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Eclampsia

OVERVIEW

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

MANAGEMENT

  • manage A, B, C
  • terminate the seizure
  • management of hypertension
  • prevention of complications
  • Call for help! – neonatologist, anaesthetist, obstetric team, ICU

Resuscitate

  • 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

Terminate seizure

  • MgSO4 IV
  • Status epilepticus -> ?propfolol/thiopentone/diazepam (acknowledging effect on baby)
  • Anti hypertensive treatments (aim SBP 140-160mmHg) -> hyrdralazine, labetalol, nifidepine

Hypertension management

  1. methyldopa PO 0.5-3g/day
  2. labetalol IV 5-10mg injected slowly
  3. nifedipine PO 10-20mg or IV 100-200mg over 2 min
  4. beta-blockers (metoprolol, pindolol, propanolol, esmolol)
  5. hydrallazine IV 10-20mg slowly
  6. GTN IV 0.1-0.8mcg/kg/min
  7. SNP IV 1-4mcg/kg/min

Prevention of complications

  • Planned delivery of baby
  • Monitoring for organ dysfunction (ICU)

Ongoing care

  • 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

CCC Neurocritical Care Series

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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