Book of Medical Disorders in Pregnancy - Tintash

women may have to work under the
scorching sun in certain countries with
very hot climate and they may be
brought to hospital in coma. Therapy is
directed at eclampsia but the above
should be excluded before a firm
diagnosis is made.
Treatment - This primarily depends on
the frequency and number of fits the
woman had. Fetal maturity and wellbeing
plays a secondary and minor role
in deciding about the time and mode of
therapy. When the patient is having fits
or had multiple fits, then active intervention
is required on emergency basis,
irrespective of fetal maturity. In our unit,
the patient is admitted to the eclampsia
room, which is located at a fairly quiet
corner in the ward and equipped with
suction apparatus, oxygen cylinder, nasal
tubing, face mask, respirator, mouth gag
and tongue depressor, oximeter and
cardiac monitor. A trolley containing all
life saving emergency drugs is also
available at the bed side of the patient.
At the time of admission, a complete and
detailed history is taken. A thorough
general physical, systemic and obstetrical
examination is rapidly completed.
Vital signs which include pulse,
temperature, respiratory rate, blood
pressure and joint reflexes are recorded
at regular intervals. Level of consciousness
is assessed by response of the
patient to the examiner's questions, brisk
and sluggishness of reflexes and reaction
of pupils to light. Fetal heart rate and
regularity is established. An intravenous
line is started with five per cent dextrose
solution and blood is drawn for studies
such as grouping, cross matching,
hemoglobin, hematocrit, sugar and
electrolytes including blood urea and
serum creatinine. Indwelling Foley's
catheter is passed into the bladder and
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complete accountancy of intake and
output is maintained. Urine is analyzed
for albumen, sugar, ketone, red cells and
casts.
Therapy for control of convulsion-
One hundred mg of pethidine are given
intravenously as a stat dose; this is
followed by phenobarbitone, 90 to 120
mg given by intramuscular route, every
4 to 6 hours depending upon the level of
consciousness of the patient, her reflexes,
respiratory rate, and urinary
output. If the convulsions are not
controlled with this regime within 6 to 8
hours then 2 gram of magnesium
sulphate is injected in each buttock by
deep intramuscular route, while 10
grams are added in 1000 ml .of 5 per
cent dextrose in water and given slowly
by intravenous route. The rate of
administration is controlled by its effect
on reflexes and respiratory rate which is
never allowed to go below 12 per
minutes.
Paraldehyde: This drug can be used as
an alternative to the above regime 10 ml
of paraldehyde are mixed in one ounce
of olive oil and given rectaly. The
patient is strictly observed for depression
of respiration. As soon as the
convulsions are controlled, the
membranes are ruptured and Syntocinon
drip started to induce the labor.
However, if convulsions are not
controlled within 12 hours, induction is
carried out irrespective of fetal maturity.
In most cases, delivery is com-pleted
rapidly. However, in some cases
Cesarean Section may have to be performed,
especially when labor fails to
proceed after rupturing of the membranes.
The patient is carefully observed
and her vital signs monitored in the