MIAMI BEACH — Eclamptic seizures are a rare but serious complication best treated according to a preestablished protocol, Dr. Baha Sibai said at an ob.gyn. conference sponsored by the University of Miami.
“Don't look for fetal heart rate first or think of the seizure. Don't stop to give meds to stop the seizure, and cover the fetal heart rate monitor,” he said. Instead, take care of the mother first, and “treat the patient according to her vital signs,” said Dr. Sibai, professor of obstetrics and gynecology at the University of Cincinnati.
He suggested the following seven steps for managing eclamptic seizure:
1. Prevent hypoxia by supporting maternal respiratory and cardiovascular functions.
2. Prevent maternal injury and aspiration.
3. Avoid the temptation to try to arrest the first seizure.
4. Prevent convulsions from recurring. This is accomplished chiefly with intravenous magnesium sulfate, administered slowly and never as an intravenous push, Dr. Sibai said. He suggested 6 g administered IV over 20 minutes, with 2 g IV per hour for maintenance. “When you give the loading dose, they feel terrible,” Dr. Sibai said. “I know this feels bad. I gave it to myself when I developed these protocols.” Talk to the patient to prevent magnesium toxicity. “If they are disoriented, they are approaching toxic levels,” Dr. Sibai said. “If a patient on magnesium shows abnormal behavior for any reason, for heaven's sake, stop it. No one has ever died from a lack of magnesium.”
5. Control severe hypertension to prevent cerebrovascular injury. “Most people don't know how to give antihypertension meds,” he said. “Call someone if you don't know, but not someone more ignorant than you. An IV bolus of 5 mg hydralazine, with another 10 mg IV bolus given 20-30 minutes later, can help control severe hypertension, he added. “Notice I haven't mentioned the fetal heart rate or baby yet,” Dr. Sibai said.
6. Manage complications such as disseminated intravascular coagulation and pulmonary edema.
7. Begin induction/delivery within 24 hours. “The worst thing you can do is everyone panics and rushes the woman to a C-section,” Dr. Sibai said. “Assess neurologic status. This is extremely important—do not take her for a C-section if unconscious.” Ask the patient to state her name, where she is, and the time of year.
Taking care of the mother first is important because “the baby will not do well if the mother is not doing well,” Dr. Sibai concluded.