The basic principles for the treatment of eclampsia

Currently believed to be strictly individual (selective), I at the same time, comprehensive treatment of women who have symptoms of toxemia, ignoring, of course, with the clinical form and with the stage of the process (predation and convulsive status) and General condition of the body, and given the anamnestic data.
All therapeutic measures should be aimed to create the right protective conditions and thus to contribute to the restoration of violations corticosterone regulation. Among the above mentioned measures include:
1) organization of the corresponding mode and care of the patient, taking into account the existing high reflex excitability.
So, numerous clinical observations have shown that bright and strong light, noise, skin irritation, etc. can trigger the onset of convulsions. In this regard, the patient should be placed in a separate (one bed), a spacious, well-ventilated chamber; the temperature should be 15-16° N the Room should be isolated from the maternity rooms and premises so that it does not penetrated the noise. Windows darkening curtains, making the room is to create twilight. In the ward where the patient eclampsia, prohibited loud conversation, well-trained midwife must continually be located next to the patient, in order to provide better care and timely provision of necessary medical assistance.
Bed headboard move to the wall so that you can approach a patient with two sides. On each side of the bed put in the form of two boards are smoothly hewed boards to prevent accidental fall sick on the floor at the time of seizure *.
Before you pack sick, bed pre warm heaters; it is recommended to put the patient on a water mattress or, at least, on a rubber circle.
Under his head and upper body of the patient enclose a pillow, or put it on a special frame-headboard in order to facilitate breathing and to prevent lung disease that often affect patients with eclampsia.
The patient is desirable to lay on his right side. If you suspect the possibility of pneumonia (after several seizures) the position of the body is better to change for better ventilation of individual sections of the lungs.
The body of the patient cover warm, but at the same time light blanket. To increase diureza on the lumbar region (on both sides) and feet, put a rubber bags filled with warm water.
You must ensure that the temperature of the water in the bag is not excessively hot, as sick of this kind are very sensitive to burns and are often unconscious. Heat, causing perspiration, calms the nervous system and reduces spasm of blood vessels.
The duties of the midwife is a careful observation of the oral cavity of the patient, as poor care of the mucous membrane of the mouth have afty, ulceration. Dentures should be removed in advance of the oral cavity. Similarly, you need to monitor for cleansing nose to create the best conditions for breath.
It is more likely to apply for breathing oxygen!
When seizures eclampsia should be protected sick from bruises, and her tongue from the bites. For this purpose must be the mouthpiece and down, or rubber wedge, or the handle of the spoon, wrapped up by cotton wool and gauze. When atlanticheskom fit the mouthpiece and down (wedge or a spoon) insert between molars, which certainly improves also the act of breathing.
Equally, one must always be ready syringe, drip with ether, rubber cushion with oxygen and necessary medicines.
2) All treatment activities should be carried out under anaesthesia.
Depending on the state in which delivered a woman
in the hospital (conscious or unconscious), carried out a number of preparatory events is required under inhalation (essential) anesthesia. During a seizure, as a rule, the patient to narcotizirutego not necessary! This is not just aimlessly, but also harmful, because the breath of the patient is difficult and often even asphyxia. Anesthesia contributes to poor supply of oxygen.
In such cases it is more appropriate (to eliminate asphyxia) to appoint inhaling oxygen. Only in exceptional cases during a seizure, the permissible use of intermittent inhalation of air. After the termination of seizure use ether narcosis.
The patient, being in an unconscious state, cleansing enema, as a rule, is not raised, except excessive overflow intestines.
Hygienic shower when taking a patient in hospital is replaced by sponging with a towel soaked in warm water or diluted with alcohol.
This procedure is performed in bed. Each patient eclampsia taken to hospital, is necessarily subject (under General anesthesia) vaginal research to ascertain the current obstetric situation. In this case: if it is in childbirth and how the birth canal prepared for their completion; if the conditions for this are obvious, childbirth should be possible to complete one way or another, with regard to this occasion (forceps delivery turn of fruit on the leg when the transverse position and its extraction, extraction of a fetus for pelvic end when foot and fetal pelvic presentation, perineostomy and so on). In these cases, without delay, the patient is transferred to the operating without halting anesthesia!


If vaginal study found that birth immediately to end can't you keep the wait-and-see tactics of the past, applying simultaneously symptomatic treatment, organizing the appropriate mode for the patient and provide the required care.
Simultaneously with the vaginal examination, the patient take the catheter urine for research.
3) Based on the assumptions that the basis of the pathogenesis of toxemia late pregnancy are neuro-reflex violations of vascular tone, should be considered the most efficient method of treatment is the use of magnesium sulphate (magnesium sulfate), novocaine, drugs (pantopon, papaverine and others), hypotensive and antispasmodic drugs (as, for example, aprofen, chlorpromazine, isopropanol and others).
However, the currently used drugs in Central and mechanism of action is not always effective and even indifferent to the condition of the woman and fetus.
This applies fully and sulphate of magnesia, as will be discussed further.
Magnesium sulphate introduced in obstetric practice in our country in 1930, D. P. Brovkin. It replaces chloral hydrate, the main drug ingredient, which is part of the scheme centuries Stroganoff in the treatment of patients with eclampsia. The mechanism of action of sulphate of magnesia connected with narcotic properties and the ability to resolve vasospasm, and thus to restore the damaged brain circulation, which is observed in pregnant women with toxemia of late term disease (nephropathy - preeclamptic state - eclampsia).
In addition, magnesium sulphate has desensitizing property (G. M. Shpolyanskiy)affecting the peripheral and Central nervous mechanisms. Its beneficial effects in eclampsia is due to the ability to call in the nervous system of a protective inhibition. When magnesia anaesthesia is braking not only Central, but also peripheral nervous system (motor nerve endings). Magnesium sulphate is a powerful factor that increases urine output; it is rapidly excreted by the kidney, reduces blood pressure, interrupts spasmodic contractions.
Used mainly 25% solution of magnesium sulfate, injections are given intramuscularly. Daily dose should not exceed 24 g of dry substance; in this dosage should not be used sulphate of magnesia over two to three days.
Avoid overdose and the prolonged use of magnesium sulfate, bearing in mind the existence of a small range between therapeutic and toxic dose.
Dose, sulphate of magnesia 0,2-0,3 per 1 kg of weight of an animal leading centers of the vagus nerve in the state of maximum oppression, and the dose of 0.5 to 1 kg of weight already causes paralysis of vasomotor (I. E. Turbine).
Long-term clinical observations show that injecting sulphate of magnesia often cause patients side effects (headache, nausea, vomiting, flushing of the face). In the injection sulphate of magnesia, despite the use of novocaine, felt a sharp pain. Finally, magnesium sulphate inhibits generic activities, and even very frequent stops her, and in the following period causes a significant degree of blood loss (I. J. Yakovlev, V. A. Petrov, E. C. the Esterkin and others).
To avoid these adverse side effects of sulphate of magnesia, it can be combined with the introduction rodoslovnaya drugs (quinine, etc).
Injections of magnesium sulfate is not effective in pregnant women with toxemia of late term in combination with hypertension. In this category of patients magnesium sulphate often does not have persistent gipotenzivne/about action.
Depending on the applied dose of magnesium sulfate is reached by either sleep or anesthesia with full oppression reflexes.
As already noted, narcotic dose of magnesium sulfate is close to the toxic. Therefore, the re-introduction of magnesia solution should not be made earlier than four hours, without special testimony to the shortening of the period.
D. P. Brovkin recommends that a 25% solution of the drug every six hours to 24 ml, which corresponds to 6 grams of pure substances. Therefore, a day are four Injections that are made in marinomarini quadrant of the buttocks.
For narcotic purposes should be used only chemically pure magnesium sulphate.
In the first day used "shock" doses of magnesium sulfate (a single dose of 6 g of dry substance); in the following days depending on the condition of the patient, this number could be reduced either by lengthening the intervals between individual injection, either by reducing the dose of the drug.
Since the first injection sulphate of magnesia, the systematic treatment of a patient. Along with this drug can also be used other drugs (see diagram Stroganov - Brovkin).
The basis of treatment of eclampsia should be based on the principle of individual approach.
To avoid an overdose of magnesium sulphate and at the same time to achieve rapid effect for relief of convulsive standing, some clinicians (A. P. Nikolaev, I. I. Yakovlev and others) allow for some patients the use of intravenous chemically pure magnesium sulfate in the quantity of 10-15 ml of 25% solution in a mix with 40 ml of 40% glucose solution at the speed of not more than 40 drops per minute (A. P. Nikolaev).
For quick relief of atlanticheskih seizures may also be used intravenous administration of 0.5% solution novokaina (20 ml) mixed with 20-30 ml of 25% solution of chemically pure magnesium sulfate. The solution should be warm and be introduced slowly. Equally 1/2% solution novokaina (without admixture of magnesium sulfate) used as microclysters with 200 ml
In necessary cases the action of sulphate of magnesia removed intravenous administration of 5% solution of calcium chloride (10 ml).

* Stand purpose instead of boards can be used strong melkopatte grid.