Postpartum Eclampsia Management with Lytic Cocktail Solutions in Rural and Semirural Health Care (with Limited Resources) Services in Eritrea

Abstract

: This is a case report of 28-year-old primigravida woman with complaints of mild headache, edema of both legs and history of amenorrhea of eight + months who presented to the maternity hospital. After assessment she was admitted for mild pre-eclampsia management. Two days after admission, her membranes ruptured spontaneously, clear liquor drained and had no signs of true labor on assessment. Four hours later strong uterine contractions started with increased frequency and labor progressed well giving birth spontaneously. Third stage of labor completed with minimum bleeding. Her blood pressure was monitored every 6 hours and in the first 3 days of postpartum period B/P measurement showed slight improvement (160/90, 150/85 and 140/90). She was on Valium 20 mg twice per day. Edema of the extermities and facial puffiness decreased. Uterine involution was within normal limits. Her breasts were full and normal. Eighty hours after delivery while being assessed for postpartum follow up client developed seizures suddenly which lasted for 25 seconds. Management & Treatment : Supportive care, Valium 20 mg IV and Pethedine 100 mg IM were given stat and then an in-dwelling catheter was inserted. Lytic cocktail Solution I (Pethedine 50 mg, promethazine (Phenergan) 50 mg and chlorpromazine (largactile 50 mg) in 250 ml of 10% Dextrose was administered intravenously over 30 minutes. Since convulsions was not controlled, Solution II Lytic cocktail (chlorpromazine 100 mg and Pethedine 50 mg) in 250 ml of 10% Dextrose in water was prepared and given intravenously at 40 drops/min. While taking the Solution II Lytic cocktail she had one convulsion that lasted for 7 seconds. The same Solution II was prepared and continued intravenously at a slower rate. Convulsion was controlled. Later, she developed fever, tachycardia, crepitation of the lungs and urine output decreased. She was treated with anti-biotics, diuretics and digoxin with good outcome. The patient was followed as an outpatient weekly, biweekly and monthly after discharge. Conclusion: A pregnant or postpartum mother with blood pressure of 170/100 and history of convulsion require continued follow up by a skilled attendant in a health facility. Early hospital discharge for such cases should not be practiced under any circumstances. The need for trained, committed maternal health care providers, equipped health facility including availability of medication like magnesium sulfate to control convulsion. Up dated eclampsia management procedures (guidelines/ protocols) must be available and health care providers should be well oriented on how and when to use them properly.