1. The document provides guidelines for managing eclampsia, including administering magnesium sulfate as the primary treatment. It describes Pritchard's and Zuspan's regimens for magnesium sulfate administration. 2. Monitoring of patients on magnesium sulfate is important, including checking patellar reflexes, respiratory rate, and urine output. Signs of magnesium toxicity include decreased respiratory rate and loss of reflexes. 3. Alternative magnesium sulfate regimens are discussed that were developed to reduce pain at injection sites and better control magnesium levels.

1. ECLAMPSIA DRILL
IAN DONALD SCHOOL OF
ULTRASOUND AND REPRODUCTIVE
MEDICINE

2. A stepwise approach to managing eclampsia
and other hypertensive emergencies
OBG Manag. 2013 October;25(10):35-48

3. 1.eclampsia occurs but rarely during pregnancy and the
postpartum period,
2.most health-care providers have little to no personal
experience with management of this life-threatening
obstetric emergency.
3.Knowledge about maternal resuscitation during and
after an eclamptic seizure is critical for improving
maternal and perinatal outcomes.
4.10 practical recommendations for prompt diagnosis
and management of women who have eclampsia.
5.Immediate implementation of these recommendations
can lead to improved maternal and perinatal outcomes
(both acute and long-term).

4. By definition, 2 or more of the following
features must also be present within 24
hours of the seizure:[
•hypertension
•proteinurea
•thrombocytopenia
•elevated serum AST levels.

5. WHO mannual
(free download from internet)

6. A stepwise approach to eclampsia
Eclampsia is an obstetric emergency.
Inadequate preparation for it or an inappropriate response to
maternal and fetal conditions during and after an eclamptic
convulsion can be detrimental to the mother and fetus.
All obstetric units should have
up-to-date protocols in place and should conduct mandatory
drills to prepare nursing staff, obstetric providers, and
anesthesia staff working in these units to manage eclampsia.

7. All should not run towards patient .
• Team leader should be decided immediately.
He must guide---
• Airway
• O2 Supplementation
• Somebody to catheterize with Foley’s
• 16 /18 no. iv cannula ….. preferably at two places
• Through it only lab should be collected… CBC,LFT,RFT,PT is essential
• Without waiting for results
• Magnesium Sulphate regimen must be started
• z
7

8. Pregnant patient with convulsions….
• First diagnosis should be … eclampsia
• Quick history / referral letter
• Blood pressure and urine albumin
• Confirmation of diagnosis within a
minute
8

9. MANAGEMENT OF
SEVERE PREECLAMPSIA
Admit , Maternal & fetal evaluation
IV MgSO4, Steroids for lung maturity Antihypertensives if BP >=160/110
Eclampsia, Pulm. Edema, ARF, DIC, <22
wk., abruptio placentae, nonreassuring fetal
status.
HELLP, Severe FGR Oligohyd., Doppler with
reverse diastolic flow, Platelets ,33 – 34wk.
, Labour or ROM
23 0/7 – 23 6/7 wk. 24 0/7 – 32 6/7 wk.
Counselling Antihypertensives as needed, Daily maternal
& fetal evaluations. Delivery at 33 wk.
Termination of pregnanacy
Delivery before
completion of
steroids
Steroids 48 hr.
delay if possible.
Yes
Yes
No
Or

10. Principles of managment
 Avoid injury: Padded bed rails, restraints
 Maintain oxygenation: O2, pulse oximetry,
 Minimize aspiration: Lateral decubitis position, suction
 Initiate magnesium sulfate
 Control blood pressure
 Move toward delivery (corticosteroids if
<34 weeks and stable condition)
sibai et al
11

11. Pack containing equipment for magnesium therapy

12. • Prefilled LAB forms/consent forms/blood bank forms
• Gloves
• Bandages /cotton /gauze/sticking plasters
• Plastic Air way-1
• Suction catheter-1
• Foley’s catheter-(No.14 or 16)-1
• Syringes with needles- (2cc,5cc,10cc,20cc)-1each
• Intracaths-2-(No. 18 and No. 20 gauge ) -1 each plus three way connetor
• Blood Pressure apparatus-1
• Inj.MgSo4 (50%w/v) -14 Ampoules
• Normal Saline-100ml-2 bottles
• Inj Labetalol -4 ampoules
• Inj Calcium Gluconate –(10 ml)-1 ampoule
• Inj Hydrocortisone …2
• Ryle’s tube-1
• Adult laryngoscope-1
• Tourniquet-1
• Urobag /Urosac-1
• Lignocaine jelly
ECLAMPSIA INITIAL MANAGEMENT TOOLKIT

14. 13/12/2003

15. Step 1: Let the seizure run its course
1.During a seizure, resist the impulse to administer
anticonvulsive drugs, including intravenous (IV)
magnesium sulfate, because most eclamptic
convulsions are self-limiting.
2.Also abstain from administering medications such
as IV phenytoin, diazepam, or midazolam, as these
drugs are less effective than magnesium sulfate,
and some can suppress the laryngeal reflex,
increasing the risk of aspiration.
3.If the patient develops status epilepticus, initiate
muscle paralysis and intubate her.

16. Eclamptic seizure
identified
Diazepam 5mg IV repeated as needed up
to 20 mg to stop seizure
Secure airway
Place patient in recovery position
Facial oxygen
Contraindication to magnesium
sulphate?
Heart block
H/o myocardial infarction
Consider alternative agents (diazepam or
thiopentone)
Provide supportive therapy(maintain fluid
balance, blood pressure control, etc..)
Once seizures are controlled, blood pressure is
sustained and hypoxia corrected, delivery can be
expedited in applicable cases
Yes
No
Start magnesium sulfate therapy
Provide supportive therapy(maintain fluid
balance, blood pressure control, etc..)
Once seizures are controlled, blood pressure
is sustained and hypoxia corrected, delivery
can be expedited in applicable cases

17. Drug of choice is Magnesium Sulfate

18. Pritchard's and Zuspan's regimens for magnesium sulfate administration in eclampsia[
Pritchard's regimen
Loading dose: 4g IV (administered over 5 to
10min; concentration not to exceed 20%a ) plus
10g IM (using undiluted 50% solution)
Maintenance dose: 5g IM q4h x >/=24h after
the last seizure (using undiluted 50% solution
administered in alternate buttocks)
Zuspan's regimen
Loading dose 4g IV (administered over 5 to
10min; concentration not to exceed 20%a)
Maintenance dose: 1 to 2 g/h by controlled
infusion pump x >/=24h after the last seizure
(concentration not to exceed 20%a )
aLower concentrations, e.g. 10%, are preferred.

19. Magnista Injection
• COMPOSITION:
Each 2 ml contains:
Magnesium Sulphate IP…….…….1 g
(as heptahydrate)
Water for Injection IP…………… q.s.
20

20. Magnesium sulphate is the anticonvulsant of choice for women with
eclampsia. Lytic cocktail should be abandoned
Magnesium sulphate versus lytic cocktail for
eclampsia
The Cochrane Library, Issue 2 2003

21. Magnesium sulphate versus diazepam for
eclampsia
“Magnesium sulphate appears to be substantially more effective than
diazepam for treatment of eclampsia”
The Cochrane Library, Issue 2 2003

22. How Does it Work?
Magnesium sulfate is not a conventional anticonvulsant
agent and its mechanism of action in eclampsia is not
well understood.
Eclampsia is thought to occur secondary to ischaemia
caused by cerebral vasospasm.
Magnesium sulfate is a potent vasodilator, particularly
in the cerebral vasculature.
In women with pre-eclampsia, magnesium sulfate has
been shown to improve cerebral arterial circulation, and
preclinical evidence suggests possible neuroprotective
effects

23. Intravenous Magnesium Sulphate
• 4 ampoules of 50% solution = 4 gm (8 ml)
• It is diluted in distilled water (12ml) to make it
20 ml and give
it slow IV.
• At least 5 minutes should be taken to inject 4
gm.
• If 25 % solution is used then 8 ampoules have to be
taken(16 ml); dilute till 20 ml.
24

24. Intramuscular Magnesium Sulphate
• 5 ampoules of 50% solution = 5 gm (10 ml)
• Should be given as deep IM injection in the buttocks.
• Add 1 % xylocaine 0.5 to 1 ml to minimize the pain at site.
• Use little large bore needle say 22.
• 25% ampoule not to use as vol will be 20 ml
25

25. 13/12/2003

26. Monitor patellar reflex & respiratory rate at hourly
intervals
Regular monitoring of serum Mg Sulfate, particularly in
women with renal disease, output <100 ml/4 hours.
Therapeutic range 2-4 mmol/l
Signs of hypermagnesaemia?
Respiratory rate <16/min
Knee jerk reflexes absent
Continue mag. sulfate
Withhold further Mg sulfate
until signs of
hypermagnesaemia resolve
Significant respiratory
depression will require calcium
gluconate IV
Clinical signs of
hypermagnesaemia
resolves
Recurrent seizures?
Continue mag. Sulfate for
24 hours after last seizure
Mg sulfate 2 gm Iv over 5-10
min and continue
maintenance dose
Repeated seizures?
No
Yes
No
No
Yes
Consider alternative agents (
diazepam or thiopentone)
Yes

27. Monitoring ---–
• The maintenance dose of Magnesium Sulphate is given only after
assuring that:
• Patellar reflex is present
• Respiration not depressed. ( RR > 16/min)
• Urine output during previous 4 h- exceeded 100 mL. ( 25ml/hr)
• Serum monitoring of magnesium levels has been advocated, but is
expensive and has not been shown to be superior to clinical
monitoring.
2812 August 2017

28. Oligurea: <100 ml/4hrs or urea >10 mmol/l … give 1 gm/h maintenance…
frequent levels
ALT: 250 iu/l.. Measure Mg levels every 2-4 hrs
Mg level> 4 mmol/l: decrease maintenance dose to 0.5-1 g/h
Mg level< 1.7 mmol/l: 2 gm IV bolus over 20 min and increase
maintenance dose to 2.5g/h
No reagent for levels: maintenance dose of 0.5 g/h and R.R + Knee
reflexes monitoring
Toxicity:
 5 mmol/l: loss of patellar reflex, weakness, nausea, double vision
 6-7.5 mmol/l: muscle paralysis and respiratory arrest
 > 12 mmol/l: cardiac arrest
Dose alteration:

29. Alternative regimes for magnesium sulphate
 Lazard 1925– A first ever report
 Very low dose of 2-4 g was administered i.v.
Disadvt.- Poor control due to not achieving required plasma conc. Of
MgSO4
 Eastman 1945 - suggested that women be given 10 g as an intramuscular
injection followed by 5 g every six hours.
Disadvt.- Plasma concentrations rise slowly after intramuscular
injection
so in status eclampticus it was not effective.
3012 August 2017

30. Accepted worldwide
Pritchard 1955 –
suggested changing the loading dose to 4 g by intravenous
infusion as 20% soln at a rate not to exceed 1g/min, and
increasing the maintenance dose to 5 gm i.m. every 4 hour.
This regime is still widely used, particularly in the developing
world.
• Disadvt. - Pain and infection at the i.m. injection site.
3112 August 2017

31. • Zuspan 1978 -
Loading dose is 4 g i.v. infusion as 20% soln
at a rate not to exceed 1g/min,
followed by an infusion of 1 g per hour.
This is the standard intravenous regime, widely used in many countries.
• Sibai 1984,1990 –
Loading dose is 6 g in 100 ml of IV fluid to be administered
over 15-20 min.
Maintenance dose – 2g /hour in 100 ml as slow infusion.
3212 August 2017

32. Other low dose regimes:
• Dhaka Regime - The loading dose of magnesium sulphate was 10 gm.
Following this 2.5 gm was given intramuscularly 4 hourly,
for 24 hours after administration of the first dose.
• Disadvt. – Small sample size of trial; More randomized trials are required.
• Dr.Sardesai ,Solapur - loading dose of magnesium sulphate 4 gm
i.m. or i.v. in 20 cc 25 % dextrose .
Following this 2 gm i.m. / diluted i.v. 3 hourly
More sustained levels of Mg ++ are achieved , with better control and
low dose.
This regime is well followed in rural and interior southern Maharashtra with
good outcome.
3312 August 2017

33. Other low dose regimens:
• PADHAR REGIME : 6 - 10 g loading dose of magnesium
sulphate.
4 g maintenance dose every 4 h.
• Advt - It demonstrated that if patient has received
dizepma/pheneragan before
referral , loading dose can be reduced.
• Disadvt. – Small sample size of trial; More randomized trials
are required.
•
3412 August 2017

34. Management of toxicity –
rare occasion if monitored properly or with renal upset
• Prompt tracheal intubation
• and mechanical ventilation in case of resp depression.
• 10% Calcium Gluconate 10 ml slow i.v. over 10 min with cardiac
monitoring and then as and when required.
• Stop further Magnesium Sulphate doses.
3512 August 2017

35. Step 2: Support the maternal
condition
It is vital to support maternal respiratory
and cardiovascular functions to prevent
hypoxia, acidosis, and cardiorespiratory
arrest.
Begin by establishing airway patency and
maternal oxygenation during and after the
convulsion. ABCD of resusitation
Administer oxygen via a face mask, with or
without a reservoir, at a rate of 8 to 10
L/min.

36. During the apneic period (see “Profile of an
eclamptic seizure” on page 46), the patient
will develop hypoxia. Use pulse oximetry to
monitor oxygen saturation, with the goal of
keeping it above 94%. Arterial blood gas
analysis is required if oxygen saturation
remains below 92% or if pulmonary edema
or aspiration is suspected.
If the patient develops recurrent seizures,
status epilepticus, florid alveolar pulmonary
edema, or respiratory arrest, intubate her
immediately.

37. Iv fluids..
• Careful attention must be given to the overall fluid status of the
patient.
• Patients with eclampsia may have profound hemoconcen-
tration.
• Because of this, close hemodynamic monitoring is required in
the setting of epidural anesthesia and/or of severe blood loss.
• Patients who are hypovolemic will not respond well to acute
blood loss, yet it is also important to limit fluids, as these
patients have capillary leakage and are predisposed to
developing pulmonary edema.

38. 13/12/2003

39. Step 3: Prevent maternal
injury and aspiration
Secure the side rails of the patient’s bed by elevating
them to prevent a fall, and make sure they are
padded to prevent trauma during convulsions and
afterward, when some women become combative
and agitated.
Position the patient in a lateral decubitus position to
minimize aspiration of oral secretions.
If any secretions or vomitus are present, remove
them via suction.

40. Step 4: After the convulsion, give
magnesium sulfate
Magnesium is the drug of choice for seizure
prophylaxis in women with preeclampsia and severe
symptoms, and to prevent recurrent seizures in
women with eclampsia.
In the latter group, once the eclamptic convulsion has
ended, give a loading dose of IV magnesium (6 g/100
mL over 20 minutes), followed by a continuous
infusion of 2 g/h for at least 24 hours.
If the patient develops a second seizure during the
maintenance infusion, administer another bolus of
magnesium (2 g/100 mL over 3–5 minutes).

41. Step 5: Treat severe
hypertension
If severe hypertension persists for 60 minutes
or longer, it can lead to injury of the brain,
heart, and kidneys.
To avoid these complications, it is essential to
reduce BP to a safe range and maintain that
level without compromising cerebral perfusion
pressure and uteroplacental blood flow (which
already may be reduced in some patients).

42. The goal of antihypertensive therapy is to
keep systolic BP between 140 and 155 mm
Hg and diastolic values between 90 and 105
mm Hg.9 Several agents are available for the
treatment of severe hypertension during
pregnancy and postpartum. The most
commonly used IV medications for this
purpose are labetalol and hydralazine.
Another option is oral, rapidly acting
nifedipine.

43. Reduction of severe hypertension (blood pressure > 160/110 mm Hg or mean
arterial pressure <125 mm Hg) is mandatory to reduce the risk of
cerebrovascular accident. Treatment may also reduce the risk of further
seizures
M.A.P.=SBP -DBP +DBP
3

44. 13/12/2003

45. 13/12/2003

46. Step 6: Evaluate the patient for
complications
Pulmonary edema can develop in patients with
eclampsia or another hypertensive emergency.
Suspect it if the patient has respiratory
symptoms in association with tachypnea,
tachycardia, or sustained oxygen saturation
values below 93%, as well as when the patient
exhibits basal rales during auscultation of the
lungs.
Treatment involves the administration of
oxygen and IV furosemide (20–40 mg push),
repeated as needed.

49. HELLP SYNDROME
PREECLAMPSIA
plus
Hemolysis –
Abnormal peripheral
smear
LDH>600 U/L
Bilirubin > 1.2 mg/dl
Elevated Liver Enzymes
Serum AST > 70 U/L
LDH > 600 U/L
Low Platelets
Platelet count <
100,000 / mm3

50. Management
Corticosteroids
Magnesium sulphate
Hypotensive drugs
Blood products
Delivery

52. *The definitive treatment of eclampsia is delivery. Attempts to
prolong pregnancy in order to improve fetal maturity are unlikely to
be of value. However, it is inappropriate to deliver an unstable
mother even if there is fetal distress. Once seizures are controlled,
severe hypertension treated, and hypoxia corrected, delivery can be
expedited.
*Vaginal delivery should be considered but caesarean section is
likely to be required in primigravidae remote from term with an
unfavourable cervix.
*After delivery, high dependency care should be continued for a
minimum of 24 hours

53. 13/12/2003

54. conclusions
• Eclamsia and Hellp syndrome are two
dreaded complications of PIH
• Need multidiscplinary management
• Obstetric ICU
• Experienced obstetrician and team
• Descion making

55. Critical care
ECLAMPSIA DRILLS
10 STEPS TO BE REHEARSED
REPEATEDLY

56. 1. Practice. Practice again.
Implement regular monthly simulation training sessions
Fisher N, Bernstein PS, Satin A, et al. Resident training for
eclampsia and magnesium toxicity management:
simulation or traditional lecture? Am J Obstet Gynecol.
2010;203(4):379.e1–5.
Eclampsia is unpredictable and can develop rapidly at
home, in labor and delivery, on the
antepartum/postpartum ward, and in the emergency
room. Therefore, it is prudent that all health-care
providers who treat pregnant or postpartum women on a
daily basis be trained and knowledgeable about early
detection and management of eclampsia. This goal can
be achieved by developing drills for rehearsal and by
testing the response and skills of all providers.

57. 2. Preventive: Magnesium sulfate
Do not attempt to arrest the seizure. Use MgSO4 to prevent
recurrent convulsions.
Duley L, Henderson-Smart DJ, Walker GJ, Chou D. Magnesium
sulfate versus diazepam for eclampsia. Cochrane Database
Syst Rev. 2010;(12):CD000127.
Most eclamptic seizures are self-limiting. Therefore, there is
no need to administer bolus drugs such as diazepam or
midazolam. These drugs are usually used in the emergency
room, but they inhibit maternal laryngeal reflexes and may
lead to aspiration. They also suppress the central nervous
system respiratory centers and can cause apnea, requiring
intubation.
When used in the management of eclampsia, magnesium
sulfate is associated with a lower rate of recurrent seizures
and maternal death than is diazepam.

58. 3. FHR changes? Be patient.
Do not rush the patient to emergent cesarean section
because of an abnormal FHR tracing
Sibai BM. Diagnosis, prevention, and management of
eclampsia. Obstet Gynecol. 2005;105(2):402–410.
During an eclamptic convulsion, there is usually prolonged
fetal heart rate (FHR) deceleration or even bradycardia—with
or without an increase in both frequency and uterine tone.
After the convulsion, as a result of maternal hypoxia and
hypercarbia, the FHR tracing can show tachycardia, reduced
beat-to-beat variability, and transient recurrent decelerations.
When this happens, concern about fetal status can distract
the obstetric provider from resuscitation of the mother.
However, these FHR changes usually return to normal after
maternal resuscitation. If the FHR changes persist for longer
than 15 minutes, consider abruptio placentae and move to
delivery.

59. 4. Target: Lower BP
Reduce maternal blood pressure to a safe level to prevent stroke,
but without compromising uteroplacental perfusion
Zwart JJ, Richters A, Ory F, de Vries JI, Bloemenkamp KW, van
Roosmalen J. Eclampsia in the Netherlands. Obstet Gynecol.
2008;112(4):820–827.
In this nationwide review of complications from eclampsia in the
Netherlands, the authors found that failure to treat persistent
severe hypertension was associated with hypertensive
encephalopathy, cerebral infarction, bleeding, or congestive heart
failure. They also found that 35.2% of women had systolic or
diastolic blood pressure at or above 170/110 mm Hg at admission,
but fewer than half were given antihypertensive drugs at that time.
Among the cases deemed to have received substandard care, one
third involved inadequate treatment of hypertension.

60. 5. Know your antihypertensives
Learn which agents are best to control severe hypertension in eclampsia
Sibai BM. Hypertensive Emergencies. In: Foley MR, Strong TH, Garite TJ, eds.
Obstetric Intensive Care Manual. 3rd ed. New York, NY: The McGraw-Hill Companies;
2010.
It is critical to familiarize oneself with the mechanism of action, dose, and potential
side effects of agents used to control hypertension. For example, neither hydralazine
nor nifedipine should be used in patients who have severe headache and persistent
tachycardia (pulse, >100 bpm). Labetalol should be avoided in women who have
persistent bradycardia (pulse, <60 bpm), asthma, or congestive heart failure.
For women who have persistent headache and tachycardia, I suggest intravenous (IV)
labetalol, starting at a dose of 20 mg, 40 mg, or 80 mg every 10 minutes as needed to
keep systolic blood pressure below 160 mm Hg and diastolic blood pressure below
105 mm Hg. The maximum dose of labetalol should not exceed 300 mg in 1 hour.
For patients who have bradycardia and severe asthma, I suggest oral, rapid-acting
nifedipine, starting at 10 mg to 20 mg, to be repeated in 20 to 30 minutes as needed,
up to a maximum of 50 mg to 60 mg in 1 hour. Oral nifedipine can be used with
magnesium sulfate. An alternative is an IV bolus injection of hydralazine, starting at
a dose of 5 mg to 10 mg, to be repeated every 15 minutes, up to a maximum dose of
25 mg.

61. 6. Avoid general anesthesia
Use neuraxial anesthesia for labor and delivery in eclampsia
MD-IQ QUIZ: Postcesarean delivery: Preventing infections
Treatment & Diagnosis of Obstetrics
Drug & Dosing Information
Turner JA. Severe preeclampsia: anesthetic implications of the disease
and its management. Am J Ther. 2009;16(4):284–248.
Huang CJ, Fan YC, Tsai PS. Differential impacts of modes of anaesthesia
on the risk of stroke among preeclamptic women who undergo
Cesarean delivery: a population-based study. Br J Anaesth.
2010;105(6):818–826.
Epidural, spinal, or combined anesthesia is safe in the absence of
coagulopathy or severe thrombocytopenia. General anesthesia
increases the risk of aspiration, failed intubation due to
pharyngolaryngeal edema, and stroke secondary to the increase in
systemic and intracerebral pressures during intubation and extubation.

62. 7. Cesarean for all patients?
Eclampsia is not an indication for cesarean
delivery
Repke JT, Sibai BM. Preeclampsia and
eclampsia. OBG Manage. 2009;21(4):44–55.
Once the mother has been resuscitated and
stabilized, the provider should choose a mode
of delivery that is based on fetal condition,
gestational age, presence or absence of labor,
and the cervical Bishop score. Vaginal delivery
can be achieved in most patients who have a
gestational age of 34 weeks or greater.

63. 8. Late presentation happens
Be aware that eclampsia can develop for the first
time as long as 28 days postpartum
Sibai BM, Stella CL. Diagnosis and management of
atypical preeclampsia-eclampsia. Am J Obstet
Gynecol. 2009;200(5):481.e31–37.
Atypical eclampsia is any eclampsia that develops
beyond 48 hours postpartum. A history of
diagnosed predelivery preeclampsia is not
necessary for development of late postpartum
eclampsia. In general, more than 50% of patients
who develop late postpartum eclampsia have no
evidence of preeclampsia prior to delivery.

64. 9. Mind the differential
Be aware that the clinical and neuro-imaging features of eclampsia overlap with those of
reversible cerebral vasoconstriction syndrome (angiopathy)
Fletcher JJ, Kramer AH, Bleck TP, Solenski NJ. Overlapping features of eclampsia and
postpartum angiopathy. Neurocrit Care. 2009;11(2):199–209.
Women who have reversible cerebral vasoconstriction syndrome have clinical findings
(acute onset of recurrent headaches, visual changes, seizures, and hypertension) and
cerebral magnetic resonance imaging (MRI) findings (posterior reversible encephalopathy
syndrome) that are similar to those of women who have late postpartum eclampsia
(FIGURE). However, in women who have postpartum cerebral angiopathy, cerebral
angiography will show the presence of bead-like vasoconstriction—which is usually absent
in eclampsia.
Posterior reversible encephalopathy syndrome
Green arrows point to vasogenic edema in the occipital lobes and, partially, the parietal
lobes. The edema is gone on repeat magnetic resonance imaging (see Recommendation #9).

65. 10. Act today, see a better outcome tomorrow
Avoid long-term maternal neurologic injury by
managing eclampsia properly
Zeeman GG. Neurologic complications of
preeclampsia. Semin Perinatol. 2009;33(3):166–
172.
Residual neurologic damage is rare in the majority
of women who have eclampsia. However, long-term
cerebral white-matter injury (cytotoxic edema,
infarction) on MRI imaging and impaired memory
and cognitive function may develop in some
women who have multiple seizures and who have
inadequately controlled persistent severe
hypertension.

69. Pack containing equipment for magnesium therapy

74. THANK YOU FOR ATTENDING
THIS 6 CITIES ECLAMPSIA
IAN DONALD SCHOOL BRINGS TO GREETINGS
COMPILED BY
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