Treatment of eclampsia

In all cases of eclampsia is necessary to isolate the patient as possible in a soundproof room, darkened from daylight and bright artificial light. All manipulations (catheterization, internal investigation, surgery) is performed under General anesthesia (a few drops of an ether); this eliminates sources of irritation and warned reflex seizures Central character.
Before attack (it can be foreseen, since before this increases the excitation of the patient, increased blood pressure, pulse becomes more intense, dilate pupils) must be entered between indigenous teeth on the mouthpiece and down or table metal wrapped with gauze spoon (it is warned, biting of the tongue at the time of seizures). Outside of seizures mouth should be exempt from saliva and foam, which are in abundance highlighted during the attacks. To do this, the patient should be put on the side (which contributes to the flow of saliva and foam), mouth to wipe topferm of gauze (these are warned aspiration of saliva in the respiratory tract and the development of pneumonia). For the prevention of pneumonia patient must also be rotated from side to side and apply the dry banks (which improves circulation of blood in the lungs, reduces congestion and edema in them). Should closely monitor patient during a seizure that it did not fall, not hurt.
It is necessary to watch urination patient. Food and drink during convulsive phase should be stopped altogether. To assess the condition of the patient is required regular measurement of blood pressure, heart rate control, the nature and the number of breaths, urine analysis and measurement of quantity. At the bedside for convulsive stage must be continually doctor (only in extreme case, an experienced midwife). Treatment of eclampsia should be strictly differentiated in accordance with clinical features of the case. Most rationally for typical eclampsia perform conservative treatment, which should be based on methods that reduce swelling, blood pressure reduction, along with the improvement of blood circulation in organs.
Centuries Stroganov offered in eclampsia systematically introduce drugs include morphine and chloral hydrate, vagotonia funds, which, in his opinion, are antagonists of substances contributing to the eclampsia symptoms (edema, hypertension); in addition, morphine and chloral hydrate lower reflex excitability of the cortex of the brain that stops seizures. These drugs are not indifferent for an organism of the patient eclampsia. Chloral hydrate has a strong toxic effect on the heart muscle and the liver - the authorities, a violation of the functions which plays an important role in the pathogenesis of eclampsia. Assuming that morphine has antidiuretic property (although its action in eclampsia is not proven), clinicians began to object to its use. D. P. Brovkin, and others, have suggested replacing the morphine phenobarbital or omnomnom. Pharmacodynamic action of these funds is the same as morphine and chloral hydrate, i.e. they are vagotomy. Phenobarbital and sulphate magnesium lowers blood pressure, increases diuresis, reduce reflex excitability, kupyrya seizures eclampsia. Single therapeutic dose for the treatment of eclampsia: 1 ml of 20% solution phenobarbital sodium, 1 ml 2% solution of omnopon, 24 ml of 25% solution of magnesium sulphate (usually intramuscularly). Currently, the treatment of eclampsia spend on a modified scheme centuries Stroganov: 1) after the seizure, when the patient begins to breathe, enter phenobarbital sodium or omnopon these doses; 2) after 30 minutes introduce a solution of magnesium sulphate; 3) after 2 hours. from the beginning of treatment again introduce phenobarbital sodium or omnopon in the same doses; 4) after 3 hours. 30 minutes (after 5 hour. 30 minutes from the beginning of treatment) again enter magnesium sulfate at the same doses; introduction repeated after 6 p.m., and then in 8 hours. (i.e. over 19 hours. 30 minutes from the beginning of treatment). During the first two periods, when the forerunners of seizure give to breathe for a few drops of an ether.
D. P. Brovkin suggested the following scheme of treatment of eclampsia: immediately after the seizure intramuscularly 24 ml of 25% solution of magnesium sulphate, repeats this introduction on the first day, 4 times, every 4 hours. Then make a break for 12 hours, then repeat administration during the second day again 4 times with intervals of 4 hours.
In the days following the treatment, depending on the General condition of the patient. In the same single-dose magnesium sulfate is administered 2 times a day with intervals of 4 hours. (better in the evening - at 18 o'clock. and 22 hrs.).
This treatment of eclampsia combined with intravenous 40% solution of glucose (40 to 50 ml with ascorbic acid 300 mg) 2-3 times a day, which helps to improve urine flow, reducing intracranial pressure, compensates for the loss of sugar during the attacks and improves heart.
D. F. Chebotarev recommends slow (within 30 minutes) intravenous injection of large doses of 40% glucose solution (150 - 300 ml 1-3 times a day).
From gipotenziveh funds best eliminates or drastically reduces the perception of stimuli chlorpromazine, it has a sedative effect, prevents seizures and reduces high blood pressure. HP, Persianinov suggested for the treatment of eclampsia enter chlorpromazine intravenous (2 ml of 2.5% solution with 50 ml of 40% glucose solution). This drug has a beneficial effect in eclampsia and when harbingers of convulsive seizure eclampsia. Re chlorpromazine (1 ml of 2.5% solution) to introduce needs 2-3 times at intervals of 4-8 hours.
If the efficacy of this therapy is insufficient, and in particularly severe cases of eclampsia use other methods of treatment, in the first place bloodletting. Its mechanism of action with typical eclampsia amounts to change osmotic stress in the tissues, which after the bloodletting relative increases, which is why the water and dissolved substances from the tissues become the vessels.

Re-abundant blood-letting as an independent method of treatment of eclampsia suggested B. A. Arkhangelsky and B. N. Denisov-Vlasov. Most midwives, however, believes phlebotomy care for patients with anemia. The effectiveness of their in eclampsia is enhanced by the use of magnesium sulphate. Such combined therapy makes it possible to reduce the dose of blood-letting. Therefore, the lack of effectiveness of medical treatment and in the most severe cases of eclampsia simultaneously with the introduction of magnesium sulphate or chlorpromazine can do bloodletting (enough withdraw at a time 200-250 ml of blood).
At high intracranial pressure, which is accompanied by severe brain symptoms (agitation, amaurosis, Zaporozhie state) and increased reflex excitability of the brain, it is useful to perform a lumbar puncture. The mechanism of action puncture in eclampsia is to increase water diffusion of brain tissue in the spinal canal. This decrease intracranial pressure and reflex excitability of the brain. As bloodletting, a lumbar puncture can be repeated, and efficiency will be higher, if it is combined with the introduction of magnesium sulphate and purpose of chlorpromazine.
Amniotic fluid, as the observations and research, include in eclampsia simpatikotonia substances that can increase blood pressure, cause the muscles and hold water in the tissues, especially in the case of a typical eclampsia. This can be explained by the fact that in eclampsia childbirth often come prematurely, and labor activity, despite the systematic use of drugs in large quantities, not weakened, but, on the contrary, increases. The release of amniotic fluid by the rupture of membranes frees the body of excess toxic substances, increasing at the same time and tribal activities. Therefore, to improve the condition of the patient and to accelerate the delivery useful in eclampsia to do early and wide gap membranes.
Speedy delivery or cesarean section when a typical eclampsia contraindicated; to accelerate delivery should be careful delivery under appropriate conditions allowing obstetric operations.
When the so-called brain-eclampsia treatment method remains the same. Sometimes we can restrict the use of drugs. Because this form of eclampsia has increased intracranial pressure, due to swelling of the brain, when pronounced brain shown symptoms of spinal puncture. Bloodletting when these forms too, as edema and subcutaneous tissues of internal organs missing. When "brain" form eclampsia can not hurry with the delivery, cesarean section is not normally used; speed up delivery reach the rupture of membranes and only in extreme cases may require careful delivery by applying the ordinary obstetric operations.
As narcosis in eclampsia is usually used ether; can drip method (low dose of ether evoke patient eclampsia General anesthesia). The excitement of ether anesthesia in eclampsia is almost always missing; on the negative side it is the irritation of the mucous membranes of the respiratory tract.
In eclampsia, which developed in the postpartum period, apply the same tools and generally in eclampsia. The treatment is strictly conservative.
More active during labor should be therapy unusual, uraemic form eclampsia. In these cases it bloodletting, and (unlike typical eclampsia) it must be rich, but single. Sometimes produce up to 1000 ml of blood, if no contraindications of the General condition of the patient. This rich bloodletting is not compensated by the passage of fluids from tissues to vessels, since no swelling, so it can lead to falling tone of the cardiovascular system. To avoid this, use, substitution treatment is injected under the skin (or in the form of drip enemas) 1000 ml of 5% glucose solution.
The use of magnesium sulphate and chlorpromazine is contraindicated. If severe brain phenomena should be issued via a lumbar puncture approximately 12-20 ml of cerebrospinal fluid (to produce up until the liquid will be allocated not a stream but in drops). If this treatment has no effect, you should put the question of urgent delivery. The choice of method of delivery depends on the state of labor activity and tribal ways. In the absence of labor activity and unprepared generic paths shown caesarean section. In the period of the opening in the presence of labor activity for faster delivery is useful to break the fetal bladder, which can also improve the condition of the patient.
Under appropriate conditions, in the period of the opening or exile also demonstrates using and rodorazreshajushchaja operations, and choosing the method of operation in the first place should take into account the interests of the mother.
When uremic form of eclampsia in the postpartum period of treatment is isolation and care of the patient, in phlebotomy, a lumbar puncture, followed by the introduction of glucose (or engerausche solution), and symptomatic treatment, aimed primarily at maintaining cardiac patient.