Management

1) Resuscitation and general

management
2) Anticonvulsive therapy
3) Antihypertensive therapy
4) Delivery

1) Resuscitation and general

management

Initiate RED ALERT

Left lateral position, 2 IV lines
Maintain airway, O2 mask
Abort fit by- MgSO4 loading dose= 4g IV bolus
over 10-15 min
After fit aborted- GXM, coagulation profile, renal
profile, platelet count.
Asses level of consciousness & neurological
status
Closely monitor vital sign - BP,PR,SPO2,RR,I/O
chart

(B)Anticonvulsive therapy

MgSO4 Maintainance dose:

*IV infusion of 1g/hour
Duration: continue for 24hours after last fit or after delivery
Monitoring for MgSO4 therapy:
1.Investigations BUSE,FBC
Serum Ca2+,Mg
Renal function test (urea,uric acid,creatinine)
Coagulation profile
UFEME
ECG
GXM
2. STOP !!! If present signs of Mg toxicity:
(a) RR < 16/min
(b) Urine output < 25ml/hr
(c) patellar reflex absent
(d) Serum Mg > 3.5mmol/L (therapeutic range: 1.7-3.5)
(e) BP < 90/60 mmHg
3. Antidote: Calcium gluconate 1 gm given slow bolus over 10 minutes, whereby
during and after adminstration patient requires ECG monitoring due to potential
of cardiac arrthymia

(C)Antihypertensive therapy

initiatiate parenterally if BP>

160/110mmHg
IV Hydralazine Initial dose 5 mg
OR
IV labetolol 20-50mg
OR
Nifedipine 20 mg orally TDS until blood
pressure stabilized

(D) Delivery:

If pregnancy 34 weeks or more

deliver within 6hrs after mother is stabilised
if cervix favourable,cephalic: assisted SVD
if cervix not favaurable: LSCS
If the pregnancy is 32-34 weeks and no labor:
Stabilize and administer Dexamethazone IM should
be considered and vaginal delivery is preferred
after 24-48 hrs, 6 mg IM every 12 hrs for 48 hrs
If the pregnancy is less than 32 weeks, Cesarean
Section is preferred as the success of induction is
reduced

Complications

Maternal
CVA
Uncontrolled Blood pressure
HELLP syndrome
Renal Failure
Acute Pulmonary oedema
Retinal Detachment (Blindness)
Hematological abnormalities
Injury of the patient (Tongue Biting, falling down)
Death
Fetal
Fetal distress
Prematurity
Intra-uterine Growth retardation
Fetal demise

Prevention

Low dose Acetyl salicylic Acid

(aspirin) 75mg PO and Calcium
supplementation 1g daily can be
considered for the next pregnancy
Contraception for at least one year
Closely follow up next pregnancy