Eclampsia/Pre-Eclampsia

Assessment

History:Signs & Symptoms: Differential: 
□ Past medical history 
□ Hypertension meds 
□ Prenatal care 
□ Prior pregnancies / births 
□ Gravida / Para  		□ Upper abdominal pain
jaundice
□ Seizures 
□ Hypertension 
□ Severe headache 
□ Visual changes 
□ Edema of the hands and face 		□ Pre-eclampsia / Eclampsia 
□ Chronic hypertension
□ CHF
□ Seizure disorder

Clinical Management Options

EMT-B
• Oxygen, target SpO2 to 92-96% 
Paramedic
• Vascular access 
• Give Magnesium Sulfate (give Magnesium sulfate if pregnant and has a seizure OR two MANUAL blood pressure readings of >160 systolic or >110 diastolic 15 minutes apart, in a patient without history of hypertension)
• Can consider diazepam if seizure continue after Magnesium
• Monitoring & Interpretation of ECG and EtCO2 
Consult Online Medical Control as Needed

Pearls

  • Eclamptic seizures may occur up to 2 months post-partum. Always consider in pregnant/recently pregnant seizing patient. 
  • Magnesium is the first line treatment. Patient’s will continue to seize if not provided magnesium
    • Some patients have a seizure disorder and pregnancy. You can consider diazepam if seizures continue after magnesium as this may be a sign of a separate seizure disorder.
  • Severe headache, vision changes, edema, or RUQ pain may indicate preeclampsia. 
  • In the setting of pregnancy, hypertension is defined as a SBP greater than >140 or a DBP > 90, or relative increase of 30 systolic and 20 diastolic from the patient’s normal (pre-pregnancy) blood pressure. 
  • Magnesium may cause hypotension and decreased respiratory drive, monitor closely. 
  • If > 20 weeks consider left lateral position.