Pre-eclampsia and Eclampsia

Question 1

Patient presents with eclampsia, what are the critical steps?

Answer 1

Protect airway
Seizures usually stop on their own, but if not, give 4mg ativan IV
Give 4g of IV Mg for prevention of recurrence and start drip at 2g/hr
Expedite delivery!
Control severe blood pressure
Monitor for Mg toxicity, renal dysfunction, and other complications of PEC/eclampsia such as HELLP and DIC

Question 2

Patient with PEC with elevated BP. What is the first-line agent and the regimen for BP control?

Answer 2

Labetalol is better than hydralazine
20mg over 2 minutes, double dose every 10 minutes to max of 80 at a time and total of 300
PO nifedipine is good adjunct but takes 60 minutes to work
IV hydralazine is second-line is rapid control is needed but has significant side effects