Follow promptly with 109 of 50% magnesium sulfate solution, one half (5 g) injected deeply in the upper outer quadrant of each buttock through a 3-inch-long 20-gauge needle. (Addition of 1.0 mL of 2% lidocaine minimizes discomfort.) If convulsions persist ater 15 min, give up to 2 g more intravenously as a 20% solution at a rate not to exceed 1 g/min. If the woman is large, up to 4 g may be given slowly.
Every 4 hr thereater, give 5 g of a 50% solution of magnesium sulfate injected deeply in the upper outer quadrant of alternate buttocks, but only after ensuring that:
The patellar reflex is present, Respirations are not depressed, and
Urine output the previous 4 hr exceeded 100 mL Magnesium sulfate is discontinued 24 hr after delivery :J01500 250 deficits, prolonged coma, or atypical eclampsia (Sibai,r2012) .
200 • Clinical Findings with Eclampsia
Eclamptic seizures may be violent, and the woman must be protected, especially her air150 C way. So forceful are the muscular movements
J,..
U :L,that the woman may throw herself out of her -0 bed, and if not protected, her tongue is bitten aby the violent action of the jaws (Fig. 40-16).
his phase, in which the muscles alternately contract and relax, may last approximately a minute. Gradually, the muscular movements become smaller and less frequent, and finally the woman lies motionless.
After a seizure, the woman is postictal, but in some, a coma of variable duration ensues. When the convulsions are infrequent, the
Days after treatment woman usually recovers some degree of con sciousness ater each attack. As the woman arouses, a semiconscious combative state may nase (ASn levels in women with HELLP syndrome assigned to receive treatment with dexamethasone or placebo. (Data from Katz, 2008.) with saline aforded the same interval-to-delivery timing (Sibai,r2017).
Preeclampsia complicated by generalized tonic-clonic convulsions appreciably raises the risk to both mother and fetus. In an earlier report, Mattar and Sibai (2000) described outcomes in 399 consecutive women with eclampsia from 1977 through 1998. Major maternal complications included placental abruption-10 percent, neurological deicits-7 percent, aspiration pneumonia-7 percent, pulmonary edema-5 percent, cardiopulmonary arrest-4 percent, and acute renal failure4 percent. Moreover, 1 percent of these women died. Several subsequent reports similarly described excessive maternal morbidity and mortality rates with eclampsia that also included HELLP syndrome, pulmonary embolism, and stroke (Andersgaard, 2006; Knight, 2007). In he Netherlands, there were three maternal deaths among 222 eclamptic women (Zwart, 2008). Data from Ireland and Australia are similar (O'Connor, 2013; Thornton, 2013). In perspective, this is a thousandfold increase above the overall maternal death rates for these countries.