Eclampsia medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Treatment
The treatment of eclampsia requires prompt intervention and aims to prevent further convulsions, control the elevated blood pressure and deliver the fetus.
Prevention of Convulsions
Prevention of convulsion is usually done using magnesium sulfate (4-6 g loading dose in 100 ml iv fluid given over 15-20 minutes, then 2 g per hour as a continuous infusion).[1] Evidence for the use of magnesium sulfate came from the international MAGPIE study.[2]
Antihypertensive Management
Antihypertensive management at this stage in pregnancy may consist of hydralazine (5-10 mg IV every 15-20 min until desired response is achieved) or labetalol (20 mg bolus iv followed by 40 mg if necessary in 10 minutes; the 80 mg every 10 up to maximum of 220 mg).[1]
Delivery
If the woman has not yet been delivered, steps need to be taken to stabilize the patient and deliver her speedily. This needs to be done even if the fetus is immature as the eclamptic condition is unsafe for fetus and mother. As eclampsia is a manifestation of a multiorgan failure, other organs (liver, kidney, clotting, lungs, and cardiovascular system) need to be assessed in preparation for a delivery, often a cesarean section, unless the patient is already in advanced labor. Regional anesthesia for cesarean section is contraindicated when a coagulopathy has developed.
Invasive Hemodynamic Monitoring
Invasive hemodynamic monitoring may be useful in eclamptic patients with severe cardiac disease, renal disease, refractory hypertensionpulmonary edema, and oliguria.[1]
Contraindicated medications
Eclampsia is considered an absolute contraindication to the use of the following medications:
References
- ↑ 1.0 1.1 1.2 ACOG. "Diagnosis and Management of Preeclampsia and Eclampsia". ACOG Practice Bulletin # 33, 2002,.
- ↑ Frayling, Frayling (2004). "The Magpie Trial follow up study: outcome after discharge from hospital for women and children recruited to a trial comparing magnesium sulphate with placebo for pre-eclampsia [ISRCTN86938761]". 4 (1): 5. PMID 15113445.