MANAGEMENT OF ECLAMPSIA
Admission in obstetric ICU
Maintain airway, breathing and circulation
Secure IV line, draw 20cc of blood for following investigations -Complete
hemogram, urine protein, PT, APTT, INR, LFT, RFT, Uric acid, Blood for
grouping and cross matching
Simultaneously elicit detailed history
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Mgso4 ( various regimens available )
Antihypertensives.
Antibiotics.
IV fluids (RL) @ 75 ml/hr
Physical examination
CTG, obstetric ultrasound, Fundoscopy
Catheterize the bladder and maintain the I/O chart
Monitor for MgSo4 toxicity
( knee jerk(3+), urine output (100ml/4 hrs), RR (>12/ min) if maintenance dose
is given
Obstetric management
 Assess Bishops score
Emergency LSCS if
Vaginal delivery if imminent
Bishops score <6
vaginal delivery possible
Indications for cesarean section
1. Unfavourable cervix
2. Uncontrolled hypertension/seizures
3. Obstetric indication
Regimen
Loading dose
Maintenance dose
Pritchard
4gm (8ml of 50% 4amp
with 12ml distilled
water/16 ml of 20%
8amp diluted with 4ml
of distilled water)
ie,.20ml is given slow IV
over at least 5 min,
preferably 10-15min
5gm 4th hrly IM, after
ensuring presence of
1.patellar reflex
2.Respiratoryrate >14/min
3.Urineoutput> 30ml/hr
continued for 24 hours
after the last convulsion or
10gm undiluted -5gm of delivery whichever is later
50 % IM in each buttock
Zuspan
4gm of 20% MgSO4 over 1gm/hr IV
10 – 15 min IV
continued for 24 hours
after the last convulsion or
delivery whichever is later
Sibai
6gm 20% MgSO4 over 2gm/hr IV
10 – 15 min IV
continued for 24 hours
after the last convulsion or
delivery whichever is later
Suman Sardesai
4gm 20% MgSO4 IV over 2gm IM/IV 3hrly
10-15 min (or) 4g of 50% continued for 24 hours
20% MgSO4
after the last convulsion or
delivery whichever is later
ICMR low dose regimen 3gm of 20% MgSO4 IV Every 4 hrs, 2.5gm deep
(preferred in Indian over 10 - 15 min
IM, alternatively in each
women with low BMI)
& 2.5gm deep IM in buttock
each buttock
continued for 24 hours
after the last convulsion or
Total dose – 8 gms
delivery whichever is later
Single dose regimen
VIMS regimen
4gm of 20% magnesium
Sulphate IV over 10 to
15 minutes followed by
4gm of 50% magnesium
sulphate IM (undiluted
2gm on each buttock).
Total dose – 8 gms.
Dhaka regimen
4 gm of 20% MgSO4 iv 2.5 gm im every 4 hours.
over 10-15 min
continued for 24 hours
+ 2.5 gms of 50% MgSO4 after the last convulsion or
in each buttock
delivery whichever is later
Total dose – 9 gms.
ANTI HYPERTENSIVES :
- For acute hypertension cap. Depin 10 mg every 10 min till BP is
normalised followed by maintenance dose of 10 mg every 4th hrly
maximum dose 120 mg in 24 hrs.
( OR )
- Labetalol
Intravenous: Start with 20 mg IV as a bolus; if effect is suboptimal,
then give 40 mg 10 minutes later and 80 mg every 10 minutes for two
additional doses. Use a maximum of 220 mg.
Oral: Initially dose is 100mg twice daily, Can be titrated from 100mg
to 400mg TID. Maximum daily dose of 2400mg.
MEOWS CHART
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It is the Modified Early Obstetric Warning Score
All woman who enter an acute hospital setting should have their observations
recorded on MEOWS chart
Use- It prompts early referral to an appropriate practioner and high set up who can
under a full review, order appropriate investigations ,resuscitate and treat as required.
Woman should retain the same MEOWS chart when moving from one clinical area to
another, so that physiological trends can be observed
A full set of observations is required at each assessment as there are 5 physiological
variation that are regularly measured- Respiratory rate, Pulse rate, BP, Temperature,
Mental state
Triggering on MEOWS chart means- scoring of 1 observation in red and 2
observation in yellow
If the woman triggers, she requires-Referral to appropriate level of doctor,monitoring,
investigations,plan of care.