- Vitamin C 1,000 mg/day
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Treatment of Eclampsia
- Main and Danish guidelines by the web master
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Se also Hypertension Treatment of Preexcisting Hypertension Hypertension and sligth to moderate preeclamsia Treatment of Serverhypertension Treatment of Eclampsia Drug In UK 1/3 of women with eclampsia had maximal diastolic blood pressure of less than 100 mmHg Maintain airway, avoid aspiration, administer oxygen. Arrest seizures: magnesium sulphate and diazepam, if the fit continue. Seizure prophylaxis: Magnesium sulphate Antihypertensive therapy Monitoring: Monitoring half hourly BP (Dinamap, if available) but control with manuel recording, ½ houry pulse and urine output hourly neurological assessment serum Magnesium if indicated. If eclamptic patient is unconscious for more than 30 minutes or have focal neurological symptoms, the patient should be referred for medical opinion and CT scan. DURING LABOUR Regional anesthesia: Should be encouraged as it also helps to control hypertension and avoid fluctuation in blood pressure associated with regional anesthesia and intubation. Most anesthetist used a cut off for platelet count of 60-70 (80 in UK) Ergometrin: Should be avoided because it cause an acute rise in blood pressure Treatment of Seizures: See Eclampsia/magnesium sulphate The preeclamptic patient is dehydrated with intravascular volume, volume depletion, with increased intestitial volume. After delivery fluid is going from intestitial tissue to the intracellular and intravascular tissue with a further risk of pulmonary edema and cardiac decompensation. The patient should not receive more than 500 ml of saline if no bleeding during labor without knowledge of the central venous pressure. Right atrial pressure (specially normal and high by CVP) may not always accurately reflect left atrial pressure and a pulmonary artery catheter (Swan Ganz Catheter) may occasionally be indicated. Basal fluid regimen 85-100 ml NaCl/hour. Oliguria is common. Diuretics are usually inappropriate in the management of postpartum oliguria unless there is obvious signs of fluid overload or pulmonary edema. Treatment of long standing oliguria (> 6 hours urinary output < 30 ml/per hour) or < 0.5 mls/kg/hour. If CVP < 5 mm albumin, Hg 250-750 ml NaCl. If CVP > 5 and no effect of diuretics, Dopamine 1-5µg/kg/min IV. Treatment of postpartum hypertension is common and often not anticipated. The blood pressure rise after normal delivery and reach a peak 3-4 days postpartum. Eclampsia is a risk for the first 48 hours after delivery but can develop up to 7 days after delivery. Antihypertensive drugs can always be discontinued after 2-3 days if blood pressure < 110 diastolic. Methyldopa should be avoided post partum because of its tendency to cause depression. ACE inhibitors and Angiotensin II receptor blockers may safely be used postpartum. It is possible to switch to the patients previous anti-hypertensive regime after delivery. PROPHYLAXIS In patients with previous preeclampsia, the risk of recurrence is 15%. If the woman's mother had preeclampsia and the sister has a history of preeclampsia, the risk is about 25%. Examined for thrombophilia. If abnormal uterine artery Doppler recording (Notch) are noted the risk is further increased. Medication: Low dose aspirin 75 mg/day. Started before < 16 weeks, decrease the risk by 15% both in woman at high and low risk. Calcium gluconate 1 g daily has been shown effective in some studies. Folic acids 5 mg daily especially in women with a high level of homocystein. Anti-oxidants: (1) Fontenot MT et al. A prospective randomized trial of magnesium sulfate in severe preeclampsia: Use of diuresis as a clinical parameter to determine the duration of postpartum therapy. AMJOG. 2005, vol 192, number 6, 1793-94 (2) Nelson-Piercy C. Handbook of Obstetric Medicine. Second Edition, By Martin Dunitz, Ltd., published in the United Kingdom in 2002. (3) Sibai, MB, Barton JR. Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications. Am J Obstet Gynecol 2007;June; 196(6):514,e1-9 (4) The management of severe- pre-eclampsia/eclampsia. Royal college of Obstetricians and Gynecologists March 2006 No 10 (5) www.uptodate.com 2007
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