 Right. Our recording is going. It's my pleasure to announce Afalabi Alajimoki or Buki, who is a senior nursing officer working in a labor ward at the maternity unit at the Abba Femi Awoloa University Teaching Hospitals in Osin State, southwest Nigeria. Buki says her passion is in maternal and child health. Today, she's going to talk to us about the management of Eclampsia in Nigeria. Buki, the screen is yours. Thank you very much. Hi, everyone. I'm Afalabi Alajimoki. I'm a registered midwife. I registered for Buki in Osin State, southwest Nigeria. This is the screen I was speaking on. I'm speaking on the right, Buki. I'm speaking about the management of Eclampsia in Nigeria. I'm going to move you past the instructions. There you go. You can move the slides, Buki. I am Afalabi Alajimoki. I'm a registered midwife. I registered for Buki in Nigeria. I think, Buki, we're having some difficulty getting your transmission. All right. Ask if Lorraine has any suggestions for us. I suspect it's the headset that Buki is using. I think it's one of those types. Thank you very much. I have the feeling that my outfit is fine. It's a microphone that turns on. The sound is delayed and not clear. I hear that now. I can hear you now. Right now, yes. That's better. Yes. Go ahead. Continue the presentation, Buki. This is a call in the sub trimester. Not clear. Are you hearing me? Are you hearing me now? Are you hearing me clearly? You can hear me. Can I come to you? Can I? Can I come to you? All right. Can I come to you? That's lovely. All right. Thank you. Aklanta accounts for the difficulties of contentment and attention in pregnancy, as well as a legal cause of maternal mortality worldwide in view of the most significant involvement in pregnancy. Aklanta is part of the old state of seizure with all sorts of miscellaneous of postpartum in a women with three or five tons of pre-ecrancia. It typically occurs after the 12th of the session, and it can occur with an antipartum, intrapartum, or during the postpartum period. The most common image here, especially where I am practicing as a midwife, is the most common image that we see occur during the 12th semester of pregnancy. The pre-ecrancia, at the level of the plan, is about 60,000 maternal deaths occur globally each year from the pre-ecrancia. Both are in developing countries. The influence of the pre-ecrancia in developing patients varies widely. It ranges from 6 to 157 cases per 10,000 delivery. Compared to the range of 1.6 to 206 per 10,000 delivered, delivery is a developed world. Nigeria has one of the highest maternal mortality rate in the world, and I plan to identify as one of the major factors. Here also, the incidence varies from 30 to long services per 10,000 delivery. And this is the 12th common health course of maternal mortality in Nigeria. This time, the quality can be linked to several factors. There are several factors that can be identified with developing eclipses here. And they include, let me follow the back of transportation, most of the two episodes of the course go out to our nation. Cultural believe. So, Nigeria, we are after time, there are lots of believe that are associated. Nigeria, every group have the same cultural believe that are attached to an individual during pregnancy. Nigeria has most time, no social community, the fact of life of utilization of antennas, services, and the main thing of utilization. There was study done in a different part of Nigeria show that the cancer was the most common cause of death. Death makes it a chief killer of pregnant women. After that, the type contributing to the abortion, though, in developing communities include no utilization of unsuitable care services, especially in remote areas. And teaching may present results for the community as a last resort. This opportunity to protect women and at least live in peace is so effective. In addition, there are many of these health-sickly behaviors. There are many health-sickly behaviors. Both now we've lost your sound. At least I've lost your sound. There are poor health outcomes of this, at least once a year. However, the WHO, World Health Organization estimates that only 45% of that in developing communities is health-passive. I can hear you. Don't try to be as tough as the health-passive. We are doing this after a lot of delays and this contributes to high maternal mortality. All the factors contributing to eclampsia, developing eclampsia, include ignorance that I said earlier, or education in the U.S. and the U.S. the situation in general in the first option is to deal with the issue of government policies. This presentation, this is mainly focused on which factors for eclampsia such as physiology, diagnosis, and complications, situation and way of the needs of the device in the management of eclampsia. These are the following two waste factors for eclampsia, mainly piracy, family issues of eclampsia, physical, pregnancy, and eclampsia, or outcome of physical pregnancy, including eclampsia and eclampsia, abortion, placenta, or fetal death, multiple breast cancer, lower pregnancy, fetal high drop, family graphical, teenage pregnancy. Patients older than 35 years lose their criminal status. This loss of their criminal status is usually a major concern. It results in sustained defibrillation and failure without to seek out care. And when healthcare is resolved, young people start to run off of each path. Over-conditioning leads certain to existing medical conditions like obesity, chronic hypertension, when out of these conditions can receive. As a physiological eclampsia, the particularity of eclampsia is basically the particularity of the seizure in eclampsia. Although it is not clearly understood, the mechanism responsible for the development remains on play. However, there are genetic diseases in this position. Immunology, immunology, nutrition, abnormality of the blood circulation, inflammation of the mouth, vascular endothelial damage, cardiovascular maladaptation, direct deficiency of excess, and a certain disease has been proposed as a possible etiology factor. There are two hypotheses that have been proposed. The first one is that she was the development of eclampsia. The eclampsia, the eclampsia of the eclampsia are a type of simulation. As a result of our system is block-raised, that results in a failure of the process pattern. Thus, the disease is very sufficient and is often used to localize the failure and intercellular edema. On a second note, there is the creation of the operation of forever block-raised in response to high-situational block-raised dospercy over-partition of the failure pattern. Wow. Wow. You're coming and going when it comes to sound, Buki. Sometimes the eclampsia includes rather clear, right now we haven't heard anything for about 40 seconds. But most of the seconds are mixed up with the period. The eclampsia can typically blow up into eclampsia. I'd be happy to read the slides. Here are the versions of the eclampsia from Sentomati. Please go to your comments. I could read the slides, Buki, and then the listeners could ready some questions that would answer in the drive-in. Please go. Please go. Please go. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. Please go to your comments. because we keep announcing your voice. We can't hear you. I'll try from here for a while. I refuse working slides, so I'm a bit familiar with them. The first one is for the management of Eclampsia, starting with assessment and evaluation. Most patients with Eclampsia present with some hypertension, with some combination of proteinuria and edema. The midwives on physical examination may include the following, a sustained systolic blood pressure greater than over 60 milliliters, or a diastolic blood pressure greater than 110 milliliters, tachypnea and tachycardia. These are mother's issues, mental health changes, including hyperreflection, clonus, papillodipa on fundoscopic exam, oliguria or aneurysm, late signs, and serious signs. There may be localizing neurologic deficits, light-up quadrant or epigastric abdominal tenderness coming from edema or hypercapsules, generalized systemic edema, small fundal height for the estimated gestational age, and maternal apprehension. The cervical examination of both the woman and the plaintiff should not be overlooked because the birth load may largely depend on the woman's cervical exam set. In laboratory, in your analysis, proteinuria is typically one of the presenting symptoms in the patients of the patient. Euric acid levels may be mildly increased. Recently in the United States, anesthetical associations have said that proteinuria is the last, a later sign, to intervene before proteinuria or without proteinuria. Hematological violence, a complete blood cell count may reveal the following. Proteinuria could have micro-angiopathic causes. Hemoconcentration due to the third spacing or physiologic hemodilution of pregnancy. A midwife may also see increased bilirubin, greater than 1.2 milligrams per deciliter, a low platelet count. The coagulation profile may also be altered, revealing a normal proton time and activated partial thrombo-plastin times and fibridogen levels. Others are liver function tests, CT scanning, and MRI of the head. Trans-abdominal ultrasonography used to estimate gestational age and also measure fetal growth. This can also be used to rule out placental abruption, which can complicate eclampsia and be caused by the hypertension in eclampsia. Supportive care from midwifery includes management principles employed in the management of eclampsia, especially when the patient is convulsing. Maintain a patent airway and prevent aspiration. The woman should be placed in a recovery position, and oxygen should be administered by face mask to treat hypoxia due to hypoventilation during the convulsive episode. The use of antihypertensives has also been recommended in women with eclampsia with elevated blood pressure. Drugs used commonly include hydralazine and libatolol. Medical therapy is most often magnesium sulfate. The use of magnesium sulfate, in addition to other interventions in Nigeria, has been affected in the management of eclampsia with the midwife playing the pivotal role in the reduction of morbidity and mortalities associated with the condition. Several studies in Nigeria have reported considerable decline in the contribution of eclampsia to maternal mortality, attributed to the use of magnesium sulfate in the treatment of eclampsia. Although Buki writes, in her experience as a midwife, in her center, in over a decade on the labor ward, shows that poor maternal outcomes are reported when patients present after 12 hours following the onset of convulsions, as well as when antipartum eclampsia has occurred. The World Health Organization recommended magnesium sulfate as a safe, cheap, and effective drug for the treatment of eclampsia. Several reports have demonstrated the success recorded since the introduction in some countries, including Nigeria, as well as its safety for both the mother and child. There are several regimens for the administration of magnesium sulfate in Nigeria. However, at Buki's center, Obafemi-Ooloho University Teaching Hospitals, Ile Ife, Southwest Nigeria, magnesium sulfate regimen is as follows. A loading dose of 4 grams of magnesium sulfate diluted with sterile water to make up 20 milliliters that's administered intravenously and slowly over 10 minutes with a 5 gram intramuscular injection in each buttock. When we finish the presentation, Buki, will you answer this question for me? Is it 5 grams in each buttock or 5 grams split between the two buttocks? This is followed by intramuscular 5 grams magnesium sulfate every 4 hours into alternate buttocks for the next 24 hours. In administering magnesium sulfate, the following signs of toxicity must be watched for, flushing, sweating, hypotension, depressed reflexes, flaccid paralysis, hypothermia, circulatory collapse, cardiac and central nervous system depression, and respiratory paralysis. Steps for prevention of magnesium sulfate toxicity include, monitoring urinary output, you want to see a minimum of 30 milliliters of urine output per hour, monitor the knee jack reflexes, we would say knee jerk reflexes here in the States, monitor the respiratory rate, you want to see respirations of at least 14 cycles per minute. The midwife's responsibilities in the management of eclampsia, will cover antipartum, intrapartum, and postpartum. During the antipartum care period, maternal monitoring includes regularly checking the patient's neurologic status for signs of increased intracranial pressure or bleeding. For example, papillodema on a fundoscopic exam, cranial nerve exams, monitoring fluid intake and urine output, maternal respiratory rate and oxygenation as indicated, including continuous monitoring of fetal status. Pulmonary arterial pressure monitoring is rarely indicated, but may be helpful in patients who have evidence of pulmonary edema or oliguria and urea. Here in the United States, women who have oliguria and urea or severe signs of eclampsia often go to a maternal intensive care unit. Once the seizure is controlled and the patient has regained consciousness, the patient's general medical condition should be assessed to identify any other causes for seizures. Fetal heart rate monitoring. Fetal heart rate and uterine contractions should be continuously monitored. Fetal bradycardia is common following the eclaptic seizure. After initial bradycardia during the recovery phase, the fetal heart rate tracing may reveal a loss of short and long-term variability and the presence of late decelerations. These abnormalities are most likely due to the decrease in uterine blood flow caused by the intense vasospasm and uterine hyperactivity during the convulsion. Midwifery intrapartum care includes the following. These complications should be anticipated. Fetal growth retardation or growth restriction. Irregular fetal heart rate patterns, placental abruption, and delivery is the treatment for eclampsia after the patient has been stabilized. No attempt should be made to deliver the infant either vaginally or by cesarean delivery until the acute phase of the seizure or coma has passed. The mode of delivery should be based on obstetric indications, but should be chosen with an awareness that vaginal delivery is preferable from a maternal standpoint. Adequate maternal pain relief for labor and delivery is vital and may be provided with either systemic opioids or epidural anesthesia. In the absence of fetal malpresentation or fetal distress, oxytocin or prostaglandins may be initiated to induce labor. Cesarean delivery may be considered in patients with an unfavorable cervix and a gestational age of 30 weeks or less, as induction under these circumstances may result in a prolonged antipartum course and is frequently unsuccessful in avoiding cesarean delivery given the high rate of intrapartum complications. When emergency cesarean delivery is indicated, substantiating the absence of coagulopathy before the procedure is important. Irrespective of gestational age, a prolonged induction with clinically significant worsening of maternal cardiovascular hematologic, renal, hepatic, and or neural status is generally an indication for cesarean delivery when the anticipated delivery time is remote. Other midwife's roles are as documented for antipartum care. Maternal monitoring and fetal monitoring need to be maintained. Moving to the midwifery responsibilities for postpartum and outpatient care, there will be follow-up one to two weeks after delivery to evaluate the patient for blood pressure control and any residual deficits from the eclaptic seizure. Patients with persistent hypertension past six weeks where perium or neurologic changes may need a medical referral. Prevention of preeclampsia or eclampsia in Nigeria. Preventing the development of preeclampsia in high-risk patients, which is expected to decrease the risk of eclampsia and its complications in pregnancy, still remain a great concern in Nigeria. Therefore, early identification and prompt specialized attention should be advocated at all levels. Patients with preexisting hypertension should have good control before conception and throughout pregnancy. Studies have shown that low-dose aspirin in women at high risk for preeclampsia can contribute to a decreased risk of preeclampsia, a reduction in preterm delivery rates, and a reduction in fetal death rates without increasing the risk of placental abruption. An obstetrician should directly supervise low-dose aspirin therapy in high-risk women. Buki writes, this is actually not being practiced presently at her Nigerian center due to the problem related with the risk of early closure of the ductus arteriosus with use of non-steroidal anti-inflammatory drugs. Early booking of the pregnancy at the antenatal clinic with early identification of high-risk individuals by midwives for prompt counseling and commencement of special management is essential. Focus antenatal care for high-risk patients to further guarantee spousal participation and adequate family support from early pregnancy. Pregnancy and delivery are made safer by further incorporating safe motherhood practices into primary health care at all levels of health care, especially at the primary health care. Reactivation of the recently scrapped rural midwifery scheme in Nigeria, which is expected to reduce the three levels of delays in health care delivery in Nigeria, delay in deciding to seek care, delay in reaching appropriate care, and delay in receiving appropriate care at the facility level. The challenges that midwives face in the prevention and management of eclampsia in Nigeria include inadequate midwives at all levels of health care in Nigeria, primary, secondary, and tertiary. Lack of incentives, especially at rural areas where a large proportion of cases are recorded. A poor referral system. This usually complicates delay in reaching health care facilities, which usually results in fatal complications and mortality. Inadequate facilities or opportunities for midwifery education, as well as training and retraining of midwives regarding recent skills and techniques in modern midwifery practices. Another challenge is poor funding of the health sector. Most facilities are old, overused, and poorly equipped to handle the increasing demand from Nigeria's fast-growing population. And, as is found in many countries, Nigeria has a problem with migration of trained midwives to greener pastures. Buki concludes, eclampsia is recognized as a major cause of maternal mortality worldwide, especially in developing countries. Nigeria has one of the highest maternal mortality rates in the world, and eclampsia has been identified as one of the major causes. Preventing preeclampsia in high-risk patients is expected to decrease the risk of eclampsia and its complications in pregnancy. This all would go a long way in reducing maternal mortality in Nigeria. Buki recommends the empowerment of women, including the right to quality services and information during and after pregnancy. Improvement in access to quality reproductive health services through improved funding. Utilization of the power partnerships and multi-sectoral collaborations to strengthen midwifery training. Community mobilization and participation by midwives to encourage women to live healthy lifestyles and access health care services early. Thank you all for listening. Buki, I hope that you were able to hear what I was saying. It would be wonderful now if the listeners can type any questions they have. I have a question for everybody. Reading Buki's presentation, she must see many eclaptic seizures. It has been probably 15 years since I've seen an eclaptic seizure, and most of my midwifery practice has been in high-risk tertiary-level facilities where women are treated for preeclampsia. So if people could raise their hands if they've seen eclampsia, if they've seen an eclaptic seizure, Tammy Heap, who's a home birth midwife in New Zealand, has seen an eclaptic seizure. I asked because I think many of our listeners are from areas where antipartum services are more accessible, and transportation is easier, and women receive treatment early. Yes, Buki, please. Your microphone should be enabled, Buki. Can you hear me now? Yes, Buki, I can hear you. Please, we'll help you now. Yes. Yes, I want to go to the fourth question. The fourth question on magneton sulfate. The abnormality of the monocular admonition of the magneton sulfate is 5 grams into each buttocks. In addition to the IV 4 grams, which makes up the loving base of the magneton sulfate? I see. Thank you. It's a pity that in Nigeria, the witness and much of the eclaptic patients however, we've been trying our best as midwives to give a total nursing care. But most of them are in many of the cases that related to the postpartum eclampsia, the mortality is usually higher, the progressive is usually higher. Most patients will not be taking, will not be brought to the hospital in time. We'll have a hard period of convulsing patients, and we'll be brought in very bad conditions. So, most of the postpartum eclampsia cases that we have, we usually have a bad post-pupil. Are there other questions about eclampsia? Buki, have you seen eclaptic seizures in the immediate postpartum period with mothers who had relatively normal intrapartum courses and births? Most of these, most of these postpartum eclampsia, most of these patients are presented with postpartum eclampsia are usually on good patients. Yes. They are usually on good patients who have received their care every family clock. They currently need complications. Most of the postpartum eclampsia cases are we have. Thank you. Buki, are there any... I'm sorry, but I think we need to wrap up. It's now 10-2, and we need to clear the room for the next speaker. You got lost in the moment. Thank you so much, Buki. It was a pleasure speaking for you and with you. I'm going to turn the recording off now.