EAST ZONE MEDICO LEGAL SERVICES

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PRE - ECLAMPSIA
Pre- eclampsia is recognizedclinically by the presence of
hypertension + or - proteinuria.
Serious complications: Eclampticseizures
DisseminatedIntravascular Coagulation
Cerebral haemorrhage
Acute liveror renal impairment
Abruptio placenta
Investigations: CBC, Hematocrit, Platelets, BloodGroup and
Cross Matching
Renal Function Test including Uric Acid
Liver Function Test
Coagulation Profile

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24 hours Urine collection forprotein
ECG, Chest X – Ray ( if indicated)
Repeat investigations every 6 – 12 hours according to the patient
condition.
Admission to the hospital.
Careful assessment of patient with pre – eclampsia should
include the following: Bloodpressure ( using manual as well as
automated sphygmomanometer), monitorvital signs every 15 minutes
initially, then every 30 – 60 minutes according to the case.
Urinalysis forprotein by dip stick every 4 hours and urinary
output monitoring.
Auscultation of heart and lung fields
Abdominal palpation for epigastricor livertenderness.

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Assessment of fetal size, presentation and well being ( CTG and liquor
volume)
Examination of the optic fundus
Tendon reflexes andclonus Stabilization:
Control BP, monitor the patient’s symptoms.
- Monitor fluidintake andurine output ( 100 ml. every 4
hours and intake not to exceed150 ml./hour. Treatment Goals:
1) Prevent seizures:
Magnesium sulphate:
Initial Dose: 4- 6 gms in 50 ml. over 15 – 20 minutes followed
by

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Maintenance Dose : 1 – 2 gms/hour
Monitor for magnesium toxicity andcorelate with serum
magnesium level.
If significant toxicity is severe - give antidote
( Calcium Gluconate 1 gm. ( 10 ml. of 10%
solution slowly over 5 – 10 minutes).
StopMagnesium Sulphate at least 24 hours afterthe last fits
or 24 – 48 hours postpartum.
2) Lower blood pressure:
If BP > 160/100 ( severe hypertension)

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AGENT DOSAGE
1.) LABETALOL
OR
Start with 20 mg. IV,
repeat at 20 – 80 mg IV
every 30 minutes or 1 – 2
mg/min, max )300 mg. (
then switch to oral
2.) NIPEDIFINE
OR
mg. capsule to be bitten
and swal�10 – lowed or
just swallowed every 30
minutes 10 mg. tablet
orally every 45 minutes to
a maximum 80 mg./day
3.) HYDRALAZINE
Start with 5 mg. IV, repeat
5 – 10 mg. IV every 30

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minutes to a maximum of
20 . mg IV
Call for help, inform Specialist orConsultant on call.
- Protect airway ( assess airway , breathing, check pulse & blood
pressure) . Put patient in left lateral , suction & oxygen
supplementation.
- Give Magnesium Sulphateto abort the fits ( dose 4 – 6 gms dilutedin
50 ml. of fluidfollowed by continuous infusion of 1 - 2 gms./hour )
- Prevent maternal injury
- Once stabilized, assessthe fetal condition by CTG and USG, plan
shouldbe made to deliverthe patient
• Delivery:
Vaginal delivery can be considered but if delivery is remote or
unfavorable cervix, then caesarean section

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may be required.
Postpartum:
Monitor in Labour Room or if post operatively in ICU as indicated for
at least 24 – 48 hours or until the patient is consideredto be out of
danger from the complications of
eclampsia.