S E VE RE

OUTLINE
1. Definition Severe PE & eclampsia

​2. Management of severe PE & eclampsia

3. Magnesium Sulfate

​
 PRE ECLAMPSIA

Hypertension after the 20th week of pregnancy

until 6 week postpartum, with proteinuria.
 PRE ECLAMPSIA
Systolic BP ≥ 140,
and/or diastolic BP≥ 90
Hypertension after the 20th week of pregnancy
until 6 week postpartum, with proteinuria.
 PRE ECLAMPSIA
Systolic BP ≥ 140,
and/or diastolic BP≥ 90
Hypertension after the 20th week of pregnancy
until 6 week postpartum,
with proteinuria.
Proteinuria = 300mg/24
hours urine collection
or 1g/L or more in 2
randomly collected urine
samples 6 hours apart.
6
SEVERE PRE ECLAMPSIA
PRE-ECLAMPSIA WITH:

1. BP ≥ 160/110
2. Proteinuria 3+ / 3g/L
3. Symptoms
4. Complications – end-organ damage /
biochemical derangement
SEVERE PRE ECLAMPSIA
PRE-ECLAMPSIA WITH:

1. BP ≥ 160/110
2. Proteinuria 3+ / 3g/L

3. Symptoms
4. Complications
SEVERE PRE ECLAMPSIA
PRE-ECLAMPSIA WITH:

1. BP ≥ 160/110
2. Proteinuria 3+ / 3g/L
3. Symptoms

4. Complications end-organ damage /

biochemical derangement
 ECLAMPSIA

PIH with CONVULSION

IDENTIFYING HIGH RISK PATIENT 11
 12

MANAGEMENT
OF SEVERE
PE /
ECLAMPSIA
 13

1. CALL FOR
HELP
 14

2. RECOVERY
POSITION
 15

3. AIRWAY
4. BREATHING
 16

5. CIRCULATION
 17

6. MGSO4
7. IV ACCESS
ANTI-CONVULSANT 18

MgSO4provides fetal
neuroprotection
following preterm birth
with a significant
reduction in the
incidence of cerebral
palsy.
 19

8. TREAT HIGH BP
Presentation title 20
 21

9. IF CONVULSIONS
RECUR
 22

10. FLUID

In women with severe

pre-eclampsia, limit
maintenance fluids to
80 ml/hour unless there
are other ongoing fluid
losses (for example,
haemorrhage)*.

*Nice Guideline June 2019;

Hypertension In Pregnancy
 23

11. TRANSFER TO HOSPITAL

MAGNESIUM
SULFATE
APAKAH MGSO4
MgSO4 bertindak merehatkan otot pada saluran darah 
membalikkan kesan pengecutan saluran darah di otak,
mengurangkan iritasi otot dan saraf

MgSO4 bukan ubat anti-konvulsif

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INDIKASI
1. Eclampsia

2. Severe pre-eclampsia
 Magnesium sulphate

 Loading dose is given IV and IM

– 4g given IV (dilutent N/S!)
– 10g IM (diluent 2% Lignocaine)
 Give 5g to each buttock

 If unable to give IV loading dose give IM loading dose

only

IN PARTNERSHIP WITH
Liverpool School of Tropical Medicine
Liverpool Associates in Tropical Health
Magnesium Sulphate: Maintenance dose

IV route
 Magnesium sulphate (10g) in 1000 ml normal Saline IV
infusion at rate of 1g/hour
OR
IM route
 After loading dose continue with 5 g IM every 4 hours to
until 24 hours after birth or 24 hours after last convulsion
IN PARTNERSHIP WITH
Liverpool School of Tropical Medicine
Liverpool Associates in Tropical Health
CARA
PENYEDIAAN

MgSO4 tidak perlu dicairkan (dilution) bagi

kaedah pemberian secara IM

Suntikan perlu diberi bersama 1ml 2% Lignocaine

Presentation title 30

LANGKAH-LANGKAH PENYEDIAAN

1 Click icon to add picture Click icon to add picture Click icon to add picture Click icon to add picture

Sedut 10 mls (=5g)

MgSO4
Presentation title 31

LANGKAH-LANGKAH PENYEDIAAN

1 2
Click icon to add picture Click icon to add picture Click icon to add picture Click icon to add picture

Sedut 10 mls (=5g) Diikuti dengan

MgSO4 menyedut 1ml 2%
Lignocaine
Presentation title 32

LANGKAH-LANGKAH PENYEDIAAN

1 2
Click icon to add picture
3
Click icon to add picture Click icon to add picture Click icon to add picture

Sedut 10 mls (=5g) Diikuti dengan

Sediakan untuk
MgSO4 menyedut 1ml 2%
Lignocaine 2 belah buttock.
Presentation title 33

LANGKAH-LANGKAH PENYEDIAAN

1 2
Click icon to add picture
3
Click icon to add picture
4
Click icon to add picture Click icon to add picture

Sedut 10 mls (=5g) Diikuti dengan Suntik kedua-

Sediakan untuk
MgSO4 menyedut 1ml 2% dua belah
Lignocaine 2 belah buttock.
buttock
Presentation title 34

LANGKAH-LANGKAH PENYEDIAAN

1 2
Click icon to add picture
3
Click icon to add picture
4
Click icon to add picture
5
Click icon to add picture

Maintenance
Sedut 10 mls (=5g) Diikuti dengan Suntik kedua- 5g MgSO4 setiap
Sediakan untuk
MgSO4 menyedut 1ml 2% dua belah 4 jam – alternate
Lignocaine 2 belah buttock. buttock tanpa
buttock
lignocaine
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 PEMANTAUAN TANDA-TANDA
TOXICITI SEMASA DAN SELEPAS
PEMBERIAN MGSO4
 Kadar pernafasan <16/minit.
 Tiada reflex patellar.
 Urin output < 25 ml/jam atau <100mls/4 jam.

• Mengambil dan merekod tekanan darah, nadi ibu dan denyutan

jantung janin setiap 30 minit

• Jika kadar pernafasan kurang dari 16/min  hentikan

magnesium dan beri calcium gluconate 1g/ 10minit
THANK YOU