Tratamiento de la eclampsia y miastenia gravis: reporte de un caso y revisión de la literatura / Eclampsia treatment and myasthenia gravis: case report and review of literature

OBJETIVO: Reportar el caso de una gestante con miastenia grave (MG) más preeclampsia-eclampsia y crisis miasténica en el puerperio mediato, y realizar una revisión de la literatura sobre el manejo farmacológico. MÉTODO: Se presenta el caso de una mujer de 26 años con MG, primigesta de 36 semanas de gestación, quien cursó con eclampsia y recibió fenitoína por 24 horas. Tuvo parto espontáneo sin complicaciones y crisis miasténica al día 11 del puerperio asociada a infección de vías urinarias y sepsis. Se realiza revisión de la literatura en PubMed, Cochrane, Embase, LILACS y Scopus, empleando los términos "Hypertension, Pregnancy-Induced", "Preeclampsia" y "Eclampsia", combinados con "Myasthenia Gravis", durante el periodo de publicación de 1960 a junio 2020, en inglés y español. RESULTADOS: Se encontraron 12 reportes de caso, dos con eclampsia y MG; el caso aquí reportado es el número 13. Ocho pacientes no recibieron medicamentos profilácticos de eclampsia y tres de ellas convulsionaron. En las que se usó sulfato de magnesio, todas cursaron con crisis miasténica. CONCLUSIONES: La evidencia actual en cuanto a la profilaxis y el tratamiento de la eclampsia y la MG corresponde a reportes de casos. El uso de sulfato de magnesio está contraindicado en pacientes con MG, por lo que se han utilizado fenitoína y levetiracetam.

OBJECTIVE: To report a case of pregnant women with myasthenia gravis (MG), plus preeclampsia-eclampsia and myasthenic crisis in the mediate puerperium; to conduct a literature review regarding its pharmacological management. METHOD: 26-year-old primigravida with 36 weeks of gestation and previous history of MG, who developed eclampsia and was treated with phenytoin for 24 hours, with later spontaneous delivery without any complications nor new seizures; and myasthenic crisis on day 11 of the puerperium associated with urinary tract infection and sepsis. A literature review was conducted in PubMed, Cochrane, Embase, LILACS and Scopus, using the controlled vocabulary "Hypertension, Pregnancy-Induced", "Preeclampsia" and "Eclampsia", combined with "Myasthenia Gravis", between 1960 and June 2020, in English and Spanish. RESULTS: 12 case reports were found, two of these with eclampsia and MG, the case reported here was number 13. In eight cases patients did not receive any prophylactic drugs for eclampsia and three of them had convulsions. In the cases where magnesium sulfate was used, all developed myasthenic crisis. CONCLUSIONS: The current evidence regarding prophylactic management and treatment corresponds to case reports. The use of magnesium sulfate is contraindicated in patients with MG, therefore phenytoin and levetiracetam have been used.

Sulfato de magnésio: principais utilizações na obstetrícia contemporânea / Magnesium sulphate: main uses in contemporary obstetrics

O sulfato de magnésio tem sido utilizado em obstetrícia por décadas e milhares de mulheres já foram incluídas em ensaios clínicos que estudaram sua eficácia em uma variedade de condições gestacionais. Os principais usos do medicamento na atual prática obstétrica incluem prevenção e tratamento de convulsões eclâmpticas, prolongamento da gravidez para administração antenatal de corticosteroides e neuroproteção fetal na iminência de interrupção prematura da gravidez. Em função da alta qualidade e da consistência dos resultados de importantes ensaios clínicos, a indicação do sulfato de magnésio para profilaxia e terapia das convulsões eclâmpticas está bem estabelecida. Entretanto, tal unanimidade não ocorre com relação ao seu emprego como tocolítico, tanto pela discussão sobre sua efetividade quanto pelas doses mais altas usualmente utilizadas para esse fim. Em relação à importância do sulfato de magnésio como agente neuroprotetor fetal, a paralisia cerebral é a causa mais comum de deficiência motora na infância e tem como fator de risco mais importante a prematuridade, cuja incidência tem aumentado significativamente. Diretrizes nacionais e internacionais mais recentes, baseadas em resultados de ensaios clínicos randomizados e metanálises de boa qualidade, mostraram que a administração antenatal de sulfato de magnésio na iminência de parto pré-termo precoce é uma intervenção eficiente, viável, segura, com boa relação custo-benefício e pode contribuir para a melhoria dos desfechos neurológicos neonatais.

Magnesium sulfate has been used in obstetrics for decades and thousands of women have already been included in clinical trials that have studied its effectiveness in a variety of gestational conditions. The main uses of the drug in current obstetrical practice include prevention and treatment of eclamptic seizures, prolongation of pregnancy for antenatal administration of corticosteroids, and fetal neuroprotection in the imminence of premature termination of pregnancy. Because of the high quality and consistency of the results of important clinical trials, the indication of magnesium sulfate for prophylaxis and therapy of eclamptic seizures is well established. However, such unanimity does not occur regarding its use as tocolytic, either by the discussion of its effectiveness or by the higher doses usually used for this purpose. Regarding the importance of magnesium sulfate as a fetal neuroprotective agent, cerebral palsy is the most common cause of motor deficits in childhood and has a significantly higher incidence of prematurity as a major risk factor. More recent national and international guidelines, based on results from randomized controlled trials and good quality meta-analyzes, have shown that the antenatal administration of magnesium sulfate at the imminence of early preterm delivery is a cost-effective, viable, efficient intervention and safe and can contribute to the improvement of neonatal neurological outcomes.

Utilidad de los fluidos en pacientes con pre-eclampsia/eclampsia: evidencia / Utility fluids in patients with pre-eclampsia-eclampsia: evidence

La preeclampsia/eclampsia se caracteriza por presión arterial elevada durante el embarazo, presentándose en cerca del 8-10% de todos los embarazos. En la mujer embarazada normalmente hay un aumento del volumen plasmático, sin embargo en preeclampsia-eclampsia usualmente dicho volumen esta disminuido. Esta disminución del volumen plasmático ha llevado a la idea de que hay que administrar fluidos para mantener la estabilidad hemodinámica materna...

Magnesium sulphate therapy in pre-eclampsia and eclampsia: one year experience

To study the efficacy of Magnesium Sulphate Therapy for prevention and control of fits in patients with preeclampsia and eclampsia. Interventional Study. This study was conducted at the Department of Obstetric and Gynecology Unit II, Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Islamabad from April 2002 to March 2003. Total 50 women with preeclampsia / imminent eclampsia and eclampsia fulfilling the study criteria were admitted in HAD, adjacent to labour ward. Magnesium Sulphate therapy started after complete evaluation of the patients according to the study protocol. Patients monitored carefully for any side effects of magnesium therapy and occurrence of convulsions. Primary outcome measures were development of eclampsia or recurrent seizures in patients with eclampsia, neonatal morbidity and mortality. Secondary outcome measures were serious maternal morbidity, magnesium toxicity and other side effects of MgSO[4] and complications of labour and delivery. Total 50 women were entered into the study over a period of one year. Out of these 12 [24%] women presented with eclampsia, 5 [10%] had imminent eclampsia and 33 [66%] were diagnosed as pre-eclampsia. Of the 12 women with eclampsia, none had recurrent seizures. Out of 38 women with pre-eclampsia and imminent eclampsia, only one [2%] woman developed eclampsia. There was no case of magnesium toxicity. Overall 12 [24%] of the babies were delivered with poor Apgar score. Two babies were expired within five minutes of delivery while 5 babies expired in NICU. There were 6 intrauterine deaths and 4 intrapartum deaths. Magnesium sulphate is an effective anticonvulsant for the treatment and prevention of eclampsia when used judiciously. In the dosage used it does not have any substantive harmful effects on women and their babiesstage repair is more appropriate with satisfactory results

Magnesium sulphate therapy in eclampsia: a 5 years experience at a teaching hospital

To describe the presentation of eclampsia, its management and associated outcomes using magnesium sulphate [MgSO4], over a five years period at a tertiary care hospital. This descriptive study was conducted at Obstetrics and Gynecology Unit, Hayatabad Medical Complex, Peshawar from January 2004 to December 2008. Data was collected from all patients presenting with eclampsia. A total of 146 patients had eclampsia. Unbooked were 124 [84.93%]. Mean age 23 years +/- 5.3 years [range 18-38 years], primigravida were 69.17% [101 cases]. Antepartum fits in 72.6% [106 cases], intrapartum 14 [9.58%] and 27 [18.49%] postpartum. MgSO4 was used in all except 4 with oliguria, they were given diazepam. Recurrent fit occurred in only 20[13.69%]. MgSO4 toxicity occurred as respiratory depression in 9 cases, depressed tendon reflexes in 10 and decreased urine output in 13 cases Total deliveries were 23021, prevalence of eclampsia was 0.63%. Mode of delivery was Vaginal in 97 [66.43%], instrumental in 29 [19.98%] and cesarean section in 20 [13.69%] cases. There were 26[17.2%] stillbirths and 4 neonatal deaths. Complications included HELLP in 17 [11.64%], pulmonary complications in 17, renal failure in 7 [4.79%], DIC in 16[10.95%] and temporary blindness in 16 cases. Eleven [7.53%] maternal deaths occurred, causes included DIC in 1case, HELLP in 2, renal failure 1, cardiopulmonary failure in 2 and CVA [received deeply unconscious] in 5 cases. All were unbooked cases and with delay in reaching hospital. Eclampsia is common antenatally and in primigravidae, and a major cause of maternal morbidity and mortality in our region. It was effectively controlled with MgSO4, preventing recurrent fits and safe for both mother and fetus

Safety and efficacy of hyderalzine in hypertensive disorders of pregnancy

To find out safety and efficacy of IV bolus hydralazine in reducing blood pressure in severe hypertension during pregnancy. All pregnant patients with systolic blood pressure 160 or above and diastolic blood pressure 109 mmHg with eclampsia and hypertensive emergencies were included. The initial dose of hydralazine was 5 mg IV bolus then repeated 1mg at 20 minutes interval. Outcome measures to start treatment were, systolic and diastolic blood pressure, time required for achieving the desired BP level, total dose needed, side effects of drugs, maternal and fetal outcome in terms of safety and efficacy. One hundred and ten patients with eclampsia and hypertensive emergencies were included in the study. The mean + SD [range] of maternal age was 26.70 + 6.70[18 -45 years]. Blood pressure before starting therapy was systolic 165.5 + 16.65, and diastolic blood pressure was 115.45 + 8.25mmHg. After starting therapy, a significant difference [P=< 0.001] was observed with fall in systolic blood pressure 131.2 + 9.49 and in diastolic blood pressure 93.68+6.30mmHg. In 94[85.5%] patients, IV bolus hydralazine took 60 minutes, however, in 3[2.7%] > 180 minutes time was required to control the blood pressure. Total dose of drug required was <6mg in 40[38.4%] patients, 6 to 14mg in 44[40%] and in 17[15.5%] women 15 to 20 mg of dose was needed to control the blood pressure. Only 9[8.18%] needed dose between 21 to 30 mg IV bolus hydralazine. Hydralazine is safe and effective in controlling the blood pressure in severe hypertension during pregnancy and after delivery

Late postpartum preeclampsia with posterior reversible encephalopathy syndrome.

Posterior reversible encephalopathy syndrome is a reversible syndrome characterized by headache, seizures, altered mentation, and loss of vision associated with white matter changes on imaging. We report here a 27 year-old lady three weeks postpartum, presenting with posterior reversible encephalopathy syndrome. She was treated successfully with antihypertensives and showed dramatic improvement. This condition is important to recognize and needs to be treated promptly to prevent morbidity and mortality in pregnancy and postpartum.

Magnesium sulphate therapy in edampsia: an experience at Chanilka medical college Larkana

To evaluate the role of magnesium sulphate [MgSo4] in the management of eclamptic patients in terms of efficacy, safety, recurrence of convulsion and fetomaternal out come. This descriptive case series study was conducted over a period of one year from 1[st] October 2007 to 30[th] September 2008 at Gynae and Obs Unit-1 Sheikh Zayed Hospital for women CMC Larkana. All the patients admitted with eclampsia during the study period were included in the study. All patients were managed accordingly to the protocol. MgSO4 was given to eclamptic patients according to protocol who had no contra indications to this drug. Recurrence of convulsions, side effects of MgSO4, maternal and fetal outcome were noted. During the study period total no: of obstetrical admissions were 4051 and total deliveries were 3200. Sixty seven patients presented with eclamptic fits which accounts for 1.6% of total deliveries. Only 13 patients [19.4%] were booked and the rest were un-booked. Majority was primigravida and common age group was 21-30 years. In the antepartum period eclampsia were accounted for 29.6%, intrapartum 43.6% while 26.8% were postpartum eclampsia. Fits occurred in the 3[rd] trimester after 32 weeks in 32 cases [58%]. All patients received MgSO4. 94% had no side effects, 2.9% developed diminished reflexes, 1.4% developed hypotension, 1.4% developed renal failure, recurrence of fits was observed in 4 cases [5.9%]. 3 patients were expired due to cardiopulmonary failure with in 24 hours after arrival at Hospital. Fetal out come was analyzed 48 retuses born alive, 4 were IUL 9.were FSB, and 4 were NND. In conclusion MgSO4 was found to be were effective and cheap for control of fits and has lower risk of recurrent convulsions. The occurrences of drug complications were very low with standard protocol. Maternal mortality was also 12w 2nd fetal outcome was found to be good. Clinical monitoring seems to be sufficient in this study

Magnesium sulphate: a life saving drug.

A retrospective study of 68 eclamptic women who received Magnesium sulphate at Koshi Zonal Hospital were analyzed during a one year period (2006-2007 AD). Maternal conditions at admission, associated complications in mothers and babies, delivery outcomes and cause of death were also studied in each case. There were 5240 deliveries during the period of analysis. Of which 4976 were live births, pregnancy induced hypertension was 0.89% (47), 0.74% (39) presented with pre-eclampsia, 0.30 (16) cases with severe pre-eclampsia and 0.43 (23) cases with mild pre-eclampsia. During this period 1.3% (68) of eclampsia presented to the hospital. Of which 67.7% presented with ante-partum eclampsia, 22.1% with intrapartum eclampsia and 10.3% with post partum eclampsia. Majority of women (63.2%) were between 20-25 years of age, while teenage pregnancy contributed 30.88% of eclamptic cases. The diastolic blood pressure was >110 mm of Hg in 45.6% of cases, 90-110 mmHg in 50% of cases and in 4.4% the it was <90 mmHg. 94.1% presented to the hospital in an unconscious state, 79.4% of eclamptic women received the full dose of magnesium sulphate (initial loading plus maintenance dose), while rest failed to receive the full dose. Nine women with severe pre-eclampsia received magnesium sulphate as a prophylactic measure. 17.7% women had home delivery, one patient left against medical advice and one was referred to a tertiary care center. Caesarian Section (Lower Segment) was performed in 35.2% of cases, 30.8% had normal vaginal deliveries and 5.8% had pre term delivery. About 69.6% babies were born alive, 8.7% were still births, 11.6% were neonatal deaths and 4.4% of babies had to be admitted to the neonatal intensive care. Eclamptic women stayed less than one week in the hospital in majority of cases (64.7%), between 1-2 weeks in 32.4% and more than two weeks in 2.9%. Maternal complications included decreased urinary output, pulmonary edema in three cases; chest and wound infection two cases each; post partum psychosis, vulval haematoma, severe headache one case each. There were seven maternal deaths during this period and eclampsia contributed to one of the deaths. Eclampsia is a major cause of maternal and perinatal morbidity and mortality in our setup. Magnesium sulphate is an excellent drug of choice in management of eclampsia and pre-eclampsia. Wider coverage of pre-natal care, timely referral and optimal management of cases of eclampsia with magnesium sulphate in hospitals are key issues to prevent mortality/morbidity associated with it.

Postpartum eclampsia without pre-eclamptic prodroma - Case report and literature review

Late postparturn eclampsia without prior pre-eclampsia is known to occur more than 48 hours up to 28 days postpartum. Common preceding symptoms are headache and visual disturbance. Diagnosis is by findings of hypertension, proteinuria, oedema, hyperreflexia +/- hyperuricemia. Magnetic resonance imaging of brain reveals characteristic posterior leukoencephalopathy. Magnesium sulphate is the mainstay of therapy. Three such cases of this rare clinical entity occurring consecutively in a six month period at our hospital are reported. Prolonged postpartum vigilance for blood pressure and neurological symptoms allows timely management and reduction of maternal morbidity and mortality

Maternal mortality due to arterial hypertension in São Paulo City (1995-1999)

AIM: To describe the case profile of maternal death resulting from hypertensive disorders in pregnancy and to propose measures for its reduction. METHODS: The Committee on Maternal Mortality of São Paulo City has identified 609 cases of obstetric maternal death between 1995 and 1999 with an underreporting rate of 52.2 percent and a maternal mortality rate of 56.7/100,000 live births. Arterial hypertension was the main cause of maternal death, corresponding to 142 (23.3 percent) cases. RESULTS: Ninety-five (66.9 percent) of the deaths occurred during the puerperal period and 34 (23.9 percent) occurred during pregnancy. The time of death was not reported in 13 (9.2 percent) cases. Seizures were observed in 41 cases and magnesium sulfate was used in four of them. The causes of death were ruled to be cerebrovascular accident (44.4 percent), acute pulmonary edema (24.6 percent), and coagulopathies (14.1 percent). Cesarean section was performed in 85 (59.9 percent) cases and vaginal delivery in 15 (16.0 percent). CONCLUSION: Complications of arterial hypertension are responsible for the high rates of pregnancy-related maternal death in São Paulo City. Quality prenatal care and appropriate monitoring of the hypertensive pregnant patient during and after delivery are important measures for better control of this condition and are essential to reduce disorders in pregnancy.

OBJETIVO: Descrever o perfil dos casos de morte materna decorrente de complicações da hipertensão arterial e propor medidas para sua redução. MÉTODOS: De 1995 a 1999 o Comitê de Mortalidade Materna da Cidade de São Paulo identificou 609 casos de morte materna obstétrica, com uma subnotificação de 52,2 por cento e um CMM=56,7/100.000 Nascidos Vivos. A hipertensão arterial foi a principal causa de óbito materno, correspondendo a 142 (23,3 por cento) casos. RESULTADOS: Ocorreram 95 (66,9 por cento) de óbitos no puerpério e 34 (23,9 por cento) durante a gestação. Em 13 (9,2 por cento) casos não se teve referência ao momento do óbito. Houve relato de crises convulsivas em 41 casos com a utilização de sulfato de magnésio em quatro deles. As principais causas determinantes do óbito foram: o acidente vascular cerebral (44,4 por cento), o edema agudo de pulmão (24,6 por cento) e as coagulopatias (14,1 por cento). A cesárea foi realizada em 85 (59,9 por cento) casos e o parto vaginal em 15 (16,0 por cento). Em 28 (19,7 por cento) casos não foi realizada nenhuma conduta para interromper a gravidez e em 14 (9,8 por cento) não se obteve relato do procedimento. CONCLUSÃO: As complicações da hipertensão arterial no ciclo gravídico-puerperal determinam altos índices de mortalidade materna na cidade de São Paulo. A realização de um pré-natal de qualidade e o atendimento apropriado da gestante hipertensa no parto e no pós-parto são medidas de fundamental importância para um melhor controle desse evento, sendo primordial para a redução dessas ocorrências.

Sulfato de magnésio nas síndromes hipertensivas da gestação: efeitos hemodinâmicos maternos e fetais / Magnesium sulfate in hypertensive disorders of pregnancy: maternal and fetal hemodynamic effects

As síndromes hipertensivas constituem um grupo de intercorrências clínicas que com grande freqüência complicam a gravidez. Acometem cerca de 10 porcento das gestações, encontrando-se entre as principais causas de morte materna e com elevada taxa de morbimortalidade perinatal no mundo, oscilando entre 5 e 20 porcento. O sulfato de magnésio é a droga de escolha para profilaxia e tratamento das convulsões eclâmpticas, e seus efeitos benéficos em termos de prevenção das crises convulsivas e redução da morte materna foram já demonstrados em ensaios clínicos bem controlados. Sugere-se que o magnésio possa ainda exercer um importante papel na regulação da pressão sangüínea por modulação da reatividade do tono vascular e da resistência periférica total. Entretanto, o papel desses efeitos no tratamento dos distúrbios hipertensivos da gravidez não foi ainda elucidado. Desta forma, a presente revisão tem como objetivo descrever os mecanismos de ação do sulfato de magnésio e avaliar seus possíveis efeitos sobre a circulação materno-fetal. Até o momento não foi encontrada nenhuma evidência de que o sulfato de magnésio possa acarretar benefícios hemodinâmicos para a mãe e o feto, existindo muitas controvérsias na literatura.

Eclampsia : before and after magnesium sulphate.

This study was done to see the incidence and impact of changes in the intervention strategy for the management of eclampsia in a maternity hospital on maternal and perinatal outcome. Analysis of case records of all eclampsia cases over two different study periods designated as study period A (April, 1994 to Oct, 1996) and study period B (April, 2000 to April, 2001) were done. Total number of eclampsia cases who received intervention over two different study period (46 in study period A and 47 in study period B) were comparable despite the difference in the duration of study period. During study period A, diazepam was used as anticonvulsant, whereas magnesium sulphate was used to control fits during study period B. Incidence of eclampsia has markedly increased in this hospital (0.12% vs 0.29%). Epidemiology and clinical profile of eclamptic patients do not show remarkable change. There was no maternal death in study period B (April, 2000 to April, 2001) whereas there was one maternal death in the study period A (April, 1994 to October, 1996). Marked improvement was noticed in terms of recurrence of fit (19.13% vs 73.91%) with change in the intervention strategy. Perinatal deaths were fewer in study period B (20% vs 33%). Overall, it seems that care of eclamptic patients and use of magnesium sulphate as anticonvulsant has resulted in positive impact on maternal outcome.

Use of parenteral magnesium sulphate in eclampsia and severe pre-eclampsia cases in a rural set up of Bangladesh.

This was a quasi-experimental interventional study to see the role of injection magnesium sulphate in eclampsia and severe pre-eclampsia patients at community level in a rural set up before referral to the hospital. This study was conducted on 265 cases of eclampsia and severe pre-eclampsia over a period of six months from July 2001 to December 2001. Among 265 cases, 133 were in intervention group who had received loading dose of injection magnesium sulphate before referral and the rest 132 were in non-intervention group, had not received injection magnesium sulphate before admision in hospital. The number (mean +/- SD) of convulsion before treatment in intervention and non-intervention groups were 4.7 +/- 2.64 & 6.86 +/- 2.97 respectively. Recurrence of fits observed more in non-intervention group and the difference was statistically significant (p<.001). Mean (+/- SD) time taken to regain full consciousness was 12.0+9.6 and 17.4+7.4 hours in the intervention and non-intervention group respectively (p<.05). Control of convulsion by loading dose of 10 gm of injection magnesium sulphate was achieved in 94.0% of the intervention group and 74.0% in non-intervention group. There was only 3(2.3%) maternal death in study group whereas in non-intervention group maternal death was 14(10.4%) and the difference was highly significant (p<.005). Fourteen (13.7%) babies were still born in intervention group and 21(20%) in non-intervention group. The difference was statistically highly significant (p<.001). Remarkable achievements were obtained through use of magnesium sulphate at the community level at rural setting among the eclampsia and severe pre-eclampsia cases.

Mediciones hemodinámicas de la preeclampsia severa/eclampsia: ¿Es determinante su aportación para aplicar maniobras terapéuticas? / Severe pre-eclampsia/eclampsia. Hemodynamic measuring: is its contribution a determinant to apply therapeutic maneuvers?

La preeclampsia severa/eclampsia presenta cambios en el gasto cardíaco y en la oxigenación sistémica. Estas pacientes pueden cursar con fase hipodinámica o hiperdinámica, por lo que es determinante conocer objetivamente cual de estas etapas está presente. Objetivo: Utilizando el principio de Fick, determinar el estado hemodinámico, las variables del gasto cardíaco y del equilibrio del oxígeno, y realizar la estabilización prealumbramiento. Materiales y métodos: Se realizó un estudio descriptivo, prospectivo y longitudinal en pacientes portadoras de preeclampsia severa/eclampsia. Se analizaron el gasto cardíaco (Qt), la disponibilidad de O2 (DO2), el consumo de oxígeno (VO2), la tasa de extracción de O2 (O2ER) y las resistencias periféricas totales (RPT), y los valores de la presión venosa central (PVC), TAS, TAD, PAM y FC durante las tres fases siguientes: basal, la estabilización prealumbramiento y final. La terapia de estabilización se efectuó con administración de soluciones cristaloides, coloides, vasodilatadoras y sulfato de magnesio. Estas variables se analizaron mediante la prueba de ANOVA con una p< 0.05. Resultados: todas las pacientes cursaron con fase hipodinámica. Durante la terapia de prealumbramiento se observó un incremento en el Qt, DO2, VO2 y PVC en la fase de estabilización, y una disminución de las RPT estadísticamente significativa. En las variables de TAS, TAD y PAMd existió disminución, siendo más acentuada en la fase final. Los volúmenes urinarios fueron mayores de 1 ml/ka/h en la fase final. Discusión y conclusiones: Las pacientes estudiadas cursaron con fase hipodinámica con una evolución satisfactoria. Concluimos que es indispensable el conocimiento de la oxigenación sistémica para definir una terapéutica dirigida y favorecer el pronóstico en el postoperatorio inmediato.

Intoxicacion por sulfato de magnesio en pacientes con preeclampsia y eclampsia e insuficiencia renal

Se analiza y discute la evolución de dos pacientes, la primera con eclampsia e insuficiencia renal aguda, y la segunda con hipertensión arterial crónica e insuficiencia renal crónica más preeclampsia sobreagregada. Ambas son tratadas con sulfato de magnesio endovenoso y presentan elementos clínicos de intoxicación. Se controla la evolución clínica y bioquímica de las pacientes y los niveles de magnesemia hasta alcanzar niveles normales. Se observa que posterior a la interrupción del sulfato de magnesio, los niveles normales se logran al tercer día en la primera paciente y al décimo en la segunda.

Eclampsia: a hospital based retrospective study.

AIM AND OBJECTIVE: This study was done to see the incidence, epidemiology , clinical profile of eclamptic patients and the effect of current intervention strategy for Eclampsia on maternal and perinatal outcome. METHODOLOGY: Analysis of case records of all Eclampsia cases from mid-April,2000 to mid-April,2001. RESULTS: Incidence of Eclampsia has was found to be 2.9 per 1000 deliveries. Eclampsia was primarily a disease of young women (97.22%) and nulliparas (80.85%). Approximately half of eclamptic patients had some antenatal care (55.31%) and majority of them had fits before the onset of labour (70.21%). Most eclamptic patients presented with fits at term pregnancy (72.34%). About three fourth of them started fitting at home (74.46%) but one fourth had first fit while already admitted in the hospital (25.53%). Caesarean section was common mode of delivery (55.31%). There was no maternal death. Majority of patients stopped fitting once intervention was started (80.85%) and went home within three weeks (95.73%). One fifth of babies died [stillbirths (14%), neonatal deaths (6%)]. CONCLUSION: It appears that current intervention strategy for eclampsia in the maternity hospital is effective in reducing maternal mortality and morbidity but perinatal outcome still needs to be improved.

Dilantin as anticonvulsant in eclampsia.

Sixty-six cases of eclampsia amongst 9178 deliveries were managed from July, 1997 to December, 1998 in the department of obstetrics and gynaecology at UCMS & GTB Hospital, Delhi. The aim was to evaluate the changing trends in patients of eclampsia and to assess the efficacy of dilantin in its treatment. The incidence recorded was 1 in 139 deliveries (0.7%). Majority (90.91%) were unsupervised in antenatal period and 68.18% were primigravidae. Eclampsia developed at < 28 weeks of pregnancy in 3.03% of patients. All the patients had hypertension and proteinuria at the time of admission and 51.52% showed hypertensive changes on fundus examination. While single anticonvulsant therapy in the form of dilantin was used to manage 57.57% of patients, 13.64% required intubation and positive pressure ventilation. Fit recurrence on treatment was noticed in 40.91% of patients. Lower segment caesarean section was conducted in 18.18% of patients. Three maternal deaths (4.56%) attributed to ventricular tachycardia, aspiration and intracerebral haemorrhage were recorded. Morbidity was frequent in the form of status eclampticus (n = 5), postpartum psychosis (n = 5), retinal detachment (n = 1), coagulation abnormality (n = 11). The perinatal mortality rate was 30.43%. The study concludes that eclampsia is still rampant in India and despite better medical facilities, maternal and perinatal mortality remains high. The efficacy of dilantin as anti-eclamptic needs to be reviewed.