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.

Atuação do enfermeiro a pacientes portadoras de síndrome hipertensiva específica da gestação / Nursing's action against patients with specific hypertensive management syndrome

Objetivo: Identificar a importância da assistência de enfermagem às gestantes com Síndrome Hipertensiva Gestacional. Método: Estudo bibliográfico, descritivo e exploratório, realizado busca no banco de dados da Biblioteca Virtual em Saúde (BVS), Sistema Latino-Americano e do Caribe de Informações em Ciências da Saúde (LILACS), Scientific Eletrônic Library Online (SCIELO) e Bancos de dados em enfermagem (BDENF). Resultados: A Síndrome Hipertensiva da Gravidez (SHEG) apresenta como uma das mais importantes complicações durante o ciclo gravídicopuerperal e a sua etiologia ainda permanece desconhecida. A pré-eclâmpsia evolui naturalmente e quando não tratada/interrompida a gestação, ocorre o desenvolvimento para as formas mais graves, especialmente, a eclampsia e a síndrome HELLP. É de grande importância que o profissional de enfermagem atue de forma mais efetiva e presente, para que as reais necessidades das pacientes sejam supridas, havendo melhora do quadro clínico e eventuais complicações sejam evitadas. Conclusões: A assistência efetiva durante o pré-natal, pelos profissionais, diminui os índices de SHEG em gestantes e as tiram do grupo de risco, principalmente as que possuem fatores predisponentes e etiológicos. Assim, é possível descrever a atuação do enfermeiro frente à patologia, observando a necessidade de um trabalho conjunto à uma equipe multidisciplinar para que ocorra um atendimento eficaz à gestante (AU)

This study aimed to identify and characterize the importance of nursing care for pregnant women with Gestational Hypertensive Syndrome. Method: Bibliographic,descriptive and exploratory study, searches the database of the Virtual Health Library (VHL), Latin American and Caribbean Health Sciences Information System (LILACS), Scientific Electronic Library Online (SCIELO) and Banks. of Nursing Data (BDENF). Results: Hypertensive Pregnancy Syndrome (SHEG) is one of the most important complications during the pregnancy-puerperal cycle and its etiology is still unknown. Preeclampsia evolves naturally and when untreated / interrupted pregnancy develops into the most severe forms, especially eclampsia and HELLP syndrome. It is of great importance that the nursing professional acts more effectively and present, so that the real needs of patients are met, with improvement of the clinical picture and eventual complications are avoided. Conclusions: The effective prenatal care by professionals reduces the rates of SHEG in pregnant women and remove them from the risk group, especially those with predisposing and etiological factors. Thus, it is possible to describe the role of nurses in the pathology, noting the need for a joint work with a multidisciplinary team for effective care to pregnant women (AU)

Epilepsia na gravidez / Epilepsy in pregnancy

As epilepsias constituem uma das mais frequentes condições neurológicas encontradas na gravidez, ocorrendo entre 0,5% e 1% das gestações. O risco de morte materna está aumentado em 10 vezes nas grávidas epilépticas. Na gestante, o diagnóstico adequado é fundamental, já que deve ser afastada a possibilidade de se tratar de crise de eclâmpsia, doença exclusiva do período gravídico-puerperal. A preocupação materna quanto aos efeitos adversos (malformações) das drogas antiepilépticas no bebê pode levar à descontinuação ou redução da dose do medicamento, aumentando o risco de convulsão ou de morte súbita e inesperada na epilepsia (SUDEP). Nesta revisão foi dada atenção única e exclusiva às recomendações do Royal College of Obstetricians and Gynaecologists.(AU)

Epilepsiy is one of the most frequent neurological conditions found in pregnancy, occurring in 0.5 to 1% of pregnancies. The maternal death risk is increased 10-fold in epileptic pregnancies. In pregnant women, its adequate diagnosis is essential, since eclampsia is a differential diagnosis, which is disease exclusive to the pregnancy-puerperal period. Maternal concerns about the adverse effects (malformations) of antiepileptic drugs in the infant may lead to the discontinuation or reduction of the drug dose, increasing the risk of seizure or sudden and unexpected death in epilepsy (SUDEP). In this review exclusive attention was given to the recommendations of the Royal College of Obstetricians and Gynecologists.(AU)

Guía de práctica clínica para la prevención y manejo de preesclampsia y eclampsia: versión extensa / Clinical practice guide for the prevention and management of pre-eclampsia and eclampsia: extended version

Este documento abarca temas de prevención y tratamiento de preeclampsia y eclampsia.

Strengthening the healthcare services to prevent severe Pre-eclampsia and Eclampsia.

Preeclampsia is a hypertensive, multi-system disorder of pregnancy whose etiology remains unknown. Although management is evidence-based, preventive measures/screening tools are lacking, treatment remains symptomatic, and delivery remains the only cure. As in the past, the current role of physicians and nurses in the management of pre-eclampsia-eclampsia continues to revolve around the protection of maternal/foetal wellbeing and optimization of positive health outcomes. Given that effective preventive measures and screening tools is presently lacking, routine assessment of the signs/symptoms indicative of pre-eclampsia/eclampsia remains critical to the detection, monitoring, and effective management of pre-eclampsia/eclampsia. Patient education and the provision of a supportive environment are also essential to the optimal management of preeclampsia/ eclampsia. This article deals with the integration of health care services in preventing the complications of pre-eclampsia.

Eclampsia: still a major cause for adverse maternal and perinatal outcome

To determine the frequency of eclampsia and to investigate the maternal and perinatal outcome of the condition in order to identify whether further improvements can be made to the care of women by early interventions. A descriptive observational study. This study was conducted at the Department of Obstetrics and Gynaecology, Ghulam Muhammad Mahar Medical College Teaching Hospital Khairpur Mir's Sindh, during one year period from 1[st] January to 31[st] December 2010. All patients presenting with eclampsia in the labour room were included in the study. The diagnosis was based on case definition and was managed according to the set protocols. Data was recorded on pre-designed Performa. A total of 2796 patients were admitted in labour room during the study period and out of them total cases of eclampsia were 81 patients thus contributing 2.89% of the total admission. Most of the patients were unbooked only 11% patients were booked. 49% of women had first fit in the antenatal period, 37% in intrapartum while 13.5% had first fit in postpartum period. Headache and raised blood pressure was found in 85% of cases. 91% of women received magnesium sulphate, platelet count <150,000/m 3 were found in9.8%, deranged LFT in 14.8% women and abnormal renal function test were found in 34% . Mode of delivery was caesarean section in 57% patients, vaginal delivery in 34.2%. Two patient needed hysterectomies due to severe PPH, 4 maternal deaths were observed in study population. Regarding perinatal outcome 35 fetuses born with LBW, 26 were still born and 9 died in neonatal period. Eclampsia has strongly significant adverse impact on mother and fetus, which could be avoided by provision of integrated, adequate MCH services especially during antenatal period

Influencia de la preeclampsia/eclampsia en los indicadores de la mortalidad perinatal / Influence of preeclampsia / eclampsia in perinatal mortality indicator lamps

Introducción: La mortalidad materna perinatal es uno de los indicadores básicos que miden la calidad de la asistencia obstétrica. Objetivos: determinar la influencia de la preeclampsia/eclampsia en los indicadores de la mortalidad perinatal...

Resultados de la atención a pacientes con riesgo de preeclampsia-eclampsia / Outcomes of patient care at risk of preeclampsia-eclampsia

Introducción:en la consulta de Riesgo de preeclampsia-eclampsia se realiza el diagnóstico precoz de formas graves y tempranas de preeclampsia. Objetivos: demostrar los resultados de la atención a gestantes con riesgo de preeclampsia eclampsia. Métodos: estudio descriptivo de corte transversal en el municipio de Santa Clara, provincia Villa Clara, en el año 2010. La muestra se conformó con 181 gestantes a las que se les aplicó una encuesta que incluyen los factores de riesgo, se diseñaron estrategias de seguimiento y diagnóstico precoz de formas graves e incipientes de la preeclampsia. Resultados: las edades extremas resultaron el 58,01 porciento del total, con 105 mujeres a predominio del subgrupo de la avanzada edad materna 69 (38,12 porciento)...

Introduction: early diagnosis of serious and early forms of pre-eclampsia is made in the consultation for pre-eclampsia eclampsia. Objectives: to show the results in the care of pregnant women at pre-eclampsia eclampsia risk. Methods: a cross sectional study in the municipality of Santa Clara, Villa Clara during 2010. The sample consisted of 181 pregnant women to whom they were given a survey including risk factors; strategies were designed for monitoring and early diagnosis of serious and emerging forms of preeclampsia. Results: the extreme ages were 58.01 percent out of the total, 105 women with a predominance of the subgroup of advanced maternal age 69 (38.12 percent)...

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

Frecuencia de recién nacidos con bajo peso al nacer en pacientes con síndrome hipertensivo del embarazo en el hospital municipal Boliviano Holandés: experiencia institucional / General medical service support obstetrics and gynecology Netherlands Bolivian municipal hospital

PREGUNTA DE INVESTIGACIÓN¿Cuál es la frecuencia de recién nacidos (RN) con bajo peso al nacer(BPN) en pacientes con síndrome hipertensivo del embarazo (SHE),en el Servicio de Ginecología y Obstetricia del Hospital Municipal Boliviano Holandés entre septiembre de 2005 y septiembre de 2006? OBJETIVO GENERALConocer la frecuencia de RN con BPN en pacientes con SHE enel Servicio de Ginecología y Obstetricia del Hospital Municipal Boliviano Holandés en 13 meses de estudio. OBJETIVOS ESPECIFICOS Conocer el peso de RN de pacientes con síndrome hipertensivodel embarazo. Identifi car la edad gestacional de RN de pacientes con síndromehipertensivo del embarazo. Determinar la relación entre los tipos de síndrome hipertensivo delembarazo y RN con BPN. Identifi car la presencia de óbito en pacientes con síndrome hipertensivo del embarazo. MATERIAL Y METODOS El presente trabajo es un estudio descriptivo donde se revisó 210 historias clínicas de pacientes con síndrome hipertensivo del embarazo, internadas en el Servicio de Ginecología y Obstetricia del Hospital Municipal Boliviano Holandés de la ciudad de El Alto, entre septiembre de 2005 y septiembre de 2006.RESULTADOS En las 210 historias clínicas revisadas en el Servicio de Ginecología y Obstetricia del Hospital Municipal Boliviano Holandés en el período mencionado, hallamos 57 casos de RN con BPN, que correspondea 27,1...

Magnesium sulphate prophylaxis in pre-eclampsia

To determine the efficacy of magnesium sulphate in the management of preeclampsia. Ward 8, Department of Obstetrics and Gynaecology, Jinnah Post Graduate Medical Center [JPMC] Karachi, from January 2004 to December 2004. A study was done using non random purposive sampling. Study population consisted of 100 pre-eclamptic women. All women with severe pre-eclampsia and impending eclampsia were recruited in the study with blood pressure more than 140/100 mm Hg, proteinuria + + on dipstick or signs and symptoms of impending eclampsia like epigastric pain, nausea, vomiting, headache associated with sever hypertension. Fifty patients had magnesium sulpahte prophylaxis and 50 [control group] without any anticonvulsant. Before giving magnesium sulphate, the clinician checked that knee and other tendon reflexes were present, respiratory rate was normal [more than 16 breaths per minute] and urine output more than 100 ml in last four hours or greater than 25 ml in last four hours. The average age of patients with magnesium sulphate prophylaxis was 28.06 +/- 5.5 years and for controls, it was 27.88 +/- 5.46 years. A significant reduction in the rate of eclampsia in women assigned to magnesium sulphate 2% versus 12% [p<0.05, OR 0.15] was noted. However there was no significant reduction in the rate of abruptio placentae in either group, 6% versus 8% [p>0.5]. The rate of caesarean section was lower in women given magnesium prophylaxis 6% versus 17% [p=0.01]. There was no significant difference inperinatal outcome in either group, 41% live births in study versus 38% amongst controls [p=0. 91]. No maternal death was observed in either group. Magnesium sulphate minimizes the risk of eclampsia and decreases the morbidity and mortality related to eclampsia but at the same time it does not prevent the progression of pre-eclampsia and therefore maternal and fetal surveillance should be continued irrespective of magnesium sulphate prophylaxis

Mortalidade materna na cidade de São Paulo de 1995 a 1999, com ênfase em hipertensão arterial / Maternal mortality in the city of São Paulo, from 1995 to 1999, with emphasis on hypertension

Analisou-se a mortalidade materna na cidade de São Paulo de 1995 a 1999, com ênfase nas mortes decorrentes de complicações da hipertensão arterial. Verificaram-se falhas no atendimento à mulher em idade fértil, tais como planejamento familiar insatisfatório, atendimento pré-natal inadequado e ineficiente, presença de grandes deslocamentos à procura de vaga hospitalar, existência de hospitais com estrutura desprovida de condições ao atendimento da gestante hipertensa e suas complicações, falta de medicação apropriada para a prevenção das crises convulsivas e acompanhamento pós-natal deficitário. São sugeridas medidas para o atendimento apropriado da gestante e puérpera hipertensa / Maternal mortality in the City of São Paulo between 1995 and 1999 was analysed, emphasizing death resulting from hypertension omplications. Faults were detected in the care given to women of reproductive age, such as unsatisfactory family planning, inadequate and inefficient prenatal care, long distances to overcome in search of a hospital vacancy, existence of hospitals with structures that lacked the necessary conditions to provide care to pregnant women with hypertension and its complications, lack of appropriate medication to prevent seizures and deficient postnatal follow-up. Measures are suggested for the appropriate care of hypertensive pregnant and puerperal women...

Descripción epidemiológica de la eclampsia en el Hospital Bertha Calderon Roque en el período enero-diciembre de 1998

Este estudio se realizó en el Hospital Bertha Calderón Roque, en la unidad de cuidados intensivos cuyo universo fueron 86 pacientes y la muestra fue de 47 pacientes con eclampsia. Esto es debido al subregistro de estas pacientes. La tasa de eclampsia en adolescentes es de 2,91 x 1000 nacidos vivos y en mayores de 19 años de 2.56 x 1000 nacidos vivos. La mayoria de las pacientes eran originarias de Managua(31) siendo primigestas nupliparas en su mayoría. Un total de 26 pacientes tenían presiones arteriales mayor de 160/110 y 20 pacientes con 160-140/90/110. El 100 porciento de los casos presentaron proteinuria, del total de pacientes 2 eran hipertensas crónicas, presentaron convulsiones recibiendo SO4MG y 3 entraron en coma. Dentro de las complicaciones 8 presentaron sd HELLP, 10 DPPNI, 7 CID, 9 insuficiencia renal y 6 edema cerebral. La tasa de mortalidad fue de 5.47 por 1000 nacidos vivos para el año 98, siendo la mayor en julio de 1.16 por 1000 nacidos vivos. De las 3 pacientes fallecidas una era primigesta y dos multigestas

Preeclampsia-eclampsia: un problema médico diferido / Preeclampsia-eclampsia: a deferred medical problem

La hipertensión arterial asociada a embarazo es un problema de Salud Pública en México por su alto índice de morbilidad y mortalidad tanto para la madre como para el feto. La investigación sobre este problema se ha mantenido diferida por limitaciones en información clínica y epidemiológica, desconocimiento de su etiología así como por su fácil resolución al interrumpirse el embarazo. Se revisan aquí aportaciones hechas al área en nuestro país y conceptos de control y tratamiento

Fatores associados à eclâmpsia em gestantes com hipertensäo arterial / Factors associated to eclampsia in pregnant women with hypertension

A eclâmpsia é uma das mais temidas complicaçoes dos distúrbios hipertensivos na gravidez, pela alta morbimortalidade, tanto materna quanto perinatal. Apesar dos avanços na Medicina nas últimas décadas, sua etiologia permanece desconhecida. O presente estudo caso-controle teve como objetivo identificar, numa populaçao de gestantes com diagnóstico de hipertensao arterial, fatores associados à ocorrência da eclâmpsia. Foram estudadas 92 gestantes hipertensas com eclâmpsia, pareadas por idade e paridade, com 92 gestantes hipertensas sem eclâmpsia atendidas no CAISM/FCM/ UNICAMP, no período de janeiro de 1986 a janeiro de 1994. A análise estatística foi realizada pelo cálculo do risco relativo estimado (OR) para amostras pareadas por regressao logística. A idade média da populaçao foi de 20 anos e a nuliparidade foi mais prevalente. Identificaram-se como fatores de risco para eclâmpsia o baixo número de consultas ao pré-natal (<5), o nível de pressao arterial (PA) na internaçao > 140/100 mmHg e o edema generalizado. O antecedente de hipertensao arterial crônica, a PA diastólica > 70 mmHg ao início do pré-natal e a PA sistólica > 140 mmHg durante o pré-natal foram identificados como fatores de proteçao. A análise multivariada por regressao logística confirmou o antecedente e a presença de edema generalizado como fatores de risco para a ocorrência de eclâmpsia.