Obstetrics and Gynecology - A.M. Hromova 2000

Early pregnancy toxicoses. Late gestosis
Late gestosis
Management of eclampsia

The Treatment of Eclampsia must begin immediately at the scene of the seizure. Transporting patients with seizure susceptibility is permissible only after a preliminary neuroleptic response has been achieved in the patient via intravenous administration of diazepam (10 mg), diprazine (25 mg), corglycon (1 ml of a 0.06% solution in 20 ml of 40% glucose), and magnesium sulfate (20 ml of a 25% solution intramuscularly). All manipulations and examinations must be performed under general anesthesia or sedation (halothane, nitrous oxide with oxygen in a 2:1 ratio, hexenal, sodium thiopental). In the hospital department, the patient is placed in a separate darkened room or in the intensive care unit. Continuous patient monitoring is mandatory. Essential Procedures include the cannulation of major Veins, Urinary Bladder catheterization to monitor diuresis, and, if necessary, gastric aspiration via a tube to prevent regurgitation.

In the event of a seizure:

1. The patient is placed on a flat surface, avoiding injury, and her HEAD is turned to the side. While securing the patient, the Airways are quickly cleared by gently opening the Mouth using a Tongue depressor and aspirating the Contents of the Upper Respiratory Tract.

2. Upon restoration of spontaneous breathing after the attack, oxygen is administered. In the event of prolonged apnea, assisted ventilation is initiated immediately.

3. If cardiac arrest occurs, closed-chest cardiac massage is performed concurrently with Artificial ventilation, along with all standard Methods of cardiopulmonary resuscitation.

4. To stop seizures, the drug of choice is magnesium sulfate (20 ml of a 25% solution intravenously), which exerts anticonvulsant and sedative effects, as well as diuretic and hypotensive actions. In addition to magnesium sulfate, sibazone is used at a dose of 0.02 g, with a repeat dose of 0.01 g administered 10 minutes later. Neuroleptanalgesia (droperidol from 0.1 to 0.3 g and fentanyl) can be utilized as part of the complex anticonvulsant therapy. Barbiturates are used for therapeutic anesthesia at a dose of 0.2–0.3 g as a last resort to control eclamptic seizures prior to the administration of Muscle relaxants. If cerebral edema and persistent intracranial Hypertension develop, lumbar puncture and craniocerebral hypothermia are indicated. Comprehensive medical treatment is carried out for 3–6 hours, similar to the management of grade III nephropathy, aimed at stabilizing the pregnant woman's condition and preparing her for urgent delivery.