Notes – Eclampsia/Pre-Eclampsia

Eclampsia/Pre-Eclampsia

Patient Safety Considerations

  1. Magnesium toxicity (progression)
    1. Hypotension followed by
    2. Loss of deep tendon reflexes followed by
    3. Somnolence, slurred speech followed by
    4. Respiratory paralysis followed by
    5. Cardiac arrest
  2. Treatment of magnesium toxicity
    1. Stop magnesium drip
    2. Give calcium gluconate/chloride 1 g IV in cases of pending respiratory arrest
    3. Support respiratory effort

Notes/Educational Pearls

Key Considerations

  1. Delivery of the placenta is the only definitive management for pre-eclampsia and eclampsia
  2. Early treatment of severe pre-eclampsia with magnesium and anti-hypertensive significantly reduces the rate of eclampsia – use of magnesium encouraged if signs of severe pre-eclampsia present to prevent seizure

Pertinent Assessment Findings

  1. Vital signs assessment with repeat blood pressure monitoring before and after treatment
  2. Assessment of deep tendon reflexes after magnesium therapy
  3. Examination for end organ involvement
  4. Evaluate fundal height

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914157 – OB/GYN-Eclampsia
  • 9914159 – OB/GYN-Gynecological Emergencies
  • 9914161 – OB/GYN-Pregnancy Related Disorders

Key Documentation Elements

  • Document full vital signs and physical exam findings.

Performance Measures

  • Patients with signs of hypertension and 20-weeks gestation or recent post-partum should be assessed for signs of pre-eclampsia
  • Recognition and appropriate treatment of eclampsia

References

  1. American College of Obstetricians and Gynecologists Committee on Obstetric Practice Magnesium sulfate use in obstetrics. Committee opinion no 652: Obstet Gynecol. 2016;127(1):e52-3.
  2. American College of Obstetrics and Gynecologists Task Force on Hypertension in Pregnancy. Report of the American College of Obstetricians and Gynecologists’ task force on hypertension in pregnancy. Obstet Gynecol. 2013;122(5):1122-31.
  3. Cipolla M, Kraig R. Seizures in women with preeclampsia: mechanism and management. Fetal Maternal Med Rev. 2011;22(02):91-108.
  4. Cuero M, Varelas P. Neurologic complications in pregnancy. Crit Care Clin. 2016;32(1):43-59.
  5. Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Committee Opinion No. 692. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;129:e90-5.
  6. Mol BW, Roberts CT, Thangaratinam S, Magee LA, de Groot CJ, Hofmeyr GJ. Pre-eclampsia. Lancet. 2016;387(10022):999-1011.
  7. Olson-Chen C, Seligman N. Hypertensive Emergencies in Pregnancy. Crit Care Clin. 2016;32(1):29-41.
  8. Shields LE, Wiesner S, Klein C, Pelletreau B, Hedriana HL. Early standardized treatment of critical blood pressure elevations is associated with reduction in eclampsia and severe maternal morbidity. Am J Obstet Gynecol. 2017;216(4):415.31-415.e.5.