ECLAMPSIA in Sudan

Geneva Foundation for Medical Education and Research

GFMER Sudan 2012Forum No: ( 1 )

Name of presenterName Position Institution

Dr/ SAMI MAHMOUD Obstetrician/Gynecologist Reproductive Health Care Centre

Name Position Institution

Dr/ MAJDI SABAHELZAIN Pharmacist/ MSc. Public and Tropical Health

University of Medical Sciences and Technology

Name of contributors

Content of the presentation

• Definition of Pre-eclampsia• Diagnosis of Pre-eclampsia• Importance of Pre-eclampsia• Risk Factors for Pre-eclampsia• Incidence in Sudan• Management and Prevention of Pre-eclampsia

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Definition

Appearance of seizures in a patient (often with pre-existing pre-eclampsia)

In 20%, BP can be normalCan occur before, during or after delivery

1/3 are post-delivery

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Diagnosis

. Classic Triad:-hypertension (>140/90)-proteinuria (>1+ or >0.3g/24hours)-generalized oedema (least reliable)

. Hypertension and proteinuria must be present on two occasions.

.Rapid weight gain is supportive evidence

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.Second cause of Maternal Mortality in Sudan.

.A cause of perinatal morbidity & Mortality.

.Risk of CVA

.Renal failure

.Risk of iatrogenic fluid overload.

.HELLP Syndrome

Importance

Main Causes of Maternal Mortality

Qualitative Research Techniques - The four parts of Qualitative Research Techniques are:

Unsafe Abortion

Infections

Pregnancy-Induced Hypertension

Haemourage:.

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Risk Factors for Pre-eclampsia

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. Nulliparity

. Maternal age <16 or >40yrs

. Multiple pregnancy

. Family history of pre-eclampsia or eclampsia

. Chronic (pre-existing) hypertension

.Chronic renal disease

.Antiphospholipid syndrome (APLS)

. Diabetes mellitus

Severe pre-eclampsia: symptoms & signs Severe pre-eclampsia: symptoms & signs Headaches

Visual Disturbances

Pulmonary Oedema

Hepatic Dysfunction

RUQ or Epigastric Pain

Thrombocytopaenia or haemolysis

Systolic BP > 160 to 180 mm HgDiastolic BP > 110 mm Hg

OliguriaElevated CreatinineProteinuria of 5 g or more in 24 hrs

Clinical Course of Neglected Severe Pre-eclampsiaClinical Course of Neglected Severe Pre-eclampsia

EyesArteriolar SpasmRetinal HaemorrhagePapilloedemaTransient Scotomata

Respiratory SystemPulmonary OedemaARDS

LiverSubcapsular HaemorrhageHepatic Rupture

Haematopoietic SystemHELLP SyndromeDIC

CNSSeizuresIntracranial HaemorrhageCVAEncephalopathy

PancreasIschaemic Pancreatitis

KidneysAcute Renal Failure

Uteroplacental CirculationIUGRAbruptionFetal CompromiseFetal Demise

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Aetiology

.Uncertain - cerebral oedema, ischaemia are possible causes.

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Incidence in Sudan.Distribution of maternal

death report according to cause of death (Jan 2010- Dec 2010)Cause of Maternal Death , No. 8891-Obstetric Haemorrhage 225 (25.1%)2-Eclampsia 134 (14.9%)

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Eclampsia EffectsMaternal death from

eclampsia in Sudan in 2010 affects 134 cases (14.9%),

. 71 case (53.0%) ante partum,

.48 cases (35.8%) post partum

. fifteen cases (11.2%) intrapartum.

Antepartum

postpart

um

Intrapart

um0%

10%

20%

30%

40%

50%

60%

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.(79.9%), the first fit started at home

. (16.4%) first fit occurred in hospital &

.(3.7%) on the way to hospital.

Fit Starting

At Home

In Hospita

l

Way

to Hosp

ital

0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

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Interval from first fit till death was:

. Less than two hours in

thirty cases (22.4%), . Two-six hours, 24 cases (17.9%),

. Seven- 24 hours, thirty cases (22.4%) &

. More than 24 hours in fifty cases (37.3%).

Interval from first fit till death

Less than 2 hours

2-6 hours

7-24 hours

More than 24

hours

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

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.Sixteen cases (11.9%) died at home, 118 cases reached hospital:

. Almost 52 cases (38.8%) had four or less fits before their death,

. 43 cases (32.1%) had five –ten fits & 39 cases (29.1%) had more than ten fits before they died

No. of Fits before Death

No. of Fits before Death

4 -5 Fits5 -10 FitsMore than 10

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common reported cause of maternal death.CVA was the common

reported cause of maternal death, 54 cases (40.3%), followed by

. acute pulmonary edema, 31 cases (23.1),

.acute renal failure, twenty two cases (16.4%),

.HELLP syndrome, fifteen cases (11.2%) & air way obstruction twelve cases (9.0%).

CVA

acute pulm

onary edema

acute re

nal fai

lure

HELLP sy

ndrome

air w

ay obstr

uction

05

1015202530354045

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. In 68 cases (57.6%) a consultant was involved in the management;

. while in fifty cases (42.4%) were managed by a junior.

.

Helth Professionals

consultants

Junior

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.Sixty three cases (53.4%) received anticonvulsant (diazepam or magnesium sulfate),

. while fifty five cases (46.6%) did not received any anticonvulsant

Receiving treatment

Receiving treatment

Received Not re-ceived

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Management

1. CALL FOR HELP +++++2. EMPHASISE IMPORTANCE OF BASIC

ABCs 3. ‘A’ – airway can’t be inserted during a fit 4. ‘C’ – includes x2 large bore cannulae5. Initiate unit – ‘Eclampsia protocol’6. DO NOT NURSE IN THE DARK!!7. Give loading dose MgSO4 8. Foley catheter/fluid balance 9. Keep NBM

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Management

• Antihypertensive ( Labetalol , Hydralazine , Methyl Dopa & Nifedipine)

• Magnesium sulphate

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Prevention

• Reducing maternal death from Eclampsia:-

• Availing of magnesium sulfate.• Availing of Hydralazine.• Training of care providers on

magnesium sulfate use & monitoring side effects.

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