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

Received: 30 June 2023     Accepted: 22 July 2023     Published: 31 July 2023
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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.

Published in Journal of Gynecology and Obstetrics (Volume 11, Issue 4)
DOI 10.11648/j.jgo.20231104.13
Page(s) 95-99
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Late Eclampsia, Lytic Cocktail Solution, Magnesium Sulfate, Supportive Care

References
[1] James R. S, Ronald SG, Beth YK et al. (2003) Danforth's Obstetrics and Gynecology, 9th Ed: Eclampsia. pp 149-152. DOI: 10.1016/j.jpag.2005.01.013.
[2] Marian HA, Venessia J, Holly M: Postpartum preeclampsia management with furosemide: A randomized clinical trial. Obstet Gynecol.2005 Jan; 105 (1): 29-33. DOI: 10.1097/01.AOG.0000148270.53433.66.
[3] FG, Cunningham: Severe preeclampsia and eclampsia: Systolic hypertension is also important. Obstet Gynecol 105 (2): 237, 2005: PMID: 15684145 DOI: 10.1097/01.AOG.0000153144.05885.fa Hugh MH, Brian MM: Abbreviated postpartum magnesium sulphate therapy for women with mild preeclampsia: A randomized controlled trial.
[4] Bigelow CA, Pereira GA, Warmsley A, Cohen J, Getrajdman C, Moshier E, et al. Risk factors for new-onset late postpartum preeclampsia in women without a history of preeclampsia. Am J Obstet Gynecol. 2014; 210 (4): 338. e1–8.
[5] Mayo Clinic. Postpartum preeclampsia. Accessed May 22, 2019.
[6] Alisse HAUSPURG, Arun JEYABALAN, Am J Obstet Gynecol. 2022 February; 226 (2 Suppl): S1211–S1221. doi: 10.1016/j.ajog.2020.10.027.
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[8] Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, Canadian Hypertensive Disorders of Pregnancy (HDP) Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens. 2014; 4 (2): 105–145. doi: 10.1016/ j.preghy.2014.01.003 [PubMed: 26104418].
[9] Overview | Hypertension in pregnancy: diagnosis and management | Guidance | NICE. https:// www.nice.org.uk/guidance/ng133. Accessed June 1, 2020.
[10] Bateman BT, Shaw KM, Kuklina EV, Callaghan WM, Seely EW, Hernandez-Diaz S. Hypertension in women of reproductive age in the United States: NHANES 1999-2008. PLoS ONE. 2012; 7 (4): e36171.
[11] American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013; 122 (5): 1122–31.
[12] S. Preventive Services Task Force. Screening for preeclampsia: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017; 317 (16): 1661–67.
[13] Data on Pregnancy Complications | Pregnancy | Maternal and Infant Health | CDC. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-complications-data.htm#. Published 2019. Accessed February 10, 2020.
[14] Hoyert DL, Miniño AM. National Vital Statistics Reports Maternal Mortality in the United States : Changes in Coding, Publication and Data Release, 2018. Natl Vital Stat Reports. 2020; 69 (2).
[15] Clapp MA, Little SE, Zheng J, Robinson JN. A multi-state analysis of postpartum readmissions in the United States. Am J Obstet Gynecol. 2016; 215 (1): 113. e1–113. e10. doi: 10.1016/ j.ajog.2016.01.174 [PubMed: 27829570].
[16] Sibai BM. Etiology and management of postpartum hypertension-preeclampsia. Am J Obstet Gynecol. 2012; 206 (6): 470–475. doi: 10.1016/j.ajog.2011.09.002 [PubMed: 21963308].
[17] Lawson J. B, Stewart D. B.: (1975): Obstetrics and gynecology in the tropics and developing countries: pp. 120-136 Arnold.
[18] Pritchard J. A.: Management of preeclampsia and eclampsia. Kidney International, Vol. 18, pp. 259–266. 1980.
[19] Joydeb RC, Snehamay C, Nabendu C et al: Comparison of intramuscular magnesium sulfate with low dose intravenous magnesium sulfate regimen for treatment of eclampsia. J Obstet Gynaecol Res 35: 119, 2009 PMID: 19215558 DOI: 10.1111/j.1447-0756.2008.00842.x.
[20] Obstet Gynecol 108 (4): 833, 2006. PMID: 17012443 DOI: 10.1097/01.AOG.0000236493.35347.d8.
[21] AC Bolte, S. F Gafar, J van Eyck et al: Ketanserin for the better treatment of preeclampsia. J Obstet Gynecol 178: S118, 1998: PMID: 11234612 DOI: 10.1515/JPM.2001.002.
[22] Alexandra EC, Louise P, James MN et al. Postpartum management of hypertensive disorders of pregnancy: a systematic review. DOI: 10.1136/bmjopen-2017-018696.
[23] F Cunningham, Kenneth L, Steven B et al. (2009): Williams Obstetrics 23rd ed.: 9780071497015: Medicine & Health Science Books: Eclampsia pp 764-758.
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    Abrehet Gebrekidan, Elias Teages Adgoy, Laban Lebahati Simel, Feven Beletse Negash. (2023). Postpartum Eclampsia Management with Lytic Cocktail Solutions in Rural and Semirural Health Care (with Limited Resources) Services in Eritrea. Journal of Gynecology and Obstetrics, 11(4), 95-99. https://doi.org/10.11648/j.jgo.20231104.13

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    ACS Style

    Abrehet Gebrekidan; Elias Teages Adgoy; Laban Lebahati Simel; Feven Beletse Negash. Postpartum Eclampsia Management with Lytic Cocktail Solutions in Rural and Semirural Health Care (with Limited Resources) Services in Eritrea. J. Gynecol. Obstet. 2023, 11(4), 95-99. doi: 10.11648/j.jgo.20231104.13

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    AMA Style

    Abrehet Gebrekidan, Elias Teages Adgoy, Laban Lebahati Simel, Feven Beletse Negash. Postpartum Eclampsia Management with Lytic Cocktail Solutions in Rural and Semirural Health Care (with Limited Resources) Services in Eritrea. J Gynecol Obstet. 2023;11(4):95-99. doi: 10.11648/j.jgo.20231104.13

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  • @article{10.11648/j.jgo.20231104.13,
      author = {Abrehet Gebrekidan and Elias Teages Adgoy and Laban Lebahati Simel and Feven Beletse Negash},
      title = {Postpartum Eclampsia Management with Lytic Cocktail Solutions in Rural and Semirural Health Care (with Limited Resources) Services in Eritrea},
      journal = {Journal of Gynecology and Obstetrics},
      volume = {11},
      number = {4},
      pages = {95-99},
      doi = {10.11648/j.jgo.20231104.13},
      url = {https://doi.org/10.11648/j.jgo.20231104.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20231104.13},
      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.},
     year = {2023}
    }
    

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  • TY  - JOUR
    T1  - Postpartum Eclampsia Management with Lytic Cocktail Solutions in Rural and Semirural Health Care (with Limited Resources) Services in Eritrea
    AU  - Abrehet Gebrekidan
    AU  - Elias Teages Adgoy
    AU  - Laban Lebahati Simel
    AU  - Feven Beletse Negash
    Y1  - 2023/07/31
    PY  - 2023
    N1  - https://doi.org/10.11648/j.jgo.20231104.13
    DO  - 10.11648/j.jgo.20231104.13
    T2  - Journal of Gynecology and Obstetrics
    JF  - Journal of Gynecology and Obstetrics
    JO  - Journal of Gynecology and Obstetrics
    SP  - 95
    EP  - 99
    PB  - Science Publishing Group
    SN  - 2376-7820
    UR  - https://doi.org/10.11648/j.jgo.20231104.13
    AB  - 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.
    VL  - 11
    IS  - 4
    ER  - 

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Author Information
  • Orotta Hospital Maternity, Ministry of Health, Asmara, Eritrea

  • Community Medicine and Primary Health Care, Orotta College of Medicine and Health Sciences, Asmara, Eritrea

  • Community Medicine and Primary Health Care, Orotta College of Medicine and Health Sciences, Asmara, Eritrea

  • Public Health, Ministry of Health, Asmara, Eritrea

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