7 Eclampsia

Question 1

Eclampsia seizures: what to use if Mag doesn’t work

Answer 1

Use benzos, then phenytoin.

Question 2

Magnesium

• sx of toxicity (2)
• Tx of toxicity
• what organ to be careful of

Answer 2

1. hyporeflexia
2. resp depression (risk for pulm edema, like preeclampsia)
   - Tx with Ca+ Carbonate.
   - Kidneys. Mag is excreted renally, so be aware of renal function/UOP.

Question 3

A new pregnant female in clinic is found to have a BP of 150/100. She has no symptoms. What to do now? How does this differ from a non-pregnant patient?

Answer 3

1. allow pt to relax and recheck later, same visit.
2. Non-pregnant: Wait 2 weeks, recheck.

Pregnant: get U/A (r/o proteinuria), then have pt keep a log of BP monitoring.

Question 4

Chronic HTN in pregnancy

• definition
• Tx/management
• what to be careful of

Answer 4

• chronic BP >140/90 before 20 weeks
• Goal remains: prevent organ damage. Use methyldopa (or labetalol, hydralazine)
• BP can no longer be used to dx preeclampsia. Close f/u must be maintained with U/A (proteinuria) and U/S (IUGR)

Question 5

Eclampsia

1. definition
2. mech
3. Tx

Answer 5

1. Seizures. (other things don’t matter in definition)
2. vasospam from fetal proteins in mom affects the brain, causing ischemia and reperfusion edema.
3. Mag and deliver emergently (C/S)

Question 6

Mild preeclampsia

• mechanism
• definition
• how is CBC affected
• Tx

Answer 6

• fetal proteins released into mom can cause diffuse vasospasm
• After 20 weeks, BP >140/90 and proteinuria (>300mg/24 h). No sx necessary
• CBC to look for hemoconcentration 2/2 3rd spacing of fluid. This is what causes edema, and this causes H/H to rise.
• Mag to prevent seizures. Delivery urgently if >37 weeks. If <37 weeks, bed rest and deliver if signs worsen.

Question 7

CBC results in preeclampsia vs HELLP

Answer 7

Preeclampsia: increased H/H because of hemoconcentration (fluid enters interstitium, causing edema)

HELLP: anemia (hemolysis)

low platelets

Question 8

severe preeclampsia

1. definition
2. If you suspect, get what labs? (3)
3. Tx

Answer 8

1. BP >160/110, and major proteinuria (5g/24h) OR alarm sx (change in vision, HA, epigastric pain)
2. CBC, DIC panel, LFTs
3. Mag + BP + urgent induced delivery (when BP is stabilized). Possible C/S, as mom is dying.

Question 9

HELLP

1. definition
2. Tx

Answer 9

1. hemolysis, elevated LFTs, low platelets
2. Tx like eclampsia: Mag and emergency delivery (C/S)