CONDITIONS IN L ATE PREGNANC YObstetric and Gynaecological Emergencies 385Pre-eclampsia and eclampsia
DIAGNOSIS AND MANAGEMENT
1 Pre-eclampsia is defined clinically by hypertension and proteinuria, with or
without pathological oedema, which develop after 20 weeks gestation.
2 Hypertension includes:
(i) A systolic blood pressure >140 mmHg and diastolic blood
pressure >90 mmHg on two successive measurements 4–6 h apart
in the third trimester of pregnancy.
(ii) A rise in blood pressure of >25–30 mmHg systolic or 15 mmHg
diastolic compared with early pregnancy (booking) blood
pressure.
3 Fulminant or severe pre-eclampsia is associated with:
(i) Systolic blood pressure (BP) >160 mmHg, diastolic BP
110 mmHg.
(ii) Headache, visual symptoms.
(iii) Nausea, vomiting and abdominal pain.
(iv) Oliguria (<500 mL/24 h).
(v) Irritability and hyper-reflexia.
4 Complications of severe pre-eclampsia include:
(i) Acute pulmonary oedema.
(ii) HELLP syndrome – haemolysis, elevated liver enzymes and low
platelets.
(iii) Disseminated intravascular coagulation.
(iv) Oliguria.
(v) Seizures (eclampsia).
5 Call the senior ED doctor and obstetric team urgently. Give oxygen, gain i.v.
access and send blood for FBC, U&Es, LFTs, blood sugar, coagulation profile
and uric acid. Commence a normal saline infusion.
6 Catheterize the patient. Place a wedge under the right hip, or nurse in the left
lateral position.
7 Magnesium sulphate is the drug of choice for seizure prophylaxis in
pre-eclampsia, and for eclampsia:
(i) Give an initial dose of magnesium 4 g (16 mmol) i.v. over
5–10 min, then commence an infusion of magnesium 1 g/h
(4 mmol/h) for at least 24 h.
(ii) Treat any seizure with a further bolus of magnesium 2 g
(8 mmol) i.v.
8 Give diazepam 0.1– 0.2 mg/kg i.v. if seizures persist.
9 Treat severe hypertension with hydralazine 5 mg i.v. bolus every 20 min (to a
maximum cumulative dose of 20 mg) or labetalol 20 mg i.v. bolus escalating
to 40 mg bolus every 10 min (to a maximum cumulative dose of 300 mg).