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Re: Treatment for eclampsiaFrom: Braun, R. Daniel (rbraun@iupui.edu)Wed Jan 21 09:52:04 2004
My G_d we have turned out a whole generation of OB's who think that pre-eclampsia is a lab diagnosis. What more do you need than HTN,headache, lethargy, and hyperactive reflexes????? albuminuria would be nice, but unnecessary.. MgSO4 is the preferred treatment. per a large randomized controlled trial done in England and published in Lancet (I think). Dan -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Len2976@aol.com Sent: Wednesday, January 21, 2004 8:11 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Treatment for eclampsia The other night while I was in L&D with a labor patient, EMS brought in a patient who was visiting relatives and had been receiving prenatal care in a nearby area. Another OB practice was on "walk-in" call, so I was mostly an observer. There were no prenatal records available (of course) and the main complaints of the patient and her husband were a mild uterine contractions, a persistant headache, and lethargy over the past day. The patient also seemed to have some confusion and "fogginess" over how she had been feeling over the past 2-3 hrs. B/Ps were 154/104 and 148/95, DTRs were +3.. Initial FHT tracing show very minimal BTBV. Labor was not well established--contractions were mild and the cervix was 1 cm. dilated. The on-call physician was called--further observation and labs were ordered. (The nurses wanted to start Mg SO4 and were concerned about the FHR tracing--he wanted to wait till labs were back--but that is another matter.) I was in the observation room evaluating another patient of mine when I heard the husband call out and the bed rails shake. I went to give assistance while waiting for staff to arrive in the room.. The usual initial seizure steps were taken--airway, position, protection. After the seizure oxygen was administered, the physician was notified, and an emergency C/S planned. Initial FHR bradycardia was followed by absent BTBV and late decelerations. The obstetrician ordered MgSO4 4 gm bolus (over 30 minutes) and the anesthesiologist (who was there) gave 10 mg of Valium IV push. The usual 2 gm per hour of MgSO4 was to follow. My question: I was always taught that the treatment for eclampsia was MgSO4--1 gm per minute--IV push--up to 5 gms. Is there another more preferred treatment? Lenora McCall, CNM
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