Seizures in labor Flashcards
Dose of Mag in labor
6g IV bolus over 15min followed by maintenance of 2g IV/hr. If renal insufficiency, could do 6g bolus and then 1g/hr. Renal insufficiency is Cr >1.1
Dose of IM mag if no IV access?
5g IM in each butt cheek. Then 5g every 4 hours.
How do you manage repetitive seizures?
can do 2-4g bolus over 5 min. Also give ativan. Most pts recover responsiveness in 5-10 min. If not, then sodium barbitol and start phenytoin.
If Mag not responsive, get head imaging to make sure there’s not another cause.
How do you prevent Mag toxicity?
- Place Foley to monitor renal function (hourly output)
- Confirm normal serum creatinine
- Serial evaluation of patellar deep tendon reflexes
- Monitor respiratory rate
- Serum magnesium levels not routinely required
- Monitor serum magnesium levels in setting of renal dysfunction and/or absence of patellar reflexes
- Maintain serum concentrations 5 to 9 mg/dL (4–7 mEq/L) range
Predictive symptoms of magnesium sulfate toxicity- Loss of deep tendon reflexes >9 mg/dL (greater than 7 mEq/L)
- Respiratory depression >12 mg/dL (greater than 10 mEq/L)
- Cardiac arrest >30 mg/dL (greater than 25 mEq/L)
Initial management of seizures in labor?
Place patient in lateral decubitus position, call for help, suction mouth, place oxygen facemask.
Can have FHR decelerations. If >15 min despite resuscitation, consider abruption and proceed with c-section.
What is reversal agent for magnesium sulfate?
Calcium gluconate. 1g/2 min IV. to avoid hypotension and/or bradycardia
What conditions are contraindications to magnesium therapy?
Myasthenia gravis
Hypocalcemia
Moderate-to-severe renal failure
Cardiac ischemia
Heart block
Myocarditis
What is fetal hydantoin syndrome?
a characteristic pattern of mental and physical birth defects that results from maternal use of the anti-seizure (anticonvulsant) drug phenytoin (Dilantin) during pregnancy
Causes growth restriction, VSD, ASD, cleft lip, dysmorphic facial features.
