1. Pre-eclampsia/Eclampsia

2. Pre-eclampsia: hypertension >140/90, proteinuria >0.3g/L Eclampsia: seizures Incidence: – Pre-eclampsia: 2-10% of all pregnancies – Eclampsia: 2-6 in 10000 deliveries 1.8% maternal mortality

3. History & Examination Symptoms – Headache – Visual disturbance – Epigastric pain – Fetal movements Signs – BP, proteinuria – Hepatic tenderness – Clonus, hyperreflexia – Papilloedema

4. Antihypertensives Labetolol – Orally – Intravenous Nifedipine – Orally Hydralazine – intravenous Methyldopa – slow acting

5. Anticonvulsants Magnesium Sulphate – 4g IV push – Maintenance dose 1-2g/hour Monitor for signs of toxicity – Loss of deep tendon reflexes – Respiratory depression – Coma – Cardiac arrest Calcium gluconate

6. Scenario A patient at 30 weeks gestation on the ward was found fitting by the staff midwives She is hypertensive 160/120, with +4 proteinuria You are called to attend

7. ABCs!!! Help – midwives, senior obstetrician, anaesthetist IV access Lab investigations – FBC, U&Es, LFTs, coag Stabilise patient before fetus

8. Mg SO4 Antihypertensives Fluid restriction – no more than 80ml/hour HDU monitoring Delivery when stabilised

9. Summary ABC’s Stabilise patient Antihypertensives/anticonvulsants Delivery