This is a life threatening situation for the mother and baby.
- 1:2000 pregnancies
- most occur in 3rd trimester
- 1/3 post-partum
- usually with in 24hrs of delivery
- vasogenic cerebral oedema from hypertensive encephalopathy
- manage A, B, C
- terminate the seizure
- management of hypertension
- prevention of complications
- Call for help! – neonatologist, anaesthetist, obstetric team, ICU
- A – jaw thrust -> RSI ETT
- B – FiO2 1.0, bag-mask, SpO2
- C – left lateral position (prevent aorto-caval compression), IV careful fluids, BP
- D – 4g MgSO4 IV over 5min -> infusion of 1g/hr for 24 hrs (therapeutic level = 2-4mmoL) – MAGPIE Trial
- MgSO4 IV
- Status epilepticus -> ?propfolol/thiopentone/diazepam (acknowledging effect on baby)
- Anti hypertensive treatments (aim SBP 140-160mmHg) -> hyrdralazine, labetalol, nifidepine
- methyldopa PO 0.5-3g/day
- labetalol IV 5-10mg injected slowly
- nifedipine PO 10-20mg or IV 100-200mg over 2 min
- beta-blockers (metoprolol, pindolol, propanolol, esmolol)
- hydrallazine IV 10-20mg slowly
- GTN IV 0.1-0.8mcg/kg/min
- SNP IV 1-4mcg/kg/min
Prevention of complications
- Planned delivery of baby
- Monitoring for organ dysfunction (ICU)
- consideration and Investigation of other causes: epilepsy, hypoglycaemia, electrolyte abnormalities, LA toxicity, CNS pathology
- BP control
- fluid balance
- monitoring for complications: ICH, CVA, pulmonary oedema, respiratory failure, hepatic failure, fetal loss
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of LITFL.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
On Twitter, he is @precordialthump.