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Pre-eclampsia/Eclampsia
• Pre-eclampsia: hypertension >140/90, proteinuria >0.3g/L
• Eclampsia: seizures• Incidence:– Pre-eclampsia: 2-10% of all pregnancies– Eclampsia: 2-6 in 10000 deliveries
• 1.8% maternal mortality
History & Examination• Symptoms– Headache– Visual disturbance– Epigastric pain– Fetal movements
• Signs– BP, proteinuria– Hepatic tenderness– Clonus, hyperreflexia– Papilloedema
Antihypertensives
• Labetolol– Orally– Intravenous
• Nifedipine– Orally
• Hydralazine– intravenous
• Methyldopa – slow acting
Anticonvulsants
• Magnesium Sulphate– 4g IV push– Maintenance dose 1-2g/hour
• Monitor for signs of toxicity– Loss of deep tendon reflexes– Respiratory depression– Coma– Cardiac arrest
• Calcium gluconate
Scenario
• A patient at 30 weeks gestation on the ward was found fitting by the staff midwives
• She is hypertensive 160/120, with +4 proteinuria
• You are called to attend
• ABCs!!!• Help – midwives, senior obstetrician,
anaesthetist• IV access• Lab investigations– FBC, U&Es, LFTs, coag
• Stabilise patient before fetus
• Mg SO4• Antihypertensives• Fluid restriction – no more than 80ml/hour• HDU monitoring• Delivery when stabilised
Summary
• ABC’s• Stabilise patient• Antihypertensives/anticonvulsants• Delivery