SEVERE PRE-ECLAMPSIA AND IMMINENT ECLAMPSIA

Question 1

Daily monitoring in severe preeclampsia and imminent eclampsia (SPIE)

Answer 1

Blood pressure
Daily weight measurements

Question 2

Protocol for BP monitoring

Answer 2

Every 15-30mins intitially and increased 2-4hrs when patient is controlled and stable

Question 3

Symptoms of severe preeclampsia and imminent eclampsia

Answer 3

Frontal headache
Visual disturbances
Epigatsric pain
Vomiting
Oliguria

Question 4

Signs of severe preeclampsia and imminent eclampsia

Answer 4

Elevated BP
Ankle clonus
Oliguria
Increased tendon reflexes
Liver tenderness

Question 4

Normal urine output

Answer 4

0.5 to 1.5ml/kg/hr for adults

Question 5

Oliguria in adults

Answer 5

Urine output less than 30ml/hour or 400ml/24hrs

Question 6

Investigations in severe preeclampsia and imminent eclampsia

Answer 6

FBC
Clotting profile
Serum uric acid
Urinalysis and culture
BUE and Creatinine
LFTs
RBG
Daily assessment of urine proteins
Ultrasound scan

Question 6

Components of blood clotting profile

Answer 6

Bedside clotting time
aPTT
INR
Prothrombin time

Question 6

Treatment objectives for severe preeclampsia and imminent eclampsia

Answer 6

Prevent complications of HTN
Prevent fits/eclampsia
Reduce BP
Stabilise and deliver

Question 7

Non-pharmacological management

Answer 7

Early delivery of baby
If less than 34 weeks and asymptomatic, continue to term
If 34 weeks or more, stabilise and deliver

Question 7

Blood pressure management for severe preeclampsia and imminent eclampsia

Answer 7

IV hydralazine or
IV Labetalol or
SL nifedipine
then
PO nifedipine retard or
PO methyldopa

Question 7

Dose for IV hydralazine

Answer 7

5-10mg IV over 5-10 mins, repeat every 20-30mins

Question 7

Dose for IV labetalol

Answer 7

20mg stat. over at least 1 mins
then
repeat at 10 mins interval if BP>160/110 as follows 40mg, 80mg, 80mg to a cummulative max of 220mg.

when BP<160/110mmHg,
start infusion at 40mg/hr and double at 30mins intervals till a satisfactory reponse or to a max of 160mg/h

Question 7

Management or prevention of seizures in severe pre-eclampsia
and imminent eclampsia

Answer 7

Magnesium sulphate, IV, 20 ml of the 20% solution (4 g)
And
Magnesium sulphate, IM, 10 ml of the 50% solution, (5 g) into each
buttock (total of 10 g)

Question 8

Dose for nifedipine retard PO

Answer 8

Nifedipine retard, oral, 20-40 mg daily

Question 8

Dose for methyldopa

Answer 8

Methyldopa, oral, 250-500 mg 8-12 hourly

Question 8

Referral criteria

Answer 8

All cases of severe pre-eclampsia and imminent eclampsia
Refer patients with immature babies to facilities that can care for the baby