eclampsia
Introduction
Introduction to eclampsia Eclampsia is a convulsion that cannot be explained by other causes on the basis of pre-eclampsia. It is one of the five conditions of hypertensive disorder complicating pregnancy, and it can also be an urgent serious complication of pre-eclampsia. Eclampsia can occur at different times before, during, and after childbirth. Atypical epilepsy can also occur before 20 weeks of gestation. Eclampsia remains a common disease worldwide that poses a threat to maternal life. In developed countries, the incidence of eclampsia is approximately 1 in 2000 births; the mortality rate of eclampsia patients is about 1%. Appears in the third trimester of pregnancy or after labor or after new birth, dizziness, headache, sudden fainting, two eyes, twitching, full body, shortness, wake up, relapse, and even unconscious illness, known as "eclampsia", also known as "pregnancy epilepsy." basic knowledge The proportion of illness: 0.003% Susceptible population: pregnant women Mode of infection: non-infectious Complications: Hypertension Diabetes Hypertensive encephalopathy Pregnancy-induced hypertension
Cause
Epilepsy etiology
More due to the weaker stomach of pregnant women, due to pregnancy and deficiency, resulting in insufficient blood, liver yang is prosperous, the upper jaw is suffering. Commonly there are kidney yin deficiency and liver dysfunction, symptoms such as dizziness, palpitations, nightingale dreams, elevated blood pressure.
Genetic factors (10%):
Preeclampsia is a multi-factor polygenic disease with a family genetic predisposition: mothers with pre-eclampsia have a pre-eclampsia incidence of 20-40%; women with pre-eclampsia have a pre-eclampsia prevalence 11-37%; the incidence of pre-eclampsia in women with pre-eclampsia in twins is 22-47%. But so far, its genetic model is still unclear.
Trophoblastic cell invasion abnormalities (25%):
May be an important factor in the pathogenesis of pre-eclampsia. The patient's trophoblasts invade the spiral arterioles, and the myometrial spiral arterioles do not recast. The abnormally narrow spiral artery reduces placental perfusion and hypoxia, which eventually leads to preeclampsia.
Abnormal immune regulation function (20%):
Maternal immunodeficiency or dysregulation of the maternal-derived placenta and fetal antigens is an important component of the preeclampsia etiology.
Endothelial damage (15%):
Oxidative stress, anti-angiogenic and metabolic factors, as well as other inflammatory mediators, can cause vascular endothelial damage leading to pre-eclampsia.
Nutritional factors (13%):
Lack of vitamin C increases the risk of pre-eclampsia-eclampsia.
Prevention
Prevention of eclampsia
Severe pre-eclampsia is a more serious type of pregnancy with hypertension. It is also a unique disease for pregnant women. The condition can be improved after termination of pregnancy, but it is available from prenatal, postpartum, postpartum 24 h to postnatal 5 days. The possibility of eclampsia, that is, convulsions, or coma. It will pose a serious threat to the health of mothers and children. Therefore, nurses should carefully observe the changes in the condition, especially the changes in blood pressure, pay attention to the patient's complaint, give psychological support to patients and their families, and care for human beings. Use drugs such as pain relief, blood pressure reduction, diuresis, etc. according to the doctor's advice, and adjust the number of drops according to blood pressure. Pay attention to the adverse reactions of the drugs, especially the poisoning reaction, prepare the rescue drugs, articles and equipment, oxygen, etc., and notify the doctor and assist in handling the abnormalities. It is of great significance to reduce maternal and perinatal mortality, reduce maternal and child complications, and improve the quality of life of patients.
Complication
Eclampsia complications Complications hypertension, hypertension, hypertensive encephalopathy, pregnancy-induced hypertension
There is no history of chronic hypertension, nephropathy and diabetes in the past. There is no convulsion in the history of pregnancy. There are edema, hypertension and egg white in the third trimester. There are symptoms of pre-eclampsia, especially primipara, twin pregnancy and polyhydramnios. In other cases, the diagnosis of pre-eclampsia is generally not difficult to be sure. If the patient has already had seizures in the hospital, pay attention to the typical performance of eclampsia, and measure the blood pressure and body temperature, check the urine protein and kidney function, check the fundus, and diagnose the eclampsia. The main needs for differential diagnosis between patients with eclampsia are related to convulsions and coma, such as common epilepsy, encephalitis, cerebral hemorrhage, hypoglycemia, and rickets.
(1) Seizures: Patients with epilepsy have a history of seizures in the past. There are often auras before the attack. The episodes are short, followed by loss of consciousness, falling, and the whole body is 1 to 2 minutes. It can also bite the tongue and incontinence. However, most of them are awake immediately after convulsions, and even if there is a short coma or confusion, they can return to normal in a short time. No high blood pressure, edema and proteinuria. There is no change in the fundus at the fundus. The patient pays attention to the relevant medical history after convulsion and emergency treatment, checks the urine protein in time, and measures the blood pressure for rapid diagnosis.
(B) hypertensive encephalopathy and cerebral hemorrhage: patients should have a history of chronic hypertension before pregnancy, often without edema and proteinuria. Sudden coma, loss of consciousness, soft hemiplegia, positive pathological reflex, and asymmetry of pupil. When the cerebral hemorrhage has special changes in the cerebrospinal fluid, it can be diagnosed.
(3) Encephalitis: The onset of encephalitis is seasonal, and encephalitis B is seen in summer and autumn. Epidemic encephalitis is more common in spring. Although the onset is urgent, but there are fever, headache, neck discomfort, rapid high fever, nausea, vomiting, irritability, coma, can also occur convulsions, convulsions.
Symptom
Symptoms of eclampsia Common symptoms Symptoms of eclampsia Pregnancy symptoms, coma, coma, chest tightness, facial muscle spasm, dizziness, urine protein, abdominal pain
In the third trimester of pregnancy, in addition to symptoms of edema, high blood pressure and proteinuria, there are symptoms such as severe headache, dizziness, nausea and vomiting, right upper abdominal pain, chest tightness, blurred vision, golden eyes, anxiety, and irritability. Can be diagnosed as "pre-eclampsia", should be immediately admitted to hospital for treatment. In the event of convulsions and coma, which is diagnosed as "eclampsia", eclampsia can occur in pre-natal, postpartum or post-natal weeks, most of which occur before delivery.
Most of the eclampsia has symptoms of pre-eclampsia before convulsions, and some patients have no obvious pre-existing symptoms, sudden seizures or coma. The epileptic seizure begins at the face, the eyeball is fixed, the strabismus is on one side, the pupil is enlarged, and facial muscle spasms appear from the corner of the mouth. After a few seconds, the whole body muscle contracts, and the side is twisted, the arm is bent and the fist is rotated, and the leg rotates for about 10 The remaining seconds. The mandible and the eyelids are opened and closed. The upper and lower limbs of the whole body are rapidly and strongly convulsed, and the mouth is foamed. When the tongue is bitten, the mouth vomits. The conjunctiva was congested, and the face was purple and red, which lasted 1 to 2 minutes into a coma. There is often a snoring after a coma, and a small number of patients wake up immediately after convulsions, or stop convulsions for a while. After pumping, blood pressure often rises, oliguria or no urine, and urine protein increases. After entering the coma, the body temperature rises and the breathing deepens. Falling ground and fractures may occur in convulsions. If vomiting occurs in a coma, it may cause asphyxia or aspiration pneumonia. There may also be placental abruption, liver rupture, intracranial hemorrhage, and childbirth.
Examine
Examination of eclampsia
Gynecological ultrasound examination.
1, blood, urine routine: due to blood concentration, blood cell volume and hemoglobin are often high, such as combined with anemia is normal and reduced. The platelet count is normal or reduced. Out, clotting time is normal or prolonged. The white blood cell count is high. Peripheral blood smears sometimes show irregular red blood cells or debris.
2, liver, kidney function and electrolyte examination : serum uric acid, creatinine, urea nitrogen can be elevated when the kidney function is damaged, carbon dioxide binding capacity decreased, indicating acidosis. Liver aminotransferase and bilirubin can be slightly elevated, indicating that hepatocyte damage may have pathological hemolysis. Blood sugar is often low when the liver is damaged. The ratio of white and globulin is often inverted, because a large amount of plasma protein leaks from the urine, especially albumin, albumin and total protein are reduced. Serum K+, Na+, Cl- were measured for reference to the rehydration solution.
24h urine volume and 24h urine protein quantitative examination, parallel urine specific gravity and urine creatinine determination.
3, blood gas analysis: understand the lack of oxygen and acidosis.
4, special examination of fetal placenta
1, fetal electronic monitoring: to understand the presence of fetal hypoxia, such as NST (non-stress test), OCT (oxytocin load test). Note that NST is non-responsive and the baseline is straight, bradycardia, and late deceleration are predictive of fetal hypoxia.
2, B-mode ultrasound scan: understand the fetal biparietal diameter and abdominal circumference, calculate the fetal weight, and estimate the possibility of intrauterine growth retardation. Understand the maturity of the placenta and the amount of amniotic fluid in order to terminate the pregnancy at the right time.
3. Determination of 24-hour urine or serum estriol and HPL (human placental lactogen) Estimated placental fetus.
Diagnosis
Diagnosis of eclampsia
diagnosis
On the basis of preeclampsia, convulsions that cannot be explained by other reasons occur. Although the clinical manifestations and laboratory tests of eclampsia are not specific enough, they can be confused with many other diseases that cause convulsions. However, eclampsia is the most common cause of convulsions related to hypertension during pregnancy and short-term postpartum. .
Differential diagnosis
Need to be differentiated from other tonic-sexual convulsions, such as rickets, hypertensive encephalopathy, cerebrovascular accidents (including bleeding, thrombosis, abnormal vascular rupture, etc.), epilepsy, intracranial tumors, metabolic diseases (hypoglycemia, hypokemia Calcium, white matter lesions, cerebral vasculitis, etc.
