Eclampsia: Difference between revisions
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#[[Delivery]] | #[[Delivery]] | ||
#Seizure Tx | #Seizure Tx | ||
# | #*[[Magnesium]]: Load 4-6g IV over 15min followed by 2-3gm/hr | ||
# | #**Can give up to 10gm IM | ||
# | #**Observe for loss of reflexes, respiratory depression | ||
# | #**Must adjust dose in pts w/ renal failure | ||
# | #*If seizures recur: | ||
# | #**Consider other anticonvulsant drugs | ||
# | #**Consider alternative diagnosis | ||
#BP Control | #BP Control | ||
# | #*Lower to Sys 130-150, dia 80-100 | ||
# | #**[[Labetalol]] | ||
# | #***Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg | ||
# | #***Option 2: Initial 20mg; then IV infusion of 1-2mg/min | ||
# | #**Hydralazine | ||
# | #***5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg | ||
==Disposition== | ==Disposition== | ||
Revision as of 08:27, 22 April 2015
Background
- Preeclampsia and eclampsia are diagnosed after 20wks gestation and <4wk post-partum
- May occur sooner w/ gestational trophoblastic disease
- Suspect in any pregnant pt who is >20wk or <4wk postpartum who develops seizures
Differential Diagnosis
- Standard seizure
- Preeclampsia
3rd Trimester/Postpartum Emergencies
- Acute fatty liver of pregnancy
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- HELLP syndrome
- Mastitis
- Peripartum cardiomyopathy
- Postpartum endometritis (postpartum PID)
- Postpartum headache
- Postpartum hemorrhage
- Preeclampsia
- Resuscitative hysterotomy
- Retained products of conception
- Septic abortion
- Uterine rupture
Treatment
- Delivery
- Seizure Tx
- Magnesium: Load 4-6g IV over 15min followed by 2-3gm/hr
- Can give up to 10gm IM
- Observe for loss of reflexes, respiratory depression
- Must adjust dose in pts w/ renal failure
- If seizures recur:
- Consider other anticonvulsant drugs
- Consider alternative diagnosis
- Magnesium: Load 4-6g IV over 15min followed by 2-3gm/hr
- BP Control
- Lower to Sys 130-150, dia 80-100
- Labetalol
- Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
- Option 2: Initial 20mg; then IV infusion of 1-2mg/min
- Hydralazine
- 5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
- Labetalol
- Lower to Sys 130-150, dia 80-100
Disposition
- Emergent OB/GYN consultation
See Also
Source
- Tintinalli
- EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
- Uptodate