Hello Jen
I would explain what is most likely to have happened and I would advise her to come in for a check ASAP. Common sense would say this was physiological and just the result of a long hot day's shopping and low BP. Remember the effect of increase in blood volume is at its peak at about this time (24-32/52), so BP is likely to be a bit lower than normal plus if she was hot she was probably vasodilated++. It is impossible to categorically say there is nothing wrong in a telephone consult and as we are obliged to document all contacts with the women in our care, then we have little choice but to recommend she comes in for a check, or you go out & visit. Also if she freaked out the quick check will reassure her. If she doesn't want to come in or have a visit, then document what you recommended. Probably 20 years ago I would have reassured her, but standards of risk management have altered the playing field. In my experience if it was pre-eclampsia/eclampsia then she would not recover, she would remain unwell. Always think, 'First do no harm'.
Jennifer Cameron FRCNA FACM
ProMid
Professional Midwifery Education Service
0419 528 717
----- Original Message ----- From: "Jen Semple" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Wednesday, November 17, 2004 8:45 PM
Subject: Re: [ozmidwifery] seizure at birth
Whew, that pretty much answers all of my questions! Thanks very much for taking the time to share your knowledge & experience, Jenny.
Whoops, thought of another question! Black outs reminds me... I have a friend who had a black out when she was about 30/40 during a long day of shopping.
She was having an uneventful pregnancy, normotensive, etc. Had lots of baby movements both before & after the blackout. But was understandably freaked out after the blackout.
If you were her midwife & she rang you describing this, what would you suggest to her?
She went on to have a gorgeous baby at term in a birth centre.
Jen
--- Jenny Cameron <[EMAIL PROTECTED]> wrote:Most unusual. Usual practice would assume eclampsia until proven otherwise. I once had a woman, normotensive, postdates & multigravid have a grand mal seizure immediately following an ARM for induction of labour. Fortunately the Obs was just outside the door washing his hands. On questioning she gave a history of frequent blackouts during pregnancy. Didn't think to report it! Subsequently diagnosed as epileptic. The actual seizure is not a problem for the woman (we need to protect her from physical injury). It is certainly a problem if the baby is still in utero as he will be anoxic for the period of the seizure. The major morbidity for the woman arises from the ischaemic cerebral damage and possible stroke from the hypertension. Never, ever underestimate pre-eclampsia. Beware of the woman with upper epigastric pain and be very wary of the 'twitchy' woman. New grads don't be afraid but be vigilant. Women rarely become eclamptic without some warning. Medical science is very good at detecting pre-eclampsia. The management of pre-eclampsia has changed dramatically over the period of time I have been a midwife. It so much better now.
As far as midwifery responsibility, if a woman seizures, you need to 1) Call for urgent medical help 2) Protect her from injury 3) Take BP. 4) Prepare for medication to lower hypertension.. 5) Monitor the baby...N.B.mother takes priority. If she is well oxygenated the baby will be. Therefore sort her out first. Happy midwifing Jenny
Jennifer Cameron FRCNA FACM ProMid Professional Midwifery Education Service 0419 528 717
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