Therapeutic Management: Eclampsia & Mild Pre - Eclampsia & Severe Pre - Eclampsia

Question 1

Management: Mild Pre - Eclampsia

Answer 1

a. Monitor for Antiplatelet Therapy
o Low dose Aspirin (ASA)
▪ 81 mg – baby Aspirin

b. Promote bed rest
o Aids in increased evacuation of sodium and encouraging
diuresis of edema fluid
o Maintain left-lateral position to prevent supine
hypotension syndrome

c. Promote good nutrition
o Continue her usual pregnancy nutrition while on bed rest
o No diet restriction

d. Provide emotional support
o Educate pregnant woman and family of the severity of
her situation
o Explore on financial problems, child care arrangements
o Reiterate for frequent prenatal visits; should be weekly

Question 2

Management Part 1: Severe Pre - Eclampsia

Answer 2

a. Provide hospital care
o If pregnancy is >37 weeks AOG – labor can be induced
or CS birth to end the pregnancy
o If pregnancy is <37 weeks AOG – attempt to alleviate the
symptoms and allow fetal well-being will be monitored to
term
o If compromised fetus – vaginal or CS deliver is necessary
even if preterm

b. Monitor maternal well-being
o Monitor BP frequently (q4h)
o Periodic assessment of laboratory values to include CBC
with platelet count, liver function tests (AST, ALT), lactic
dehydrogenase (LDH), uric acid, serum creatinine,
bilirubin, and 24-hour urine for protein and creatinine
clearance
o Obtain daily weights (same time each day) o Foley catheter may be inserted as ordered

c. Monitor fetal well being
o Done every day:
▪ Doppler auscultation
▪ Non-Stress Test
▪ Biophysical profile
* Fetal kick/fetal movement
o Decreased fetal movement = fetal
distress

d. Support nutritious intake
o Moderate to high in protein diet
o Moderate sodium diet
o Fluid and electrolyte replacement through IV line

Question 2

Management Part 2: Severe Pre - Eclampsia

Answer 2

a. Administer medicine to prevent Eclampsia
o Administer antihypertensives
▪ Check for VS before and after administration
▪ It decreases BP, increases PR
▪ Given to prevent stroke

• Methyldopa
  o Given for long-term control in
  pregnancy
  o Not an option for severe pre-eclampsia
  o PO; Oral
• Hydralazine (Apresoline) – via IV
• Labetalol (Normodyne) – via IV
• Nifedipine
  o Has rapid effect on BP; fewer side
  effects
  o option for severe pre - eclampsia
  o PO; Oral

b. Administer Magnesium Sulfate (MgSO4)
▪ Drug of choice to prevent eclampsia

▪ Cathartic effect
* Decrease edema formation (fluid shifting)

▪ CNS effect
* Blocks neuromuscular transmission
o Prevents seizures

c. Magnesium Sulfate Therapy
▪ Infuse loading dose (4-6g) slowly over 15-30
minutes
▪ Continuous administration as a piggyback infusion
(side drip) as a maintenance dose at 1-2g/hr. IV
▪ Assess RR, urine output, deep tendon reflexes, and
clonus every hour
▪ Urine output should be over 30 mL/hr.

▪ RR should be over 12/min.
* If RR <12, then Magnesium Sulfate toxicity
may develop

▪ Serum magnesium level should remain below
7.5 mEq/L
* Monitor every 6-8 hours

▪ Observe for CNS depression and hypotonia in
infant at birth and calcium deficit in the mother
▪ Assess maternal blood pressure and fetal heart rate
continuously with bolus IV administration
▪ Assess deep tendon reflexes every 1-4 hours
during continuous infusion
▪ Monitor intake and output every hour during
continuous infusion
▪ Assess patient’s level of consciousness, including
ability to respond to questions, every hour
▪ Obtain serum magnesium levels as indicated,
usually every 6-8 hours
▪ Keep calcium gluconate, the antidote for toxicity,
readily available at the bedside

Question 3

Management: Eclampsia for Tonic - Clonic Seizures

Answer 3

a. Maintain a patent airway
b. Assess time of onset, progress of the seizure, body
involvement, duration, presence of incontinence, status
of the fetus, and signs of placental abruption
c. Turn to side to allow secretions to drain to prevent
aspiration
d. Administer MgSO4 or diazepam (Valium) intravenously
as emergency measure

e. Assess oxygen saturation
▪ Administer oxygenation by face mask

f. Assess maternal and fetal well-being
▪ FHR and contractions or any signs of bleeding

g. Maintain on NPO
▪ Tonic – contraction stage
▪ Clonic – relaxation stage

Question 4

Management: Eclampsia for Birth

Answer 4

a. Deliver the baby once the woman has a stable condition
(12-24 hours post seizure)
b. Vaginal birth is the method of birth with minimum
anesthesia

c. If no labor, rupture of the membranes or induction of
labor with intravenous oxytocin may be instituted
▪ If this is ineffective and the fetus appears to be in
imminent danger, cesarean birth becomes the
birth method of choice

Question 5

Management during Postpartum Period

Answer 5

a. Monitor postpartum vaginal bleeding
o Count pads

b. Palpate uterus and massage when not contracted
c. Monitor VS (BP, pulse rate), urine output
o First 48 hours: increased urine output is normal
o Diuresis (due to edema) after birth is also a good sign
that it is returning to normal functioning

d. Monitor hematocrit, platelet, uric acid, AST and ALT daily
o Monitor for HELLP Syndrome and cerebral edema

e. No Methergine administration
o Methergine – drug for contracting the uterus
▪ Not given because it increases BP