Eclampsia

Question 1

What is pre eclampsia?

Answer 1

Hypertension developing after 20 weeks with proteinuria, or organ dysfunction or placental dysfunction.

Question 2

What is eclampsia?

Answer 2

Onset of one or more seizures associated with pre-eclampsia

Question 3

Incidence?

Answer 3

AN - 33
IP - 18
PN - 44

Question 4

Foetal complications of eclampsia

Answer 4

IUD, hypoxia, preterm birth, placental abruption

Question 5

Maternal complications of eclampsia

Answer 5

Pulmonary oedema, DIC, Renal failure, , Liver failure (HELLP syndrome)

Question 6

What equipment is needed?

Answer 6

Resus trolley and eclampsia box

Question 7

Airway?

Answer 7

LL, remove pillow, do not restrain

Question 8

Breathing?

Answer 8

administer high-flow facial oxygen using a non-rebreathe mask with reservoir bag. Apply sats probe

Question 9

Circulation?

Answer 9

V access x 2 and bloods (pack 1 – FBC, urea and electrolytes, liver function tests, clotting, group and save)

Question 10

How often do we check reflexes?

Answer 10

Check reflexes (before treatment and every 30mins for first 2 hours then hourly.

Question 11

How often should we check observations?

Answer 11

Obs recorded every 5 mins initially then every 10 mins for first hour then hourly once stable

Question 12

How often should we take bloods?

Answer 12

Take bloods at 1, 4, 10, 16 and 24 hours as indicated

Question 13

How much in the IV regime for fluids?

Answer 13

1ml/kg/hr

Question 14

Loading dose of MgSO4?

Answer 14

4g over 5-10mins
20ml vial IV

Question 15

Maintenance dose?

Answer 15

IV infusion
1/g per hour for 24hrs
Syringe driver - 5ml/hr

Question 16

Further bolus?

Answer 16

10ml syringe, 10mls diluted MgSO4, 2mls per min over 10 mins
2g

Question 17

target MgSO4 levels

Answer 17

Normal range 1.5 - 2.5 mmol/L
Therapeutic range: 2-3.5mmol/L

Question 18

Antihypertensives

Answer 18

Nifedipine- 10mg, repeat if at 40 min BP >160/100
Labetalol 200mg TDS

Question 19

What is a contraindication of Nifedipine?

Answer 19

T1 DM

Question 20

2nd line antihypertensives

Answer 20

Labetalol (IV) see protocol, indicated when BP persistently >160/100
Hydralazine (IV) - Nifedipine PO or Labetalol IV contraindicated

Question 21

What is a contraindication of Labetelol?

Answer 21

Asthma

Question 22

What would the plan be for delivery?

Answer 22

Arrange for CT/MRI within 24 hours of 1st seizure
Continuous EFM until delivery
Avoid Syntometrine and ergometrine at delivery

Question 23

What are signs of MgSO4 toxicity?

Answer 23

urine output <10mls/hr
RR<14/min
Absent reflexes
Oxygen sats <90%
Creatinine >150 umol/l
Magnesium sulphate level >3.5 mmol/L

Question 24

Antidote for mgSO4 toxicity?

Answer 24

1g CALCIUM GLUCONATE
10ml of 10% solution