Convulsive form eclampsia

The emergence of seizure attack is usually preceded by a number of clinical signs, in particular increased blood pressure. However, the maximum height of it fluctuates that is in direct connection with the initial level of blood pressure. It is important to consider whether the woman before pregnancy is normal, increased (hypertensive state) or, conversely, low blood pressure (hypotension). The pulse becomes tense. Sometimes develops fever and jaundice appears. The amount of urine is reduced, and there will be found in a large number of protein, shaped elements and so on. However, these precursors are often absent. Usually shortly (in minutes) before the attack has a number of other characteristics (motor anxiety, scratching his nose, small serial fibrillar jerking specific groups of muscles of the face and hands, spreading in the future on other muscles of the body, and finally turning into a typical convulsions). Cramps are often expressed so much that sick even throws up on the bed.
Simultaneously with the reduction of muscles opinion the patient becomes as if "frozen" ("crazy"), eyes fixed in a certain direction and only slightly turn up or to the side. With the onset of seizures eyelids begin to tremble (blinking), the eyes flies backwards (eyeballs away upwards and to the side), pupils narrowed from the lacrimal SAC starting to stand out tears, often with abundant (Fig. 68, a, b).

Fig. 68. Eclampsia.
a - sick during a seizure (between the top and bottom rear molars rubber wedge); 6 - the same patient on the 8th day after birth.

During a seizure, eclampsia should immediately impose between indigenous teeth sore mouthpiece and down, rubber wedge or the handle of a spoon, wrapped up by cotton wool and gauze. This event possible to prevent the bite and zapadnie language, the penetration of saliva in the respiratory tract; however, facilitated the access of the air. Simultaneously, in the respiratory tract by a thin rubber catheter oxygen. Oxygen comes from the rubber cushions in the respiratory tract, pre-passing (with the goal of dampening) via Bobrov's apparatus. After the attack asphyxia the patient is given a short-term inhalation narcosis (ether), which inspect and perform the appropriate treatment procedures (injections of magnesium sulfate, izopropanole, Dibazol, chlorpromazine, etc).
If you start narcotizirutego patient during spasms of muscle groups, i.e. even before the emergence of asphyxia, it is often possible to prevent the development of further symptoms or at least to weaken the latter. If the patient asphyxia anesthesia is contraindicated!
If you use these activities to suspend the further development of the attack fails, soon to all the enumerated phenomena joins tetanicescie reduction of muscles of face and neck with a separate twitching. As a result of this head is sick leans back.
First, the mouth, the patient is slightly ajar, and then jaw firmly stickymouse. Convulsions capture the whole body. Fists highly compressed. Soon (after an average of half a minute) tetanicescie cramps become clonic.
To top it off, the patient stops breathing and a state of asphyxia. Sharply blue face and body, mouth oozed saliva, often mixed with blood (tongue bite, sharp clenching of the jaw and bleeding of the gums). However, soon there is a deep sigh with rattling, and the patient starts slowly, but very deep breathe. Simultaneously mouth usually spent a lot of saliva mixed with blood; if saliva is not timely removed, the patient may inadvertently inhale.
Following the restoration of the even breathing of the appearance of the patient changes. Her face, and then the whole body becomes normal color.
However, the consciousness of the patient is recovering slowly.
Fit eclampsia usually lasts 1-2 minutes, but often shorter or, conversely, longer - up to 5-6 min (centuries Stroganov). However, in some cases, the patient, after the first attack, falls into a deep coma, which lasts 10-20 minutes Coma indicates the oppression of the brain cortex. Then the consciousness of the patient gradually restored, if only by that time will not start a new atlanticheskii attack.
In other cases, especially when mixed forms eclampsia, a seizure can cause extensive bleeding in the brain. Clinically, this is manifested in the sharp decrease in blood pressure, increased heart rate and a steady increase in body temperature.
When bleeding in the brain develop hemiparesis or paralysis.
Following a seizure occurs commonly in 1.5-2-3 h (often before, but maybe later if the patient severe headache). After the second attack consciousness often returns after a longer period of time than after the first; after 3-4 seizures consciousness is usually not refundable longer. After many seizures (10-15), the patient begins to weaken cardiac activity. In these cases, the pulse raised to 110 to 120 beats per minute and becomes weaker filling; breathing quickens; often join phenomena swelling of the lungs and etc.
Before the introduction of the in medical practice of sulphate of magnesia period cramps usually lasts about a day (85%); relatively rare (15%), repeated seizures have been on the second and third day. With the use of magnesium therapy such cases are extremely rare.
In some cases, seizures may be repeated at long intervals. The occurrence of seizures again after 24 hours after the last of the former fit eclampsia is called a relapse, and this form of eclampsia is called return or recurrent (centuries Stroganov).
According to S. A. lot, under the recurrence should understand such a state, when seizures resumed only after the disappearance of all forms of eclampsia observed during this pregnancy. Relapses are rare (for centuries Stroganov, less than 5%, S. A. Lot - 2.7% of cases). Relapses weaken the condition of the patient and worsen the prognosis. Seizures are of different length and different forces that depends on the degree of intoxication and the state of its reactivity. That the degree of intoxication and reactivity of the organism play a significant role in the clinic eclampsia, testifies, according to the old authors, the fact that in some cases the death of patients was observed even from one attack, on the other hand, the number of women who had had from 50 to 200 seizures remained alive! However, this does not mean that the number of seizures does not affect the condition of the patient eclampsia.
Cessation of seizures in the absence of a coma, increased output, increased sweating, reduce swelling, demotion AD under the rhythmic pulse of good content, reduce albuminuria favorable prognostic signs.
During the attacks, the amount of protein in the urine usually increases, and urine output decreased, and in some cases even been a full anuria. Along with this there have been cases of eclampsia, when the protein in the urine is not defined and the amount of urine are not sharply reduced.

There is no doubt that frequent seizures bring a woman's body to a grave condition, in this regard, the increasing number of deaths.
With the end of the genera usually seizures stopped. Therefore, tactics of accelerated delivery in these cases should be considered quite reasonable.
If under the influence held regime and treatment of the condition of the pregnant improved and pregnancy progresses in the future ends physiological childbirth, and the seizures is not renewed, then this form eclampsia is called intercurrent (intermediate).
Re form of late toxemia in subsequent pregnancies occur in 2-2,5%. The frequency of eclampsia in previous years (1925-1929,) reached 0,5-0,75% (I. I. Yakovlev), even 0,81% (E. S. Malkin). Currently the frequency of toxemia pregnancy recent periods, including eclampsia, sharply decreased, amounting to 0.2-0.3% of the total number of births. This reduction in the incidence of cases of eclampsia, of course, is in direct connection with the great medical and preventive work carried out in the system of obstetric-gynecological Association of doctors of antenatal clinic.
Atlanticheskoi state can occur during pregnancy, at childbirth and in the postpartum period (table. 18); it is rare in one and the same woman for two and even more rarely during these three periods (table. 19). Forecast in eclampsia quite serious. It depends not only on the severity of intoxication and the state of the reactivity of the organism, from the period when it is in eclampsia (pregnancy, childbirth and postnatal period), but also from many other related psycho-somatic factors discussed above. Fatal outcome for patients may occur for the following reasons: 1) the weakening of cardiac activity; 2) bleeding in the brain; 3) pulmonary oedema and hypostatic pneumonia; 4) sepsis and other

Table 18. Frequency eclampsia during pregnancy, childbirth and in the postpartum period (the total number of all cases of eclampsia)
Author The period of occurrence eclampsia
during pregnancy during childbirth in the postpartum period
B. N. Mikhailov
S. A. Lot
I. Century Sudakov
C. S. Gruzdev
I. I. Yakovlev

Table 19. Frequency eclampsia during pregnancy, childbirth and in the postpartum period (I. Yakovlev)
Pregnancy The number of cases Percentage
Eclampsia during pregnancy
Eclampsia during childbirth
Eclampsia during pregnancy and childbirth
Eclampsia in the postpartum period
Eclampsia during childbirth and in the postpartum period
Eclampsia during pregnancy, childbirth and the postpartum period

The most adverse forecast with eclampsia during pregnancy. In these cases, the doctor often deprived of the opportunity to quickly finish childbirth because of the unpreparedness of the generic ways (if not to resort to forced delivery by caesarean section). Eclampsia that occur in the early months of pregnancy, illness is more severe than in the later stages.
Most favorably flows postpartum eclampsia when the seizures appear for the first time after delivery. If seizures eclampsia begin at birth and continue in the postpartum period. the prognosis is bad. The frequency of death of patients also depends on whether there has come from them eclampsia in a hospital or even before entering the hospital. Eclampsia, which began before enrolling women in the hospital, more often causes death than eclampsia, for the first time occurred in a medical institution.
Mortality in convulsive form eclampsia, on materials of domestic authors, ranging between 3.5 to 5.4% (in. A. Stroganov, D. P. Brovkin, and others).
According to the Sverdlovsk Institute of maternity and infant mortality is 1.45% (E. S. Malkin).
Among the negative symptoms that have a value in the forecast, should include:
1) frequent, following each other cramps;
2) stay a woman in a coma after the seizure;
3) sharp decrease of diuresis and the color of blood and urine;
4) jaundice (indication of liver disease);
5) the rise in body temperature;
6) high blood pressure amplitude is small or sharp drop in blood pressure;
7) fiery breath (points to pulmonary edema).
The timely application of preventive measures in toxicosis
pregnancy (corresponding mode and treatment) prevents the onset of eclampsia, and began to be and eclampsia.
Great also in eclampsia mertvorozhdennosti and early child mortality (from 14 to 50%).