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- If patient’s condition does not progress, discharge and follow on a twice weekly basis.
- In a field or remote setting, manage aggressively with dexamethasone 6 mg IM q 12 hours for a total
of 4 doses to prevent fetal respiratory distress syndrome and maternal thrombocytopenia, and to improve
perinatal outcome in severe preeclampsia. - Give magnesium sulfate (to prevent seizures) by a controlled continuous infusion with a loading dose of
4-6 gm in 100 ml over 15-20 min. followed by a continuous infusion of 2-3 gm/hr. Toxic levels cause
muscle weakness, respiratory paralysis, and cardiac arrest. Administer calcium gluconate 1 gm slow IV
push over 2-3 minutes to counteract magnesium toxicity.
Severe Preeclampsia: - With SBP > 180 mm Hg or the DBP > 110 mm Hg, the possibility of intracerebral damage increases
warranting antihypertensive medication. Give Hydralazine (Apresoline) 5-10 mg IV every 20 minutes as
indicated, or labetalol 20 mg IV q 10 min with a max dose of 300 mg, to reduce BP. Monitoring BP q 5
minutes for at least 30 min. after giving the drug. Please note that some of the side effects with labetalol
are maternal tachycardia, headache and flushing. - Give magnesium sulfate as above.
- Evacuate.
Eclampsia: - Give magnesium sulfate as above.
- Provide oxygen and airway support as needed.
- Evacuate.
- If evacuation not feasible deliver the fetus after seizure activity has abated.
- If magnesium sulfate is not available, consider cesarean section as only option to save both mother and
fetus (see Cesarean Section procedure).
Patient Education
Activity: Remain at bedrest on left side to minimize symptoms.
Prevention: Increase water intake, but maintain normal salt intake.
Follow-up Actions
Evacuation/Consultant Criteria: Evacuate early to avoid complications of eclampsia. Consult experts for
management in remote settings (to include C-Section if necessary).