MAKALAH

EKLAMSIA






Oleh :

Name : NOVITA UTAMI
NPM : 13002
Level : 1 A

AKBID MITRA HUSADA MEDAN
T.A. 2013/2014

CHAPTER I
INTRODUCTION

A. Background
Eclampsia is a cause of the increased risk of maternal morbidity and mortality and
perinatal.kejadian eclampsia in developing countries ranges from 1 in 100 to 1 in 700 births.
In pre-eclampsia and eclampsia Indonesia range of 1.5% to 25%. Significant life-threatening
complications as a result of maternal eclampsia is pulmonary edema, liver and kidney failure,
DIC, HELLP syndrome and brain hemorrhage.
Eclampsia called antepartum, intrapartum, or postpartum. Depend on whether the
seizures arise before, during or after childbirth. Eclampsia occurs most often in the last
trimester and become more frequent near term.
A major problem in preventing and treating eclampsia is the cause of the condition is
unknown. There is a strong association between hypertension and cerebral diseases that
identify the clinical similarities between eclampsia and hypertensive encephalopathy
(Vaughan & Delanty 2000).
However, the significant results obtained indicate that hypertension is not always the
perkursor onset eclampsia but almost always occurs after a seizure.

B. Purpose
a. Able to perform midwifery care in patients with eclampsia.
b. Able to carry out an assessment and collect data of patients with eclampsia.
c. Being able to interpret correctly the problem or diagnosis based on the data of the
patients with eclampsia.
d. Able to identify potential diagnoses that may occur in patients with eclampsia.
e. Being able to identify the need for urgent action independently, collaboration and
referral in patients with eclampsia.
f. Merancanakan capable of rational care according to the needs of patients with
eclampsia.


CHAPTER II
THEORETICAL REVIEW

A. Definition
Eclampsia is derived from the Greek word meaning "lightning" because it came with a
sudden eclampsia symptoms and causes serious atmosphere in obstetrics. Eclampsia is also
called an acute life-threatening complication of pregnancy, is characterized by the appearance
of tonic - clonic seizures, usually in patients who have had preeclampsia. (Pre-eclampsia and
eclampsia are collectively called hypertensive disorder of pregnancy and toxemia of
pregnancy.) Prawiroharjo, 2005.
Eclampsia is a disorder of pregnancy, childbirth or the postpartum period marked by
seizures (not arising from nerve abnormalities) and or coma which previously had symptoms
of pre eclampsia. (Ong Tjandra & John 2008)
Eclampsia include seizures and coma that occur during pregnancy. Ahead of seizures -
seizures may be preceded by symptoms:
Headache in the frontal region
epigastric pain
increasingly blurred vision
The presence of nausea and vomiting
Examination shows hyperreflexia or easy teransang.

Then the ischemia theory placental implantation can also occur various symptoms of
eclampsia, namely:
1. Increase in blood pressure
2. Expenditure protein in the urine
3. Edema feet, hands to the face
4. Occurrence of subjective symptoms:
Headache
Blurred vision
Pain in the epigastric
Shortness of breath
Reduction of urine
5. Decreased awareness of pregnant women to coma
6. Occurrence of seizures

In normal pregnancy blood test there is an increasing angiontensin, renin and aldosterone
as compensation so that the blood circulation and metabolism can take place. In eclampsia the
decline of angiotensin, renin and aldosterone but can be found edema, hypertension and
proteinuria.
Based on the timing of eclampsia can be divided:
1. Eclampsia gravidarum
incidence of 50% to 60%
The attack occurred in a state of pregnancy
2. Eclampsia parturientum
The incidence of about 30% to 50%
While inpartu
Limit the specified eclampsia gravidarum difficult especially when starting inpartu
3. Eclampsia puerperal
10% rarely Genesis
There was a seizure or coma seletah delivery ends
Seizures - seizures in eclampsia consists of 4 levels:
1. The initial rate or aura
Lasts 30-35 seconds
Hand and shaking eyelids
Eyes open with a blank look
Head on a swivel to the right or to the left
2. Levels tonic seizures
Takes about 30 seconds
The whole body rigid: a rigid face, breathing stops, can be followed by cyanosis,
holding hands, feet turn inward, the tongue may be bitten.
3. Levels clonic seizures
Lasts 1 to 2 minutes
seizures tonic clonic seizure turns into
Concentration of rapid muscle
open mouth closed and be bitten off his tongue
Eyes bulging
Mouth foaming
Advance congestion and cyanosis appear
Patients may fall, causing additional trauma
4. Levels coma
After clonic seizures stopped breathing patients
Followed, whose length varies

During seizures - seizures may occur the temperature rose to 40 C, quickened pulse, and
blood pressure increases.
Seizures can cause complications in the mother and fetus.
1. Complications mother:
o May cause cyanosis
o Aspiration of saliva adds impaired lung function
o increased blood pressure cause brain hemorrhage and sudden heart failure
o The tongue may be bitten
o Falling out of bed causing fractures and wounds - wounds
o Impaired renal function
o Bleeding
o Impaired liver function and cause ikhterus
2. Complications of the fetus in utero:
o sudden asphyxia
o Placental abruption
o Delivery of prematurity
Various factors affecting eclampsia:
The number of primigravida especially young primigravida
Excessive uterine distension is hidramnoin, double pregnant and sunfish hidatosa
The presence of diseases that accompany pregnancy are diabetes mellitus, obesity
The number of maternal age above 35 years

B. Etiology of eclampsia
With the causes of maternal death are hemorrhage of the brain, heart failure or kidney
pains, and gastric fluid aspiration or pulmonary edema - pulmonary. While the causes of
infant mortality are birth asphyxia and prematurity, intrauterine.
The mechanism of fetal death in utero in patients with eclampsia:
a. Due to O2 deficiency causes metabolic changes in the direction of fat and protein may
lead to ketone bodies
b. Stimulate and alter the balance of the vagus nerve simfatis and the cause:
Changes in fetal heart rate becomes tachycardia and bradycardia and continued into an
irregular rhythm
increased intestinal peristalsis and sphincter ani in keluarkannya open so that will
meconium into the lungs - lungs at the first time of neonatal aspiration.
c. So if O2 deficiency state can continue to accrue until the occurrence of death distress in
the womb and outside the womb.

Therefore it is necessary to pay attention to complications and high rates of maternal and
infant mortality. So the main effort is to prevent pre-eclampsia to eclampsia needs to be
known midwife and subsequent referral to the hospital.

C. Pathophysiology eclampsia
Weight gain and edema caused by accumulation of excess fluid in the interstitial space.
Eclampsia found that at low levels of aldosterone and prolactin concentrations were higher
than in normal pregnancy. Aldosterone is important to maintain plasma volume and regulate
water and sodium retention. Eclampsia as well as on vascular permeability to proteins
increases.
In the placenta and uterus decreased blood flow to the placenta resulting in impaired
placental function. In hypertension resulting in impaired fetal growth-fetal distress to cause
death due to lack of oxygenation. The increase in uterine tone and sensitivity to stimulation
often occurs in eclampsia, parturition prematurus so easily happen.
Changes in renal blood flow due to the decreased kidney, thus causing reduced
glomerular filtration. Abnormalities in the kidneys is important is the relationship with
proteinuria and perhaps the retention of salt and water. Mechanisms of salt and water
retention due to changes in the ratio between glomelurus filtration rate and tubular re-
absorption rate. In normal pregnancy the absorption increases with the increase in glomerular
filtration. The decrease in filtration glomelurus due to spasm arteriolus cause kidney via
glomerular filtration sodium decreased, which led to the retention of salt and water retention.
Glomerular filtration can be down to 50% of normal, thereby causing diuresis further down on
the state of oliguria or anuria may occur.
In the retina appear retinal edema, local or generalized spasm in some arteries rarely seen
bleeding or exudate. Retinal detachment caused by intraocular edema and an indication for
termination of pregnancy. Once the delivery is over, the retina is attached again in 2 days to 2
months. Scotoma, diplopia, and ambiliopia a symptom that indicates the occurrence of
eclampsia. This condition is caused by changes in blood flow in the center of vision in the
cerebral cortex or the retina.
Pulmonary edema is the major cause of death eclampsia patients. Complications caused
by cardiac dekompensasio left. Changes in the brain that vascular resistance in the brain in
hypertension in pregnancy is higher in eclampsia. So that blood flow to the brain and oxygen
consumption will decline in eclampsia.
Metabaolisme and accompanying electrolyte hemokonsentrasi eclampsia is why there is a
shift of fluid and the intravascular space into the interstitial space. This event, followed by an
increase in hematocrit, an increase in serum protein, and increased edema, causing reduced
blood volume, increased blood viskositet, peripheral blood circulation time longer. Therefore,
blood flow to the tissues in various parts of the body is reduced as a result of hypoxia. With
the improvement of the state, hemoconcentration reduced, so that the decrease in hematocrit
can be used as a measure of disease state improvement and success of treatment.
In eclampsia, seizures can cause blood sugar levels to rise temporarily. Asidum laktikum and
other organic acids rose, and bikarbonas natrikus, causing alkali reserve fell. After the seizure,
the organic matter is oxidized so that sodium is released to be able to react with carbonic acid
into bikarbaonas natrikus. Thus, alkaline reserves to recover. At term pregnancy increased
fibrinogen levels. Shorter clotting time and is sometimes found to be less than 1 minute in
eclampsia.

D. The diagnosis of eclampsia
Eclampsia is always preceded by pre-eclampsia. Prenatal care for pregnancies with pre-
eclampsia predisposition should strictly be done in order to be detected as early as possible
the symptoms - symptoms of eclampsia. Often encountered in apparently healthy pregnant
women suddenly go into spasm - eclamptic seizures because of pre-eclampsia was not
detected earlier.
Eclampsia should be distinguished from epilepsy; known in the history of the attacks
before pregnancy or in early pregnancy with no sign of pre-eclampsia, seizures due to
anesthetic drugs, coma because of other reasons.
E. Complications of eclampsia
Complication is the toughest maternal and fetal deaths, the main effort is to give birth to live
babies of mothers who suffer from pre-eclampsia and eclampsia. The complications following
usually occurs in severe pre-eclampsia and eclampsia:
1. Abruption placenta
Because of the high blood takanan, the blood vessels can be easily broken, resulting in
hematoma retropalsenta which can lead to partial placenta detached.
2. Hipofibrinogenemia
The presence of circulating fibrinogen deficiency in the blood, usually below 100 mg per
cent. So checks should be periodically fibrinogen levels.
3. Hemolysis
Damage or destruction of red blood cells due to disruption of membrane integrity of red
blood cells which causes the release of hemoglobin. Showed clinical symptoms of
hemolysis are known as jaundice.
4. Brain hemorrhage
These complications are a major cause of maternal mortality in patients with eclampsia.
5. Eye disorders
Loss of sight for a while, which lasts up to a week. Bleeding sometimes occurs in the
retina which is a sign of impending acute cerebral apoplexy.
6. Pulmonary edema - pulmonary
7. Liver necrosis
Periportal necrosis of the liver in eclampsia is general arteriolar vasopasmus result.
Damage to liver cells can be identified by examination of liver function, particularly the
determination of the enzymes.
8. HELLP syndrome
Is a multisystem damage with signs: hemolysis, elevated liver enzymes, and
thrombocytopenia resulting from systemic endothelial dysfunction. HELLP syndrome
can occur in two mid-trimester of pregnancy until a few days after giving birth.
9. Kidney disorders
This disorder is a endoteliosis glomerular endothelial swelling of renal tubular cell
cytoplasm without other structural abnormalities. Other disorders that can arise is anuria
to kidney failure.
10. Kopmlikasi others are tongue biting, trauma and fractures from falls due to seizures -
seizures aspiration pneumonia, and DIC.
11. Prematurity, dysmaturity, and intra-uterine fetal death.

F. Prognosis eclampsia
Eclampsia in Indonesia is still a disease of pregnancy where the victims of the mother and
baby (Hanifa in Prawiroharjo, 2005).
Diurese be held for prognosis; if diurese more than 24 hours in 800 cc or 200 cc every 6 hours
eating somewhat better prognosis. Instead oliguric and Anuri a bad symptom.
Symptoms - other symptoms aggravate prognosis is presented by Eden; long coma, pulse
above 120 x / min, temperatures above 39 C, a blood pressure above 200 mmHg, proteinuria
10 grams a day or more, the absence of edema, pulmonary edema - pulmonary and apoplexy
is a condition that usually precedes death.

G. Prevention of eclampsia
In general, the incidence of eclampsia can be prevented or subtract frekuensinyadi.
Efforts - efforts to reduce eclampsia consists of increasing the number of antenatal
examination hall and see to it that all women haiml check myself since early pregnancy,
finding in each examination mark - a sign of pre eclampsia and treat immediately if found,
terminate the pregnancy at 37 weeks sedapatnya up when treated sign - a sign of pre
eclampsia can also not be lost. (Hanifa in Prawiroharjo, 2005)

H. Handling eclampsia
The main goal is to stop the recurrence of eclampsia handling seizures and terminate the
pregnancy as soon as possible in a safe manner after maternal circumstances permit. Handling
is done:
Give drug anticonvulsants
Equipment for the treatment of seizures
Protect the patient from possible trauma
aspirations of the mouth and throat
lay the patient on the left side
ririskiky trandelenburg position to reduce the risk of aspiration
give oxygen 4-6 liters / minute.




REFERENCES
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Manuaba, Ida Bagus Gede , Ilmu kebidanan , Penyakit kandungan dan Kb untuk pendidikan
bidan , Jakarta EGC 1998
Obstetri William : panduan ringkas / Kenneth J. Lereno, Egi Komara Yudha, Nike Budhi
Subekti, Jakarta EGC 2009.
Rukiyah, Lia yulianti. 2010. ASUHAN KEBIDANAN 4 PATOLOGI, Jakarta Tim.