Managing an eclamptic patient
Most Ob/Gyns have little experience managing acute eclampsia, but all maternity units and obstetricians need to be prepared to diagnose and manage this grave threat.
As a result, women who develop eclampsia—particularly those with abnormal renal function, abruptio placentae, and/or preexisting chronic hypertension— face an increased risk for pulmonary edema and exacerbation of severe hypertension.2
Frequent evaluation of the amount of intravenous fluids is necessary, as well as oral intake, blood products, and urine output. They also need pulse oximetry and pulmonary auscultation.
Continue magnesium sulfate
Parenteral magnesium sulfate should be given for at least 24 hours after delivery and/or for at least 24 hours after the last convulsion.
If the patient has oliguria (less than 100 mL over 4 hours), both fluid administration and the dose of magnesium sulfate should be reduced.
Oral antihypertensives
Other oral antihypertensive agents such as labetalol or nifedipine can be given to keep systolic blood pressure below 155 mm Hg and diastolic blood pressure below 105 mm Hg. Nifedipine offers the benefit of improved diuresis in the postpartum period.
The author reports no financial relationships relevant to this article.
