Management

Hypertensive crises and convulsions may continue for 48h post-partum, during which time close monitoring in a high dependency or intensive care area is essential.

Circulatory management

• High blood pressure is due to arteriolar vasospasm so controlled plasma volume expansion is essential as the first line treatment.

• A standard fluid challenge regimen may be used in the intensive care area with little risk of fluid overload.

• Oliguria may coexist with reduced plasma volume; controlled volume expansion is usually more appropriate than diuretic therapy.

• If plasma volume expansion fails to control hypertension, anti-hypertensives such as labetalol, nifedipine or hydralazine may be used.

Convulsions

• Convulsions are best avoided by good blood pressure control.

• Initial seizure control may be achieved with small doses of benzodiazepines.

• Magnesium sulphate is the treatment of choice for eclamptic convulsions. Magnesium levels should be monitored and kept between 2.5-3.75mmol/l. Above 3.75mmol/l toxicity with possible cardiorespiratory arrest may be seen.

• Prophylactic anticonvulsant therapy with magnesium may also be considered in pre-eclampsia.

• Excess sedation should be avoided due to the risk of aspiration although continued seizures may require elective intubation, mechanical hyperventilation and further anticonvulsant therapy.

Early fetal delivery

The definitive treatment for eclampsia is fetal delivery but the needs of the fetus must be balanced against those of the mother. If fetal maturity has been reached immediate delivery after control of seizures and hyper-tension is necessary.

P.539

0 0

Post a comment