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Eclampsia is the development of new-onset seizures,
superimposed upon preeclampsia,
in a woman between 20 weeks of gestation and 4 weeks postpartum.
Eclampsia should be suspected and treated in any pregnant woman
who is at >20 weeks of gestation or < 4 weeks postpartum
who develops seizures, coma, or encephalopathy.
Occasionally, eclampsia can present with seizure
in the absence of blood pressure elevation and proteinuria.
血壓可以不高
Headache, Visual change, Epigastric pain, then GTCs
可能發生在產前產中產後 ( 24hr 甚至 10 天 )
Complication :
母親腦出血, 中風, 肺水腫, 肝腎衰竭, DIC
胎盤剝離, 早產, 胎兒死亡
Management of eclampsia includes treatment of seizures,
treatment of hypertension,
and emergent obstetric consultation
to facilitate urgent delivery of the fetus
足月 37 週, HELLP,
Eclampsia, Worsen Severe preeclampsia = 立即生產
Treat seizures with magnesium sulfate,
4 - 6 g IV in 100-mL aliquot given over 20 to 30 minutes
followed by an infusion of 2 g per hour for at least 24 hours
with renal insufficiency, reduce the dose to 2 g IV bolus
and obtain a serum magnesium level before increasing the dose.
Prevent seizure
MgSO4 禁用於 MG
Loading dose : MgSO4 4g IV over 20 – 30 minutes
Maintenance dose : MgSO4 1g / hour IV
Maximum : 40 g/24 hours
Further Seizures after initial bolus :
Should be treated with an
additional bolus of Magnesium 2 g IV over 5 minutes
followed by an infusion of 1.5 g/hour
Therapeutic range : 4-8 mEq/L
BP, Respirations monitored,
Check DTR regularly
10 cc of 10% calcium gluconate in case of overdose
High levels of magnesium :
flushing, diaphoresis, hypothermia, hypotension,
flaccid paralysis, and respiratory depression.
Hyprtension
Labetolol 20 mg IV then 20-80mg q20-30 mins to a maximum dose of 300mg
or constant infusion 1-2mg/min IV to a target BP <160/110.
Nifedipine 10-20mg orally, repeat in 30 mins prn; then 10-20mg q2-6h.
Hydralazine 5mg IV or IM, then 5-10mg IV q20-40 min or continuous infusion 0.5-10mg/hr
禁用 ACEI / ARB ! !
Corticosteroids are indicated to
improve fetal lung maturity for preterm labor
between 24 and 34 weeks gestational age
when delivery is not an immediate possibility.
Corticosteroids :
Betamethasone 12mg IM q24h x 2 or Dexamethasone 6mg IM q 12h
Fluid administration should be judicious and
fluid balance should be monitored very carefully.
Detailed input and output recordings should be charted (i.e., q1h).
Careful fluid balance is aimed at avoiding fluid overload.
The total IV rate should be limited to 80 ml/hour
(Approximately 1 ml/kg/hr, using current weight).
Even in the setting of oliguria and severe pre-eclampsia,
guidelines recommend not to give fluid boluses.
Platelet transfusion in HELLP :
plt < 20,000 or C-section deliveries when platelets are <50,000
https://emergencymedicinecases.com/pre-eclampsia-preterm-labor-management/
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