Escolar Documentos
Profissional Documentos
Cultura Documentos
MMR:
194/100,000 live birth
During the period of 2001-2010 Maternal Mortality Ratio reduced by 40% Maternal Mortality Ratio reduced due to Eclampsia: 50%
28%
7%
Hemorrhage
Direct 15%
Indirect 17%
Eclampsia 24%
Direct 20%
Eclampsia
Indirect 5%
20%
Labetalal- 200 mg in 200 ml Normal Saline in 20 drops/hours 1994 MgSo4 In DMCH, first trial 68% eclamptic death 2001 MgSo4 in community . 1998-2001 Participated in Magpie trial- 22 countries including
Bangladesh
2003 Follow up study was done both for mother and child up to
2 years
60-70 drops/minute
Magnesium Sulphate (6g = 12ml) of 50% solution Maintenance Dose Magnesium Sulphate (2.5 g = 5ml) of 50% solution
Deep Intramuscular injection 2.5 g every 4 hourly in alternate buttock. Continue for 24 hours after last convulsion or delivery (If needed)
Control of B.P.
Inj. Hydralazine, 1 amp (20mg) in 200 ml of NS IV @ of 8-10 d/m Or Injection Labeta is used to control acute hypertension.
Inj. Dopamin, 1 amp (200mg) in 200ml of NS IV @ 8-10 d/m till systolic pressure is 120 mm Hg.
Check BP every 15 min. interval and stop drip when Diastolic Pressure is 90 mm Hg.
regimen
Madhupur
Objectives
To determine the effectiveness of early administration
of injection Magnesium Sulphate in PEE patients at the community level to prevent fits before referral to hospital
To examine whether early intervention of convulsion
by Magnesium Sulphate and proper obstetric management can reduce both maternal and perinatal mortality
Methodology
Type of Study:
Quasi-experimental
Study Period:
Study Population: Eclampsia and severe pre-eclampsia cases of study area Sample Size: 265 cases
133 were in intervention group (patients with eclampsia or severe
eclampsia coming directly to hospital from same area but without receiving loading dose of MgSo4 before referral; but they received injection MgSo4 after admission in the hospital)
Training of doctors
10 5 0
2.3 1.5 8.27 6.01 2.27 10.4
12.87 6.06
Intervention Group
Maternal Deaths Pulmonary edema
Non-intervention Group
Renal Failure Obstetric shock PPH
The number of patients who developed complications in intervention and non-intervention groups show statistically significant difference ( p<0.05)
27.6
Perinatal out-come of non-intervention group was poorer than intervention group though both groups were managed in the same way after admission in the hospital
Study Conclusion
The findings of this study concluded Earlier administration of injection Magnesium Sulphate at the community level is effective before referral to hospital
Useful result was found regarding control of convulsion by
To administer early injection of MgSO4 To include the loading dose of MgSo4 before referral in the national protocol
Intramuscular loading dose vs combined IV and IM loading dose of MgSo4 in the management of eclampsia in a tertiary level hospital.
Study conducted by Dr. Salma Rouf, DMCH
A pilot project is conducting in DMCH where IM administration of MgSo4 is found to be equally effective both in preventing and controlling of recurrent fit.
Govt., MaMoni, Mayer Hashi, OGSB & ICDDR,B. High numbers maternal and perinatal death FWV, SBA, HA will work in that area, they will diagnose severe PE and eclampsia and will administer IM MgSo4 (10 gm) referral center. Same type of work will be done in another district like Bramhanbaria. Referral center will manage according to OGSB protocol.
Mild Pre-eclampsia
Management
Findings Diagnosis
DBP 90 -- convulsion
Eclampsia
Challenges
Though, health infrastructure in Bangladesh exists up to the
grass root level; a system of registering pregnant women has not been developed re administering the loading dose
forwarding address
Challenges