ED Management of Pre-eclampsia:
Definitive management:
Definitive management of pre-eclampsia is ultimately delivery of the fetus. Timing of delivery will be decided by senior members of the obstetric team according to the severity of pre-eclampsia, the current gestation and in consultation with the patient. Following diagnosis of pre-eclampsia, the majority of women are managed as inpatients until delivery.
Learning bite
For management of severe hypertension in pregnancy, follow local guidelines. An oral antihypertensive may be given initially (nifedipine MR 10mg or labetalol 200mg) followed by IV labetalol or IV hydralazine if adequate BP control is not achieved.1
ED Management of Eclampsia:
Pitfall
If a patient is presumed to have eclampsia but is not responding to repeated boluses of magnesium sulphate, commence an anti-epileptic and consider alternative diagnoses. If not known to have epilepsy and no strong evidence that seizure is eclamptic, will need neuroimaging with CT head and/or MRV to look for other diagnoses including venous sinus thrombosis.
Learning bite
Eclampsia should be considered in all women presenting with a seizure after 20 weeks gestation or in the postpartum period. Unless a seizure can be clearly attributed to epilepsy, magnesium sulphate should be commenced.