IN PARTNERSHIP WITH

Liverpool School of Tropical Medicine

Liverpool Associates in Tropical Health

Eclampsia and severe

preeclampsiaEclampsia and Severe

Pre-eclampsia

Aims

To recognise eclampsia and severe pre-

eclampsia

To practise an effective response to a

woman with eclampsia (fit) or severe

pre-eclampsia

To achieve competence in those skills

Principles of management

Stabilise mother and then deliver fetus

Treat and prevent fits

Treat blood pressure

Attention to fluid balance

Be aware of and prevent complications

Signs and Symptoms of Pre-Eclampsia

• Headache

• Blurred vision

• Upper epigastric pain

• Hyperreflexia/clonus

Diagnosis:

BP > 140/90

Urine protien +

Eclampsia - recognition

Fitting or unconscious

Management of fits

Fitting or unconscious

Call for help

Recovery position

Open and maintain airway

iv access and give magnesium sulphate

1 litre Ringer’s lactate to be given very

slowly iv

Magnesium sulphate

The anticonvulsant of choice

Loading dose is given IV and IM

4g given IV (dilutent N/S!)

10g IM (diluent 2% Lignocaine) Give 5g to each buttock

If unable to give IV loading dose give IM loading dose only

Magnesium Sulphate: Maintenance

dose

IV route

Magnesium sulphate (10g) in 1000 ml normal Saline IV infusion at rate of 1g/hour

OR

IM route

After loading dose continue with 5 g IM every 4 hours

Continue maintenance dose until 24 hours after birth or 24 hours after last convulsion

Magnesium caution!

Do not give the next dose of magnesium if

Absent knee jerk

Urine output less than 100 mls in last 4

hours

Respiratory rate less than 16 breaths per

minute

• If respiratory rate less than 16 breaths /

minute stop magnesium and give

calcium gluconate 1 g iv over 10

minutes

Magnesium Sulphate

If convulsions recur give an additional

2-4g iv over 10-15 minutes

Consider giving lower dose (2g) if

patient is small and/ or weight is less

than 70kgs

Magnesium sulphate has various

concentrations

For IV injection concentration of

magnesium should not exceed 20%

20% solution=200mg/ml

Diazepam

Only use if magnesium not available or

magnesium toxicity develops

Blood pressure

Uncontrolled blood pressure leads to

intracranial haemorrhage and death

Monitor

Treat if BP diastolic >110 mm Hg or

systolic >160 mmHg

Nifedipine, hydralazine, labetalol

according to local protocol

Delivery

Assess fetal heart, gestational age, lie of the

baby and assess cervix

Vaginal delivery or CS?

Vaginal if no maternal or fetal distress, no

obstetric contraindication and cervix

favourable

CS if repeated fits, fetal distress or

unfavourable cervix

Fluid

Careful fluid balance required

Capillaries are ‘leaky’ therefore control fluid

input to prevent pulmonary oedema

Monitor closely via fluid in and output chart

Restrict iv fluids to 30 drops per minute

Complications of (pre) eclampsia

Brain

Lung

Liver

Clotting (abruption, DIC)

Heart

Kidney

Eye

Fetal

Death

Monitor!

HR

BP

Urine Output

RR

Reflexes

Fluid in and output

Temperature

Fundi

Bloods (platelets, clotting, Hb, renal function)

After delivery

Monitor, monitor, monitor

Remember (pre-)eclampsia get worse or first fit can occur in post partum period

Continue magnesium for 24 hours after delivery or after last fit – no need to “tail off”

IN PARTNERSHIP WITH

Liverpool School of Tropical Medicine

Liverpool Associates in Tropical Health

??

IN PARTNERSHIP WITH

Liverpool School of Tropical Medicine

Liverpool Associates in Tropical Health

RECAP

Recognition of Eclampsia and Severe pre-

eclampsia

Management of fits and blood pressure

Decision on delivery

Monitoring of patient

Complications