Modern management of eclampsia

Eclampsia complicated by acute subdural haematoma: A case report

INTRODUCTION

Acute subdural haematoma (ASDH) is usually a post-traumatic sequel but only a few spontaneous cases complicating eclampsia have been reported.

PRESENTATION OF CASE

We report the case of a 19-year-old patient who presented with intrapartum eclampsia at 38 weeks gestation, and developed neurologic signs that persisted after delivery. Computerized tomography (brain) revealed an acute subdural haematoma which was successfully managed conservatively in our facility.

DISCUSSION

Subdural haematoma is bleeding into the space between the dura and pia matter. This report presents the management of a case of eclampsia which was complicated by subdural haematoma. The decision to manage this patient non-operatively was due to her improved neurological status and brain CT scan finding which showed no significant mass effect being exerted by the haematoma.

CONCLUSION

The good outcome in this report demonstrates the importance of a multidisciplinary approach, early detection, and diagnosis which are crucial for the successful management of subdural haematoma that may complicate eclampsia.

Strategies to prevent eclampsia in a developing country: II. Use of a maternal pictorial card

OBJECTIVE

To assess the efficacy and acceptability of a patient-held pictorial card aimed at raising awareness and appropriate health seeking behavior in response to prodromal symptoms of imminent eclampsia.

METHOD

Pictorial cards (and posters) were issued to antenatal clinics and used to focus instruction and advice to pregnant women. Mothers were surveyed before and after the cards were introduced to assess maternal likelihood of seeking care if edema was seen, and of attending hospital if so advised. We monitored the eclampsia rate. Health workers were interviewed 6 months after cards and posters were issued to determine the acceptability of using the cards as part of routine antenatal care.

RESULTS

The card was seen as widely acceptable by health professionals, and increased their own awareness of the prodromal symptoms of eclampsia and their discussion of these symptoms with antenatal mothers. Mothers' awareness and response to symptoms improved significantly and there was a marked drop in eclampsia incidence. Suggested improvements to the card were made by mothers and health workers.

CONCLUSION

The cost of providing a card for every pregnant mother is likely to be offset by health service delivery savings.

Critical pathways for the management of preeclampsia and severe preeclampsia in institutionalised health care settings

BACKGROUND: Preeclampsia is a complex disease in which several providers should interact continuously and in a coordinated manner to provide proper health care. However, standardizing criteria to treat patients with preeclampsia is problematical and severe flaws have been observed in the management of the disease. This paper describes a set of critical pathways (CPs) designed to provide uniform criteria for clinical decision-making at different levels of care of pregnant patients with preeclampsia or severe preeclampsia. METHODS: Clinicians and researchers from different countries participated in the construction of the CPs. The CPs were developed using the following steps: a) Definition of the conceptual framework; b) Identification of potential users: primary care physicians and maternal and child health nurses in ambulatory settings; ob/gyn and intensive care physicians in secondary and tertiary care levels. c) Structural development. RESULTS: The CPs address the following care processes: 1. Screening for preeclampsia, risk assessment and classification according to the level of risk. 2. Management of preeclampsia at primary care clinics. 3. Evaluation and management of preeclampsia at secondary and tertiary care hospitals: 4. Criteria for clinical decision-making between conservative management and expedited delivery of patients with severe preeclampsia. CONCLUSION: Since preeclampsia continues to be one of the primary causes of maternal deaths and morbidity worldwide, the expected impact of these CPs is the contribution to improving health care quality in both developed and developing countries. The CPs are designed to be applied in a complex health care system, where different physicians and health providers at different levels of care should interact continuously and in a coordinated manner to provide care to all preeclamptic women. Although the CPs were developed using evidence-based criteria, they could require careful evaluation and remodelling according to each system's demands. Additionally, the CPs need to be tested in large-scale, multi-level studies in order to thoroughly examine and evaluate their efficacy and effectiveness.