REPRODUCTIVE HEALTH UNIT OBSTETRIC MANAGEMENT PROTOCOLS DISTRICT/CENTRAL HOSPITAL PRE-ECLAMPSIA AND ECLAMPSIA MAGNESIUM SULPHATE PREVIOUS CAESEREAN PRE-ECLAMPSIA ECLAMPSIA SECTION Admit at hospital at 37 Definition: Diagnosis Loading dose weeks (if coming from The following symptoms and signs are typically present: Preeclampsia is a 4 g of 20% solution in far) complication of Convulsions 200 ml of normal Make an assessment: pregnancy saline over 10 minutes Diastolic BP 90 mm Hg or more after 20 weeks gestation find out why the characterized by plus 5 g of 50% caesarean section elevated blood pressure solution in each was done plus proteinuria or buttock deep IM check the oedema or both. Maintenance dose presentation and 5 g of 50% solution size of the baby Hypertension is every 4 hours till take blood samples diagnosed when blood delivery or after the for haemoglobin, pressure is (BP) 140/90 last convulsion which Differential diagnoses: blood group and mmHg or higher, on two ever was the last. Epilepsy, cerebral malaria, meningitis, encephalitis, hypoglycaemia. occasions at least four General management Monitor the patient hours apart or elevated closely. Admit in a quiet room of the hospital Deliver by caesarean systolic BP >30 mmHg, Place the woman on her side to reduce risk of aspiration. section if: or diastolic BP >15 Before repeat Keep airway clear. more than one mmHg from levels administration, ensure Protect the woman from injury. previous caesarean recorded in early that: Put IV line of normal saline or Ringer's lactate section or a classical pregnancy. Respiratory rate is Insert urinary catheter. scar by elective C/S at least 16 per at 38 weeks Mild hypertension is minute Control convulsions malpresentation (if 140-150mm Patellar reflex Give magnesium sulphate according to protocol to control convulsions. persisting to term) Hg. present If convulsions recur before maintenance dose of magnesium sulphate is due history of previous Urinary output is
REPRODUCTIVE HEALTH UNIT OBSTETRIC MANAGEMENT PROTOCOLS DISTRICT/CENTRAL HOSPITAL PRE-ECLAMPSIA AND ECLAMPSIA PRE-ECLAMPSIA ECLAMPSIA MAGNESIUM SULPHATE PREVIOUS CAESEREAN SECTION Definition: Preeclampsia is a complication of pregnancy characterized by elevated blood pressure plus proteinuria or oedema or both. Hypertension is diagnosed when blood pressure is (BP) 140/90 mmHg or higher, on two occasions at least four hours apart or elevated systolic BP >30 mmHg, or diastolic BP >15 mmHg from levels recorded in early pregnancy. Mild hypertension is 140-150mm Hg. Diagnosis The following symptoms and signs are typically present: Convulsions Diastolic BP 90 mm Hg or more after 20 weeks gestation Differential diagnoses: Epilepsy, cerebral malaria, meningitis, encephalitis, hypoglycaemia. General management Admit in a quiet room of the hospital Place the woman on her side to reduce risk of aspiration. Keep airway clear. Protect the woman from injury. Put IV line of normal saline or Ringer's lactate Insert urinary catheter. Control convulsions Give magnesium sulphate according to protocol to control convulsions. If convulsions recur before maintenance dose of magnesium sulphate is due Loading dose 4 g of 20% solution in 200 ml of normal saline over 10 minutes plus 5 g of 50% solution in each buttock deep IM Maintenance dose 5 g of 50% solution every 4 hours till delivery or after the last convulsion which ever was the last. Monitor the patient closely. Before repeat administration, ensure that: Respiratory rate is at least 16 per minute Patellar reflex present Urinary output is Admit at hospital at 37 weeks (if coming from far) Make an assessment: find out why the caesarean section was done check the presentation and size of the baby take blood samples for haemoglobin, blood group and Deliver by caesarean section if: more than one previous caesarean section or a classical scar by elective C/S at 38 weeks malpresentation (if persisting to term) history of previous
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