Pre-eclampsia/Eclampsia

• Pre-eclampsia: hypertension >140/90, proteinuria >0.3g/L

• Eclampsia: seizures• Incidence:– Pre-eclampsia: 2-10% of all pregnancies– Eclampsia: 2-6 in 10000 deliveries

• 1.8% maternal mortality

History & Examination• Symptoms– Headache– Visual disturbance– Epigastric pain– Fetal movements

• Signs– BP, proteinuria– Hepatic tenderness– Clonus, hyperreflexia– Papilloedema

Antihypertensives

• Labetolol– Orally– Intravenous

• Nifedipine– Orally

• Hydralazine– intravenous

• Methyldopa – slow acting

Anticonvulsants

• Magnesium Sulphate– 4g IV push– Maintenance dose 1-2g/hour

• Monitor for signs of toxicity– Loss of deep tendon reflexes– Respiratory depression– Coma– Cardiac arrest

• Calcium gluconate

Scenario

• A patient at 30 weeks gestation on the ward was found fitting by the staff midwives

• She is hypertensive 160/120, with +4 proteinuria

• You are called to attend

• ABCs!!!• Help – midwives, senior obstetrician,

anaesthetist• IV access• Lab investigations– FBC, U&Es, LFTs, coag

• Stabilise patient before fetus

• Mg SO4• Antihypertensives• Fluid restriction – no more than 80ml/hour• HDU monitoring• Delivery when stabilised

Summary

• ABC’s• Stabilise patient• Antihypertensives/anticonvulsants• Delivery