Eclampsia Flashcards
23yo P0G 30w by early U/S referred to labour ward from local ANC complaining of headache and blurred vision for past 2 hours. She is booked, uneventful pregnancy so far and her BP is now 170/110mmHg. Outline your management once she arrives in labour ward.
Is the patient stable?
GCS - awake and orientated but still has headache and blurred vision
BP - 190/130mmHg
Pulse - 96bpm
Urine +3 protein
Immediate:
Insert ivi Line
100ml RL
Insert urinary catheter
Load mgSO4 200ml NaCl over 20min and 5g with 1ml lignocaine imi in each buttok
Do bloods - Hct, plt, urea, creatinine, AST, LDH
23yo P0G 30w by early U/S referred to labour ward from local ANC complaining of headache and blurred vision for past 2 hours. She is booked, uneventful pregnancy so far and her BP is now 170/110mmHg. Outline your management once she arrives in labour ward.
History
She is booked, no complications so far and 20w by early U/S
Presenting complaint - paracetamol - flashing lights - previous episodes Booking bloods - Rh - Medical history - HIV +, asthma Family history Social history
23yo P0G 30w by early U/S referred to labour ward from local ANC complaining of headache and blurred vision for past 2 hours. She is booked, uneventful pregnancy so far and her BP is now 170/110mmHg. Outline your management once she arrives in labour ward.
Examination
Weight, height, MUAC Vitals after MgSO4 Big 5 Forgotten 4 Core 1
23yo P0G 30w by early U/S referred to labour ward from local ANC complaining of headache and blurred vision for past 2 hours. She is booked, uneventful pregnancy so far and her BP is now 170/110mmHg. Outline your management once she arrives in labour ward.
What investigations will you do?
Urine dipstick PET bloods Indirect Coomb's VL 24h urine protein Sonar
23yo P0G 30w by early U/S referred to labour ward from local ANC complaining of headache and blurred vision for past 2 hours. She is booked, uneventful pregnancy so far and her BP is now 170/110mmHg. Outline your management once she arrives in labour ward.
Problem list
- Primi with breech
- Rh negative
- Imminent eclampsia
- HIV positive
23yo P0G 30w by early U/S referred to labour ward from local ANC complaining of headache and blurred vision for past 2 hours. She is booked, uneventful pregnancy so far and her BP is now 170/110mmHg. Outline your management once she arrives in labour ward.
How do you manage the problem list?
- Admit to high care, insert ivi and catheter if not done
- MgSO4 maintain every 4h for 6 doses and check for toxicity
- Short acting antiHT
- nifedipine 10mg po
- labetolol ivi 20, 40, 80, 80, 80 every 30min to 300mg - Repeat if BP >160/110
- Steroids
- CTG once BP controlled
- Start methyldopa 500mg 8hrly po
- Monitor vitals and urine output, CTG and 6hrly bloods
23yo P0G 30w by early U/S referred to labour ward from local ANC complaining of headache and blurred vision for past 2 hours. She is booked, uneventful pregnancy so far and her BP is now 170/110mmHg. Outline your management once she arrives in labour ward.
Interpret her CTG
Name, date, time Paper speed Contractions HR - baseline 150, variability decreased, no accel, no decel Categorise - suspicious
23yo P0G 30w by early U/S referred to labour ward from local ANC complaining of headache and blurred vision for past 2 hours. She is booked, uneventful pregnancy so far and her BP is now 170/110mmHg. Outline your management once she arrives in labour ward.
Possible causes of decreased FHR variability
Fetal sleep Fetal acidosis Drugs (MgSO4, opiates) Prematurity Congenital heart abnormality
23yo P0G 30w by early U/S referred to labour ward from local ANC complaining of headache and blurred vision for past 2 hours. She is booked, uneventful pregnancy so far and her BP is now 170/110mmHg. Outline your management once she arrives in labour ward.
Bloods from lab once she is in labour ward: Hct 0.45 Plt 132 Urea 4.1 Creat 100 AST 31 LDH 356
Haemoconcentration
Mild thrombocytoenia
Mild renal impairment
23yo P0G 30w by early U/S referred to labour ward from local ANC complaining of headache and blurred vision for past 2 hours. She is booked, uneventful pregnancy so far and her BP is now 170/110mmHg. Outline your management once she arrives in labour ward.
Patient is now fitting. What is your management?
- CAB
- Vitals
- 2g MgSO4 in 200ml NaCl over 20min
- Eclampsia - deliver!
- Breech, not in labour - C/S
- Rh of baby, 100-300ug imi to mother post delivery
- Complete MgSO4 and control BP post delivery
23yo P0G 30w by early U/S referred to labour ward from local ANC complaining of headache and blurred vision for past 2 hours. She is booked, uneventful pregnancy so far and her BP is now 170/110mmHg. Outline your management once she arrives in labour ward.
HIV plan for patient
1w postnatal visit then 6w for both mom and baby Contraception - no oral No mixed feeding Refer for ARV treatment Baby on NVP for 6w
23yo P0G 30w by early U/S referred to labour ward from local ANC complaining of headache and blurred vision for past 2 hours. She is booked, uneventful pregnancy so far and her BP is now 170/110mmHg. Outline your management once she arrives in labour ward.
Advice for patient?
2y between pregnancies Folic acid 3mo before conception Book early (2nd missed menses) Start aspirin once FH visible on U/S Ca supplement Asthma management
23yo P0G 30w by early U/S referred to labour ward from local ANC complaining of headache and blurred vision for past 2 hours. She is booked, uneventful pregnancy so far and her BP is now 170/110mmHg. Outline your management once she arrives in labour ward.
Initial assessment History Examination Investigations Problem list Management CTG Causes of decreased FHR HIV plan Future advice
