My first (and hopefully last) eclampsia patient

TMPaul · May 10, 2005

Im a nursing student, and currently in ob/gyn rotation. When doing pre-rounds at the maternety observation ward today I heard one of the midwifes on the ward cry out for help, and rushed to see what was going on. The patient she was with had all the signs of eclampsia, generous amounts of foam in/around the mouth, tonic-clonic seizure activity, the whole cahuna. Patient was sendt to the OR, sedated and ventilated, and then prepped for a c-section.
When trying to read up on the subject afterwards, I can find little or no explanation in regards to the patho-physiologicals in eclampsia. Anyone got a clue? Feel free to enlighten me, as I find this subject somewhat interesting (and even more terrifying). Thanks in advance :) ,
Beo

I think even more terrifying for the patient (who happens to be a NP) - ME ! Yup, with my first child but not so for numbers 2 and 3. Luckily, I stopped at full blown seizures and intubation. Was on bed rest (in the hospital), lights out, No salt diet, and MgSo4 IV for about 2 1/2 weeks.

Baby is now 14 and thankfully never had to relive that experience. :)

Tina, RN,MSN,APRN-BC

beochicken · May 10, 2005

Just one little question: do you have any recognition of the seizures? Most books and articles i have read states that pts are usually not concious during eclampsia seizures. But then, the books may not be right.

Edit: And did they do an emergency c-section after they managed to control the seizures?

TMPaul · May 10, 2005

Just one little question: do you have any recognition of the seizures? Most books and articles i have read states that pts are usually not concious during eclampsia seizures. But then, the books may not be right.
Edit: And did they do an emergency c-section after they managed to control the seizures?

No. I do recall feeling "funny", sort of like I was floating and everything was buzzing around me and my vision was fuzzy just before I went out.

Yup, emergency C-Section with a neonatologist standing by in the delivery room.

beochicken · May 10, 2005

Thanks for the information, good to hear that you and your kid didnt suffer any long time consequences.

FrumDoula · May 11, 2005

From what I understand, eclampsia is one of those conditions that researchers are forver trying to understand.

Apparently, there was a doctor named Thomas Brewer who was able to prevent pre-eclampsia from taking ahold of his high risk patients through the use of high protein diets (it's now the diet emphasized through the Bradley Method). 80-100 g of protein a day. By emphasizing good nutrition, he was able to produce amazing results. He refused to have his methods studied in double blind studies, however, because he felt it would be unethical to the women in the control group.

There are midwives and some physicians who have controlled signs of pre-eclampsia by raising protein levels in their patients. It can be an effective first step, especially because nutrition is a heck of a lot more pleasant than the side effects of Mag, which I've heard are awful. And bed rest is no picnic, either.

I'm wondering why you were put on a low salt diet, though? I remember reading that it's important for pregnant women to salt their food to taste.

His site is http://www.blueribbonbaby.org I do wish he had cited some studies to back up his claims, but his emphasis on whole foods and sound nutrition are certainly worthwhile. And the results in his own clinic were amazing.

Alison

Marijke · Jun 5, 2005

The true cause of eclampsia and pre eclampsia is unknown at this point (as far as I am aware). The only cure at present time is delivery of the baby. Early warning signs are: high bloodpressure and spilling of protein in urine. As symptoms get worse, the mom can get a really bad headache, bloodpressure increases further, changes in blood values (increased liver enzymes, reduced platelets), epigastric pain (often described as really bad heartburn), reflexes are hyperactive. As things get really out of control, several things can happen, including seizures, fetal demise, HELLP syndrome ( this stands for:Hemolysis, Elevated Liver enzymes, Low Platelets), shut down of kidneys and ruptured liver.

There are several actions that can be taken to prevent things from going very wrong:

bedrest

infusion with magnesium sulfate (this helps prevent seizures)

if there is a risk of seizures, reduce stimuli (low light, no noise)

careful observation of signs and symptoms

delivery of baby, as soon as baby has a chance to survive

delivery of baby when mom's life is at risk (even if baby can not survive)

These last two are very tricky, baby is not getting very good perfusion from the placenta when moms BP is very high, and if mom has a seizure, blood supply can be totally gone. If mom gets HELLP syndrome, she can bleed to death.

After delivery, mom still needs close watching for a while, it takes some time for the body to go back to normal. There is still some risk for HELLP and seizures, but usually she starts to improve within 48 hours.

The whole thing can be very scary, good prenatal care very often prevents the seizures from happening. However if you remain in the field of obstetrics, you will see eclampsia again. It is just good to know the signs and symptoms, so you might be able to prevent the worst from happening. Nurses have a very big role in this.

I am sure this story is not complete, the obstetrical textbooks will provide you with a lot of info.

Marijke :rolleyes: