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 veryslowly 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 IMloading dose only
Magnesium Sulphate: MaintenancedoseIV route Magnesium sulphate (10g) in 1000 ml normalSaline IV infusion at rate of 1g/hourORIM route After loading dose continue with 5 g IM every 4hoursContinue maintenance dose until 24 hoursafter 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 4hours Respiratory rate less than 16 breaths perminute
• If respiratory rate less than 16 breaths /minute stop magnesium and givecalcium gluconate 1 g iv over 10minutes
Magnesium Sulphate If convulsions recur give an additional2-4g iv over 10-15 minutes Consider giving lower dose (2g) ifpatient is small and/ or weight is lessthan 70kgs
Magnesium sulphate has variousconcentrations For IV injection concentration ofmagnesium should not exceed 20% 20% solution=200mg/ml
Diazepam Only use if magnesium not available ormagnesium toxicity develops
Blood pressure Uncontrolled blood pressure leads tointracranial haemorrhage and death Monitor Treat if BP diastolic >110 mm Hg orsystolic >160 mmHg Nifedipine, hydralazine, labetalolaccording to local protocol
Delivery Assess fetal heart, gestational age, lie of thebaby and assess cervix Vaginal delivery or CS? Vaginal if no maternal or fetal distress, noobstetric contraindication and cervixfavourable CS if repeated fits, fetal distress orunfavourable cervix
Fluid Careful fluid balance required Capillaries are ‘leaky’ therefore control fluidinput 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 orfirst fit can occur in post partum period Continue magnesium for 24 hours afterdelivery or after last fit – no need to “tailoff”
IN PARTNERSHIP WITHLiverpool School of Tropical MedicineLiverpoolAssociates in Tropical Health??
IN PARTNERSHIP WITHLiverpool School of Tropical MedicineLiverpoolAssociates in Tropical HealthRECAPRecognition of Eclampsia and Severe pre-eclampsiaManagement of fits and blood pressureDecision on deliveryMonitoring of patientComplications
A particular slide catching your eye?
Clipping is a handy way to collect important slides you want to go back to later.