pregnant woman does not have cerebral edema, she suffers from preeclampsia. But as soon as the development of cerebral edema begins, this indicates the transition of preeclampsia to eclampsia.

The period of increased blood clotting and subsequent development of hemophilia in eclampsia is a chronic DIC syndrome.

Eclampsia and preeclampsia - symptoms and signs

The main symptoms of preeclampsia are edema, hypertension and proteinuria (the presence of protein in the urine). Moreover, to be diagnosed with preeclampsia, a woman does not have to have all three symptoms; only two are sufficient - a combination of hypertension with edema or hypertension with proteinuria.

Edema with preeclampsia can be of varying severity and prevalence. For example, some women experience swelling only on the face and legs, while others experience swelling all over the body. Pathological edema in preeclampsia differs from normal swelling characteristic of any pregnant woman in that it does not decrease or go away after a night's rest. Also, with pathological edema, a woman gains weight very quickly - more than 500 g per week after the 20th week of pregnancy.

Proteinuria is considered to be the detection of protein in an amount of more than 0.3 g/l in a daily portion of urine.

Hypertension in a pregnant woman is considered to be an increase in blood pressure above 140/90 mm Hg. Art. At the same time, the pressure is in the range of 140 – 160 mm Hg. Art. for systolic value and 90 – 110 mmHg. Art. for diastolic it is considered moderate hypertension. Pressure above 160/110 mm Hg. Art. considered severe hypertension. The division of hypertension into severe and moderate is important in determining the severity of preeclampsia.

In addition to hypertension, edema and proteinuria, severe preeclampsia is accompanied by symptoms of damage to the central nervous system and cerebrovascular disorders, such as:

• Severe headache;
• Visual impairment (the woman indicates blurred vision, a feeling of spots running before the eyes and fog, etc.);
• Abdominal pain in the stomach area;
• Nausea and vomiting;
• Convulsive readiness;
• Generalized edema;
• Reducing urination to 500 ml or less per day or less than 30 ml per hour;
• Pain when palpating the liver through the anterior abdominal wall;
• Decrease in total platelet count less than 100 * 106 pieces/l;
• Increased activity of AST and ALT more than 70 U/l;
• HELLP syndrome (destruction of red blood cells, low levels of platelets in the blood and high activity of AST and ALT);
• Intrauterine growth retardation (IUGR).

The above symptoms appear against the background of increased intracranial pressure and associated moderate cerebral edema.

Mild preeclampsia characterized by the obligatory presence of hypertension and proteinuria in a woman. Swelling may or may not be present. Severe preeclampsia characterized by the obligatory presence of severe hypertension (pressure above 160/110 mm Hg) in combination with proteinuria. In addition, preeclampsia is considered severe, in which a woman experiences any level of hypertension in combination with proteinuria and any one of the symptoms of cerebrovascular accident or central nervous system damage listed above (headache, blurred vision, nausea, vomiting, abdominal pain, decreased urination, etc.).

If symptoms of severe preeclampsia appear, the woman must be urgently hospitalized in an obstetric hospital and begin antihypertensive and anticonvulsant treatment aimed at normalizing blood pressure, eliminating cerebral edema and preventing eclampsia.

Eclampsia is a seizure that develops against the background of swelling and brain damage due to previous preeclampsia. That is, the main symptom of eclampsia is convulsions in combination with a woman’s comatose state. Convulsions during eclampsia can be different:

• Single convulsive seizure;
• A series of convulsive seizures following one after another at short intervals (eclamptic status);
• Loss of consciousness after a seizure (eclamptic coma);
• Loss of consciousness without a seizure (eclampsia without eclampsia or coma hepatica).

Immediately before eclamptic convulsions, a woman may experience increased headaches, worsened sleep up to the point of insomnia, and a significant increase in blood pressure. One convulsive seizure during eclampsia lasts from 1 to 2 minutes. At the same time, it begins with twitching of the facial muscles, and then convulsive contractions of the muscles of the whole body begin. After the end of the violent spasms of the body muscles, consciousness slowly returns, the woman comes to her senses, but does not remember anything, and therefore is not able to talk about what happened.

Eclamptic seizures develop due to deep damage to the central nervous system during cerebral edema and high intracranial pressure. The excitability of the brain is greatly increased, so any strong irritant, for example, bright light, noise, sharp pain, etc., can provoke a new attack of seizures.

Eclampsia - periods

A seizure in eclampsia consists of the following successive periods:
1. Pre-convulsant period lasting for 30 seconds. At this time, the woman begins to have small twitches in her facial muscles, her eyes close with her eyelids, and the corners of her mouth droop;
2. Period of tonic convulsions , also lasting on average about 30 seconds. At this moment, the woman’s torso stretches, the spine bends, the jaw clenches tightly, all muscles contract (including the respiratory muscles), the face turns blue, the eyes look at one point. Then, when the eyelids tremble, the eyes roll upward, as a result of which only the whites become visible. The pulse stops being palpable. Due to contraction of the respiratory muscles, the woman does not breathe during this period. This phase is the most dangerous, because due to respiratory arrest, sudden death can occur, most often from a cerebral hemorrhage;
3. Period of clonic convulsions , lasting from 30 to 90 seconds. With the beginning of this period, lying motionless with tense muscles, the woman begins to literally convulse. The spasms pass one after another and spread throughout the body from top to bottom. The convulsions are violent, the muscles of the face, torso and limbs twitch. During convulsions, the woman does not breathe, and the pulse cannot be felt. Gradually the convulsions weaken, become less frequent and finally stop completely. During this period, the woman takes her first loud breath, begins to breathe noisily, foam comes out of her mouth, often stained with blood due to a bitten tongue. Gradually breathing becomes deep and rare;
4. Seizure resolution period lasts several minutes. At this time, the woman slowly regains consciousness, her face turns pink, her pulse begins to be felt, and her pupils slowly constrict. There is no memory of the seizure.

The total duration of the described periods of an attack of eclamptic convulsions is 1 – 2 minutes. After a seizure, a woman's consciousness may recover, or she may fall into a coma. A comatose state develops in the presence of cerebral edema and continues until it goes away. If a coma during eclampsia continues for hours and days, then the prognosis for the woman’s life and health is unfavorable.

Eclampsia and preeclampsia - principles of diagnosis

To diagnose eclampsia and preeclampsia, the following studies must be performed regularly:

• Detection of edema and assessment of its severity and localization;
• Blood pressure measurement;
• Urine analysis for protein content;
• Blood test for hemoglobin concentration, platelet count and hematocrit;
• Blood during clotting;
• Electrocardiogram (ECG);
• Biochemical blood test (total white blood, creatinine, urea, ALT, AST, bilirubin);
• Coagulogram (APTT, PTI, INR, TV, fibrinogen, coagulation factors);
• Fetal CTG;
• Fetal ultrasound;
• Doppler analysis of the vessels of the uterus, placenta and fetus.

The simple examinations listed above allow you to accurately diagnose preeclampsia and eclampsia, as well as assess their severity.

Emergency care for eclampsia

For eclampsia, it is necessary to place the pregnant woman on her left side to reduce the risk of vomit, blood and gastric contents entering the lungs. The woman should be placed on a soft bed so that during convulsions she does not accidentally injure herself. It is not necessary to forcibly restrain during a convulsive eclamptic seizure.

During convulsions, it is recommended to supply oxygen through a mask at a rate of 4 - 6 liters per minute. After the convulsions are completed, it is necessary to clean the oral and nasal cavities, as well as the larynx, with suction from mucus, blood, foam and vomit.

Immediately after the end of the seizure, magnesium sulfate should be administered intravenously. First, 20 ml of a 25% magnesia solution is administered over 10–15 minutes, then switch to a maintenance dosage of 1–2 g of dry matter per hour. For maintenance magnesium therapy, 80 ml of 25% magnesium sulfate is added to 320 ml of saline. The prepared solution is administered at 11 or 22 drops per minute. Moreover, 11 drops per minute corresponds to a maintenance dose of 1 g of dry matter per hour, and 22 drops - respectively, 2 g in a maintenance dosage of magnesium sulfate should be administered continuously for 12 - 24 hours. Magnesium therapy is necessary to prevent possible subsequent seizures.

If after the administration of magnesia the convulsions recur after 15 minutes, then you should switch to Diazepam. Within two minutes, 10 mg of Diazepam should be administered intravenously. If seizures recur, the same dose of Diazepam is re-administered. Then, for maintenance anticonvulsant therapy, 40 mg of Diazepam is diluted in 500 ml of saline, which is administered over 6 to 8 hours.

Regardless of the stage of pregnancy, eclampsia is not an indication for emergency delivery, since it is first necessary to stabilize the woman’s condition and stop the seizures. Only after the convulsive seizures have been relieved can the question of delivery be considered, which can be done either through the natural birth canal or through a cesarean section.

Eclampsia and preeclampsia - principles of treatment

Currently, there is only symptomatic treatment for preeclampsia and eclampsia, which consists of two components:
1. Anticonvulsant therapy (prevention or relief of seizures due to eclampsia);
2. Antihypertensive therapy – reducing and maintaining blood pressure within normal limits.

It has been proven that only antihypertensive and anticonvulsant therapy is effective for the survival and successful development of the fetus and woman. The use of antioxidants, diuretics to eliminate edema and other treatment options for preeclampsia and eclampsia are ineffective, do not benefit either the fetus or the woman and do not improve their condition. Therefore, today, for eclampsia and preeclampsia, only symptomatic therapy is carried out to prevent seizures and reduce blood pressure, which, in most cases, is effective.

However, symptomatic therapy for preeclampsia and eclampsia is not always effective. After all, the only remedy that can completely cure preeclampsia and eclampsia is getting rid of pregnancy, since it is carrying a child that causes these pathological syndromes. Therefore, if symptomatic hypotensive and anticonvulsant treatment is ineffective, emergency delivery is performed, which is necessary to save the life of the mother.

Anticonvulsant therapy

Anticonvulsant therapy for eclampsia and preeclampsia is carried out using intravenous administration of magnesium sulfate (magnesia). Magnesium therapy is divided into loading and maintenance doses. As a loading dose, a woman is given 20 ml of 25 magnesium solution (5 g in terms of dry matter) once intravenously over 10–15 minutes.

Then a magnesium solution in a maintenance dose of 1–2 g of dry matter per hour is administered continuously for 12–24 hours. To obtain magnesium in a maintenance dosage, it is necessary to combine 320 ml of physiological solution with 80 ml of 25% magnesium sulfate solution. Then the finished solution is injected at a rate of 11 drops per minute, which is equivalent to 1 g of dry matter per hour. If the solution is administered at a rate of 22 drops per hour, this will correspond to 2 g of dry matter per hour.

When continuously administering magnesium, monitor for symptoms of magnesium overdose, which include the following:

• Breathing less than 16 per minute;
• Decreased reflexes;
• Reducing the amount of urine less than 30 ml per hour.

If the described symptoms of magnesium overdose appear, you should stop the magnesium infusion and immediately administer an antidote intravenously - 10 ml of a 10% calcium gluconate solution.

Anticonvulsant therapy is administered periodically throughout pregnancy as long as preeclampsia or the risk of eclampsia persists. The frequency of magnesium therapy is determined by the obstetrician.

Antihypertensive therapy

Antihypertensive therapy for preeclampsia and eclampsia consists of bringing the pressure to 130 – 140/90 – 95 mm Hg. Art. and keeping it within specified limits. Currently, for eclampsia or preeclampsia in pregnant women, the following antihypertensive drugs are used to reduce blood pressure:

• Nifedipine– take 10 mg (0.5 tablets) once, then after 30 minutes another 10 mg. Then during the day, if necessary, you can take one tablet of Nifedipine. The maximum daily dose is 120 mg, which corresponds to 6 tablets;
• Sodium nitroprusside – administered intravenously slowly, the initial dosage is calculated from the ratio of 0.25 mcg per 1 kg of body weight per minute. If necessary, the dose can be increased by 0.5 mcg per 1 kg of weight every 5 minutes. The maximum dosage of Sodium nitroprusside is 5 mcg per 1 kg of body weight per minute. The drug is administered until normal pressure is achieved. The maximum duration of sodium nitroprusside infusion is 4 hours.

The above drugs are fast-acting and are used only for a one-time reduction in blood pressure. To subsequently maintain it within normal limits, drugs containing as an active substance methyldopa(for example, Dopegit, etc.). Methyldopa should be started at 250 mg (1 tablet) once a day. Every 2–3 days, the dosage should be increased by another 250 mg (1 tablet), bringing it to 0.5–2 g (2–4 tablets) per day. At a dosage of 0.5 - 2 g per day, methyldopa is taken throughout pregnancy until delivery.

If a sudden attack of hypertension occurs, the pressure is normalized with Nifedipine or Sodium nitroprusside, after which the woman is again transferred to methyldopa.

After childbirth, it is necessary to carry out magnesium therapy for 24 hours, consisting of loading and maintenance dosages. Antihypertensive drugs after childbirth are used on an individual basis, gradually being discontinued.

Rules of delivery for eclampsia and preeclampsia

In case of eclampsia, regardless of the duration of pregnancy, delivery is carried out within 3 to 12 hours after the seizures have stopped.

For mild preeclampsia, delivery is performed at 37 weeks of pregnancy.

In case of severe preeclampsia, regardless of the stage of pregnancy, delivery is carried out within 12 to 24 hours.

Neither eclampsia nor preeclampsia are absolute indications for cesarean section; moreover, vaginal delivery is preferable. Delivery by cesarean section is performed only in case of placental abruption or unsuccessful attempts to induce labor. In all other cases, women with preeclampsia or eclampsia undergo vaginal delivery. In this case, they do not wait for the natural onset of labor, but carry out its induction (labor induction). Childbirth with eclampsia or preeclampsia must be carried out with the use of epidural anesthesia and against the background of careful monitoring of the fetal heartbeat using CTG.

Complications of eclampsia

An attack of eclampsia can provoke the following complications:

• Pulmonary edema;
• Aspiration pneumonia;
• Brain hemorrhage (stroke) followed by hemiplegia or paralysis;
• Retinal detachment followed by temporary blindness. Vision is usually restored within a week;
• Psychosis, lasting from 2 weeks to 2 – 3 months;
• Coma;
• Brain swelling;
• Sudden death due to strangulation of the brain due to its swelling.

Prevention of eclampsia and preeclampsia

Currently, the effectiveness of the following drugs for the prevention of eclampsia and preeclampsia has been proven:

• Taking small doses of Aspirin (75 – 120 mg per day) from the beginning to the 20th week of pregnancy;
• Taking calcium supplements (for example, calcium gluconate, calcium glycerophosphate, etc.) at a dosage of 1 g per day throughout pregnancy.

Aspirin and calcium for the prevention of eclampsia and preeclampsia should be taken by women who have risk factors for the development of these pathological conditions. Women who are not at risk of developing eclampsia or preeclampsia can also take Aspirin and calcium as preventatives.

Preeclampsia and eclampsia are severe stages of gestosis and represent a serious complication of pregnancy. According to statistics, the percentage of preeclampsia is 5-10%, and eclampsia 0.5% among the total number of women in labor, pregnant women and postpartum women.

Preeclampsia is a preconvulsive condition that is characterized by a significant rise in blood pressure, high protein content in the urine and severe edema (not the main prognostic sign).

Eclampsia is a seizure that either resolves or progresses to a coma.

Kinds

Preeclampsia and eclampsia are classified according to the period associated with pregnancy:

• preeclampsia and eclampsia in pregnancy;
• preeclampsia and eclampsia of the mother;
• preeclampsia and eclampsia of the postpartum mother.

Preeclampsia has 2 degrees of severity: moderate and severe.

Eclampsia, depending on the prevailing manifestations, is divided into cerebral, comatose, hepatic and renal.

Causes

The causes of preeclampsia and eclampsia have not yet been precisely established. There are 30 or more theories that explain the causes and mechanisms of development of preeclampsia and eclampsia. But the general opinion of all doctors is that there is a pathology of the placenta, the formation of which is disrupted in the early stages of pregnancy.

If the placental attachment is disrupted (superficially implanted placenta) or there is a deficiency of receptors for placental proteins, the placenta begins to synthesize substances that cause vasoconstriction (vasoconstrictors), which leads to a generalized spasm of all blood vessels in the body to increase pressure in them and increase the supply of oxygen and nutrients substances to the fetus. This leads to arterial hypertension and multiple organ damage (primarily the brain, liver, and kidneys are affected).

Heredity and chronic diseases play an important role in the development of preeclampsia and eclampsia.

Symptoms of eclampsia and preeclampsia

Signs of preeclampsia

Preeclampsia is just a short interval between nephropathy and a seizure. Preeclampsia is a dysfunction of the vital organs of the body, the leading syndrome of which is damage to the central nervous system:

• the appearance of spots before the eyes, flickering, blurriness of objects;
• tinnitus, headache, feeling of heaviness in the back of the head;
• nasal congestion;
• memory disorders, drowsiness or insomnia, irritability or apathy.

Preeclampsia is also characterized by pain in the upper abdomen (“in the pit of the stomach”), in the right hypochondrium, nausea, and vomiting.

An unfavorable prognostic sign is increased tendon reflexes (this symptom indicates convulsive readiness and a high probability of developing eclampsia).

With preeclampsia, swelling increases, sometimes for several hours, but the severity of edema does not matter in assessing the severity of the pregnant woman’s condition. The severity of preeclampsia is determined based on complaints, proteinuria and arterial hypertension (an increase in blood pressure for normotensive patients above 140/90 mm Hg should be alarming). If arterial hypertension is 160/110 or more, they speak of severe preeclampsia.

Kidney damage manifests itself in the form of a decrease in the amount of urine excreted (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:

• First phase. The duration of the first (introductory) phase is 30 seconds. At this stage, small contractions of the facial muscles appear.
• Second phase. Tonic cramps are a generalized spasm of all muscles of the body, including the respiratory muscles. The second phase lasts 10-20 seconds and is the most dangerous (the woman may die).
• Third phase. The third phase is the stage of clonic seizures. The motionless and tense patient (“like a string”) begins to beat in a convulsive seizure. The convulsions go from top to bottom. The woman is without a pulse or breathing. The third stage lasts 30-90 seconds and is resolved with a deep breath. Then breathing becomes rare and deep.
• Fourth phase. The seizure resolves. Characteristic is the release of foam mixed with blood from the mouth, a pulse appears, the face loses its cyanosis, returning to normal color. The patient either regains consciousness or falls into a coma.

Diagnostics

Differential diagnosis of preeclampsia and eclampsia must first be carried out with an epileptic seizure (“aura” before the attack, convulsions). Also, these complications should be distinguished from uremia and brain diseases (meningitis, encephalitis, hemorrhages, neoplasms).

The diagnosis of preeclampsia and eclampsia is established based on a combination of instrumental and laboratory data:

• Blood pressure measurement. Increasing blood pressure to 140/90 and maintaining these numbers for 6 hours, increasing systolic pressure by 30 units and diastolic by 15.
• Proteinuria. Detection of 3 or more grams of protein in the daily amount of urine.
• Blood chemistry. An increase in nitrogen, creatinine, urea (kidney damage), an increase in bilirubin (decomposition of red blood cells and liver damage), an increase in liver enzymes (AST, ALT) - impaired liver function.
• General blood analysis. An increase in hemoglobin (a decrease in the volume of fluid in the vascular bed, that is, blood thickening), an increase in hematocrit (viscous, “stringent” blood), a decrease in platelets.
• General urine analysis . Detection of protein in urine in large quantities (normally absent), detection of albumin (severe preeclampsia).

Treatment of eclampsia and preeclampsia

A patient with preeclampsia and eclampsia must be hospitalized in a hospital. Treatment should be started immediately, on the spot (in the emergency room, at home in case of calling an ambulance, in the department).

An obstetrician-gynecologist and a resuscitator are involved in the treatment of these pregnancy complications. The woman is hospitalized in the intensive care ward, where a therapeutic-protective syndrome is created (a sharp sound, light, touch can provoke a convulsive attack). Additionally, sedatives are prescribed.

The gold standard for treating these forms of gestosis is the intravenous administration of a solution of magnesium sulfate (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 diphenhydramine and promedol.

At the same time, the volume of circulating blood is replenished (intravenous infusions of colloids, blood products and saline solutions: plasma, rheopolyglucin, infucol, glucose solution, isotonic solution, etc.).

Blood pressure is controlled by prescribing antihypertensive drugs (clonidine, dopegit, corinfar, atenolol).

During pregnancy up to 34 weeks, therapy aimed at maturing the fetal lungs (corticosteroids) is carried out.

Emergency delivery is indicated in the absence of a positive effect from therapy within 2-4 hours, with the development of eclampsia and its complications, with placental abruption or suspicion of it, with acute oxygen deficiency (hypoxia) of the fetus.

First aid for an attack of eclampsia:

Turn the woman on her left side (to prevent aspiration of the respiratory tract), create conditions that reduce trauma to the patient, do not use physical force to stop convulsions, and after an attack, clear the oral cavity of vomit, blood and mucus. Call an ambulance.

Medication relief of an attack of eclampsia:

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 coma, the trachea is intubated with further mechanical ventilation.

Complications and prognosis

The prognosis after an attack (coma) of eclampsia and preeclampsia depends on the severity of the patient’s condition, the presence of extragenital diseases, age and complications.

Complications:

• placental abruption;
• acute intrauterine fetal hypoxia;
• hemorrhages in the brain (paresis, paralysis);
• acute liver and kidney failure;
• HELLP syndrome (hemolysis, increased liver enzymes, decreased platelets);
• pulmonary edema, cerebral edema;
• heart failure;
• coma;
• death of a woman and/or fetus.

Some studies during pregnancy

Immediate action - first aid for eclampsia - must be carried out clearly and consistently to prevent irreversible consequences of the pathology. Eclampsia is a complication of the last months of pregnancy with severe toxic manifestations. Health problems manifest themselves in the form of increased blood pressure, convulsive seizures, and coma. It can occur before, during and in the first days after childbirth. First aid is based on symptom relief.

Causes and symptoms of pathology

The main causes of eclampsia include existing pathologies of the cardiovascular system associated with increased blood pressure and kidney disease. Risk factors that increase the possibility of complications:

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• age of the first pregnant woman before 20 and after 35 years;
• general diseases: arterial hypertension, diabetes mellitus, systemic lupus erythematosus, rheumatoid arthritis, colitis, gastritis;
• conditions of preeclampsia and eclampsia in close relatives;
• multiple pregnancy;

The course of pregnancy is influenced by a woman’s compliance with medical prescriptions. The basic rules are developing the correct daily routine, balanced nutrition, being in the fresh air, maintaining a stable psycho-emotional background and giving up bad habits. Violation of norms increases the risk of complications of toxicosis.

Before an attack of eclampsia, preeclampsia occurs. appear:

• nausea, vomiting, stomach pain;
• headaches;
• the appearance of swelling of the body;
• beginning visual disturbances;
• coordination disorders;
• increased excitability.

At the first symptoms of eclampsia, you need to consult a doctor, as this threatens the life of the child and mother.

An attack of eclampsia is accompanied by:

• increased blood pressure;
• dizziness;
• increased temperature;
• spasms of the facial muscles;
• increased coordination and visual impairment;
• convulsions, cramps, numbness of the limbs;
• increased nausea, vomiting and foaming at the mouth;
• loss of consciousness.

With pathology, disorders of the entire body occur. The central nervous system is characterized by increased excitability, which can provoke seizures. To remove possible irritants, it is necessary to avoid bright light, pain, sharp and loud sounds, and nervous shock.

Stages and forms of eclampsia

In the development of an attack of eclampsia in pregnant women, four stages are distinguished, which are characterized by a gradual increase in symptoms and manifestations, followed by their decrease and restoration of the body’s vital functions. A description of the development of eclampsia is presented in the table:

Stage	Duration	Characteristic
Preconvulsant	20-30 seconds	Small contractions of the facial muscles, drooping of the corners of the mouth, rolling of the eyes.
				Tonic convulsions	10-30 seconds	Tension, contraction, spasm of body muscles. Difficulty, cessation of breathing. Bluishness of the face.
Clonic seizures	20-90 seconds	Severe cramps of the whole body. Lack of breathing, pulse.
				Seizure resolution	–	The appearance of hoarse breathing, pulse, foam mixed with blood from the mouth. The face returns to normal color. Gaining consciousness or falling into a coma.

Forms of manifestation and clinical signs are presented in the table:

Severe eclampsia can be fatal.

The severity of seizures is determined by their duration, number, time intervals between them and the patient’s well-being. If a woman does not regain consciousness for a long time, damage to vital organs, especially the brain, is possible, followed by death for the pregnant woman and the fetus.

Complications of the pathology are manifested by the following disorders:

• pneumonia, pulmonary edema;
• deterioration of brain activity;
• renal failure;
• suffocation;
• premature placental abruption;
• hypoxia, fetal death;
• cerebral hemorrhage, cerebral edema.

Algorithm of actions for symptoms of pathology

Emergency assistance must be provided strictly in a certain order. Since the pathology gives serious complications and poses a threat to the mother and fetus, at the first signs of seizures, call an ambulance. Before doctors arrive, you must:

1. Place the patient on a pillow with her left side and cover her with blankets.
2. Open your mouth and fix the position of your tongue, preventing it from swallowing and choking.
3. Wipe your mouth to remove vomit, foam and mucus.
4. If necessary, perform a heart massage.

The main focus in treating the disease is to eliminate seizures.

Next, the patient is transported to the intensive care unit. The room should be soundproof, with darkened windows and dim lighting. Diagnostic measures are carried out under anesthesia to eliminate additional irritating factors. Ensuring the vital functions of the body during convulsive seizures is ensured by the following resuscitation measures:

• artificial ventilation to maintain breathing;
• administration of intravenous diuretics;
• catheterization of the bladder to ensure the excretory functions of the body;
• intravenous administration of glucose to lower intracranial pressure and stabilize cardiac activity;
• drip or intravenous administration of drugs to improve the activity of the hematopoietic system;
• the use of sedatives to relieve stimulation of the central nervous system.

Emergency care for pathology is aimed at maintaining the functioning of all organs and systems of the body, especially the kidneys, liver, heart and brain. When providing first aid, the following indicators are constantly monitored:

• blood pressure;
• heart rate;
• completeness of breathing;
• functioning of the urinary system.

From the earliest stages of pregnancy, a special system of interaction between the mother’s body and the fetus is formed. In gynecology, it is called the “mother-placenta-fetus system.” Thanks to it, the woman’s body does not reject the embryo, but on the contrary: it contributes to its preservation and development.

However, some pregnant women may experience a disruption in the functioning of this system, which leads to eclampsia, a condition in which there is dysfunction of the mother’s vital organs, which poses a direct threat to both the life of the woman and the life of the fetus.

To date, there is no consensus on why this disease begins, but it is reliably known that its appearance is typical only for pregnant women, women in labor and postpartum women. In obstetric practice, two conditions of late gestosis are distinguished: preeclampsia and eclampsia, but what is it in simple terms?

Preeclampsia– this is a condition in which damage to the nervous system, liver, kidneys occurs, and arterial hypertension develops.

is a condition that requires emergency hospitalization; it can develop in patients with preeclampsia, and also exist as an independent form of a serious disease.

Causes of eclampsia in pregnant women

Since eclampsia is a dysfunction of the “mother-placenta-fetus” system, the causes are diseases that the woman already had before conceiving the child. During pregnancy, these pathologies can be a trigger for the onset of severe gestosis. Among the causes of eclampsia are the following:

1. Fetoplacental insufficiency (FPI) is a condition in which the blood flow of the placenta begins to function poorly. Only a doctor can assess the condition of the arteries using a Doppler examination.
2. Thrombophilia is a genetic disease that involves a special mutation of genes that provoke thrombus formation. During pregnancy, thrombophilia becomes active and in later stages is the cause of the development of FPN.
3. Mutations of the eNOS gene affect the functioning of blood vessels. If there is a genetic defect, a woman’s body may perceive the fetus as a foreign body and try to get rid of it.
4. Defects in the attachment of the placenta to the walls of the uterus cause deterioration in fetal nutrition and provoke the appearance of FPN. With this pathology, blood flow disturbances can develop either gradually or suddenly.

In addition to the causes, there are risk factors for eclampsia and preeclampsia. At the very beginning of pregnancy, when registering, the gynecologist should pay attention to their presence and prescribe the patient appropriate therapy so that risk factors do not provoke the onset of severe gestosis.

• Chronic hypertension;
• Multiple pregnancy;
• Presence of eclampsia or preeclampsia in obstetric history;
• The presence of eclampsia or preeclampsia in the obstetric history of the mother, grandmother, aunt or sister;
• Old-time women (over 40 years of age at the time of pregnancy).

Particularly close attention to the patient’s condition should be paid if one or more risk factors for the development of gestosis are combined with the fact that the woman is carrying her first pregnancy.

Types of disease

In general, eclampsia can be divided into two types: according to the severity of the disease and the time of its onset. Depending on this, the treatment regimen will be determined and the risk to the health of the mother and fetus will be assessed.

The Russian classification of the stages of development of gestosis is somewhat different from that adopted in European countries. According to domestic experts, preeclampsia is the initial stage of eclampsia.

Severity of the disease

• Mild preeclampsia – involves blood pressure in the range of 140 – 170/90 – 110 mm Hg. Art. In this case, proteinuria (more than 0.3 g/l) will be determined in a urine test.
• Severe preeclampsia - involves blood pressure above the limit of 170/110 mmHg. Art. Proteinuria is pronounced.

Time of onset of illness

• Eclampsia during pregnancy is the most common and poses a threat to the life of mother and child. Treatment is complicated by the fact that the fetus may not tolerate certain medications to relieve attacks.
• Eclampsia during childbirth - occurs in approximately 20% of all cases and poses a threat to the life of the woman and child. In this case, the provocateur of the attacks is labor.
• Eclampsia after childbirth occurs very rarely and develops within 24 hours after the baby is born.

Signs of eclampsia and symptoms

Despite the variety of species, the signs of eclampsia have a certain similarity, so they can be divided into a general list:

• Increased blood pressure - depending on the level to which it has increased, the doctor will determine the severity of the disease.
• Edema - the more severe the patient’s condition, the stronger the fluid retention in her body. The swelling is mainly in the upper body (face, arms).
• A series of convulsive seizures are numerous, lasting 1-2 minutes. The intervals between seizures are small. Loss of consciousness is short-term.
• Eclamptic status is a series of convulsive seizures in which the patient is in a coma and does not regain consciousness.

Characteristics of a seizure

The attack begins with involuntary contractions of the facial muscles. After a short period of time, the entire musculature of the body is involved in the process. The woman loses consciousness and limb clonus appears. After a series of clonus, coma occurs.

Diagnostics

Making a diagnosis is complicated by the fact that eclampsia does not have specific symptoms that would correspond only to it. Cramps, edema and proteinuria may be symptoms of other diseases that have nothing to do with gestosis.

Currently, the problem of determining eclampsia is being actively studied, and to make a diagnosis, doctors use special examinations and tests that reveal the initial stage of the disease - preeclampsia:

• Systematic blood pressure measurement. Moreover, to confirm eclampsia, it is necessary to monitor the state of blood pressure over time.
• Urine analysis to determine the amount of protein. The daily test () is important here.

If the indicators indicate the presence of preeclampsia, then subsequent convulsive seizures will indicate that the pathological processes in the woman’s body have entered the most severe stage of their development - eclampsia.

Since severe degrees of gestosis suggest the presence of convulsive seizures, self-medication must be completely avoided. First aid for eclampsia will consist of the following:

1. Call an ambulance (most likely they will send an ambulance).
2. Lay the woman on her left side and build rolls of blankets around her. This precaution will help the patient avoid injury until doctors arrive. In addition, this position will ensure the free flow of foam released during an attack.
3. Fix the tongue to prevent it from falling into the pharyngeal cavity.
4. In between attacks, remove vomit and foam from the mouth.

A repeated series of seizures can be stopped by intravenous administration of magnesium (20 ml of a 25% solution over 30 minutes).

It is important to remember - in emergency cases, you can call 03 and ask the doctor on duty to give you instructions on the actions that need to be taken while the ambulance team is on the way.

Treatment of eclampsia in pregnant women

Therapy for severe gestosis consists of two stages. First you need to stop the seizures, and then lower your blood pressure. At the same time, it is necessary to eliminate swelling in order to alleviate the woman’s condition.

However, this is only an auxiliary measure in the treatment of eclampsia. The main actions should be normalization of blood pressure and anticonvulsant therapy. It is important to adhere to a certain sequence in prescribing treatment.

Thus, reducing blood pressure without eliminating seizures will not give the expected effect and will generally be difficult, since a pregnant woman will not be able to take pills or medicine due to the high muscle tone that occurs during seizures.

Anticonvulsant therapy

All medications intended to relieve seizures can be divided into three categories:

1. Drugs intended for emergency use: 25% magnesia solution, Droperidol, Diazepam.
2. Drugs intended for maintenance therapy: 25% magnesium solution at a dosage of 2 g per hour, Fulsed, Seduxen, Andaxin.
3. Drugs that enhance the sedative effect: Diphenhydramine, Glycine.

The dosage must be prescribed by a doctor. All anticonvulsants tend to significantly relax muscles and cause excessive drowsiness. If attacks of eclampsia were stopped and delivery did not take place, then therapy should be repeated throughout the entire pregnancy to avoid new manifestations of gestosis.

Antihypertensive therapy

It is carried out after stopping the seizures. It is important not just to reduce high blood pressure one-time, but also to keep it within normal limits - this can be difficult if, with eclampsia, a decision was made not to do an emergency delivery.

• Drugs intended for emergency use: Nifediline, Sodium nitroprusside (intravenously, maximum - 5 mcg per 1 kg of body weight per minute.)
• Drugs intended for maintenance therapy: Methyldopa.

Anti-high blood pressure medications should be taken until the end of pregnancy to prevent attacks from recurring. Antihypertensive therapy should be carried out primarily only if the patient is at risk of cerebral hemorrhage.

In severe cases of eclampsia, delivery is indicated as treatment, regardless of the gestational age and condition of the fetus. In this case, the mother’s life is at stake, so all possible measures must be taken to save her. However, when organizing childbirth, the following conditions must be met:

• Convulsions must be stopped. Delivery procedures should begin only a few hours after the attack has stopped.
• If possible, childbirth should be done through natural means. Caesarean section involves general anesthesia, which can provoke a new wave of seizures after recovery from anesthesia.
• Labor must be stimulated artificially. It is important to meet the period when the attack has subsided - when it resumes, the muscles of the whole body will become toned again and the birth of a child will become difficult.

Prevention

Preventive measures to prevent eclampsia are prescribed either to those patients who have a history of this condition during previous pregnancies, or to those who have already had attacks and there is a need to prevent new ones.

The gynecologist may prescribe calcium supplements or aspirin. Depending on the condition of the woman and the fetus, these drugs are prescribed for the entire term, or for a certain period of time, until the doctor is convinced that the patient is out of danger.

Treatment of eclampsia in a pregnant woman requires the immediate intervention of a specialist, so all actions of her relatives should be limited to providing first aid until the medical team arrives.