Severe Pre-Eclampsia - Childbirth Series — Transcript

Full transcript

1. 0:04Severe pre-eclampsia.
2. 0:09Pre-eclampsia is a serious problem that
3. 0:12can occur in the last half of pregnancy
4. 0:15through 2 weeks after birth.
5. 0:17It can cause convulsions or strokes and
6. 0:20can be life-threatening for both woman
7. 0:22and baby.
8. 0:24This video will show how to determine if
9. 0:27a woman has severe pre-eclampsia
10. 0:30and how to manage her first care.
11. 0:39This woman is in her last few weeks of
12. 0:42her first pregnancy.
13. 0:44She is here with a severe headache that
14. 0:46hasn't gotten better with pain medicine.
15. 0:49This is a danger sign for pre-eclampsia.
16. 0:53Ask the woman about other danger signs.
17. 0:57Does she have changes in her eyesight
18. 1:00such as blurred vision or seeing spots?
19. 1:04Difficulty breathing
20. 1:07or pain in her right upper abdomen?
21. 1:12Now, take her blood pressure.
22. 1:14It's too high if the top number is more
23. 1:16than 140
24. 1:19or the bottom number is more than 90.
25. 1:35This woman's blood pressure is 150 over
26. 1:3896.
27. 1:40This is too high.
28. 1:44Next, check the woman's urine for
29. 1:46protein.
30. 1:48To get an accurate sample, ask her to
31. 1:50clean the inner lips of her vagina and
32. 1:53hold them open.
33. 1:55Start to urinate.
34. 1:57Then a clean cup under the stream.
35. 2:03Now check to see if she has protein in
36. 2:05her urine.
37. 2:08To use a test strip, dip the end of the
38. 2:10strip in the urine.
39. 2:13Wait a moment, then compare the color of
40. 2:15the square on her strip to those on the
41. 2:18bottle.
42. 2:20In this example,
43. 2:22protein is the top row.
44. 2:28Her square matches the square indicating
45. 2:31three plus protein.
46. 2:35Two plus protein or more is abnormal.
47. 2:41This woman has severe pre-eclampsia.
48. 2:44She has one danger sign,
49. 2:47plus high blood pressure,
50. 2:49and protein in her urine,
51. 2:52two plus or more.
52. 2:56Severe eclampsia is also diagnosed if a
53. 2:59woman has very high blood pressure,
54. 3:02more than 160 over 110,
55. 3:06plus protein in her urine.
56. 3:11A woman with severe pre-eclampsia needs
57. 3:13treatment right away.
58. 3:16Tell the woman about her condition and
59. 3:18what you need to do to help her.
60. 3:21To prevent convulsions, she will need a
61. 3:23loading dose of magnesium sulfate right
62. 3:26away.
63. 3:28If you transfer the woman to a higher
64. 3:29level of care, give her the loading dose
65. 3:32before she leaves.
66. 3:36Have a pre-eclampsia emergency kit
67. 3:38stocked and kept in a location that
68. 3:41staff can access at all times.
69. 3:47The kit should have
70. 3:49magnesium sulfate 50% 1 g in 2 ml
71. 3:53ampules, at least 16.
72. 3:572% lidocaine,
73. 4:00sterile water or saline,
74. 4:02calcium gluconate 1 g,
75. 4:05medicine for high blood pressure,
76. 4:07IV cannula,
77. 4:09a reflex hammer,
78. 4:11tape,
79. 4:13a tourniquet,
80. 4:151 20 ml syringe,
81. 4:182 10 ml syringes,
82. 4:20and exam gloves.
83. 4:25There are two standard regimens for
84. 4:27giving magnesium sulfate.
85. 4:31An IM plus IV regimen
86. 4:35and an IV only regimen if you can
87. 4:37precisely monitor IV flow rates in your
88. 4:40facility.
89. 4:44Here the IM plus IV regimen is used.
90. 4:47Prepare three syringes.
91. 4:51The IV dose is 4 g or 8 ml of magnesium
92. 4:56sulfate 50%
93. 4:58plus 12 ml of sterile water for
94. 5:01injection in a 20 ml syringe.
95. 5:06This makes a 4 g magnesium sulfate 20%
96. 5:10solution.
97. 5:13The two IM doses have 5 g or 10 ml of
98. 5:17magnesium sulfate 50%
99. 5:20plus 1 ml of lidocaine in each syringe.
100. 5:29Let the woman know you will be giving
101. 5:31her medicine by IV followed by two IM
102. 5:34injections, one in each buttock.
103. 5:38Let her know it's normal to feel warm
104. 5:41all over her body.
105. 5:43Give the IV dose slowly over 5 minutes.
106. 5:55Then, give the two IM injections.
107. 5:59Locate the injection site in the upper
108. 6:02outer quadrant of the buttock.
109. 6:09Clean the site.
110. 6:14Then, give the injection deep in the
111. 6:16muscle.
112. 6:43Give the second injection in the other
113. 6:45buttock.
114. 7:02Give only the two IM injections if you
115. 7:04cannot give medicine by IV in your
116. 7:07facility.
117. 7:15A woman with severe preeclampsia can
118. 7:17convulse at any time.
119. 7:23Act fast. This is an emergency.
120. 7:27Position her on her side, but don't put
121. 7:29anything in her mouth.
122. 7:32Give her oxygen if available.
123. 7:34Stay with her at all times.
124. 7:38If she has not yet received a loading
125. 7:40dose of magnesium sulfate. Give it now.
126. 7:46If she has another convulsion after 15
127. 7:49minutes,
128. 7:50give 2 g or 4 ml of magnesium sulfate
129. 7:5350% IV slowly over 5 minutes.
130. 8:01A woman with severe preeclampsia or
131. 8:04eclampsia needs advanced care.
132. 8:07If your facility cannot provide close
133. 8:09monitoring, the woman must be
134. 8:11transferred after receiving the initial
135. 8:14loading dose of magnesium sulfate.
136. 8:19Explain to the woman the need for higher
137. 8:22level care.
138. 8:24Then, make contact with the hospital to
139. 8:27let them know the condition of the
140. 8:28woman,
141. 8:29the care already provided, and the
142. 8:31estimated time of arrival.
143. 8:35Write a referral note.
144. 8:38Transfer the woman with a skilled health
145. 8:41worker and a companion to provide care
146. 8:44and monitoring.
147. 8:50Remember,
148. 8:53preeclampsia occurs in the last half of
149. 8:55pregnancy up to the first few weeks
150. 8:58after birth.
151. 9:01A woman has severe preeclampsia if she
152. 9:04has a danger sign,
153. 9:06high blood pressure,
154. 9:08and protein in her urine.
155. 9:12Have a preeclampsia emergency kit
156. 9:15stocked and ready.
157. 9:40Mhm.