--
Richard Chudacoff, MD
It is necessary for me to establish a winner image.
Therefore, I have to beat somebody.
Richard M. Nixon
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Steve &
Eryl Raymond
Sent: Wednesday, January 21, 2004 3:48 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Treatment for eclampsia
The loading dose of Mag Sulph which was used here is the same as we use in
our unit, but the faster regime you mention would be quite acceptable. This
eclamptic fit could have been prevented had she been started on Mag Sulph on
admission. With a diastolic above 100 our protocol prescribes both Mag
Sulph and an acute antihypertensive - usually dihydralazine.
Steve
Len2976@aol.com <mailto:Len2976@aol.com> wrote:
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
--
S.H. Raymond FRCOG
Principal Specialist
Department of Obstetrics & Gynaecology
Empangeni Hospital
Private Bag X20005
Empangeni
SOUTH AFRICA 3880
Phone: (+27)-35-9028560
Fax: (+27)-35-7922596
Everyone thinks of changing the world, but no one thinks of changing
himself.
Leo Tolstoy (1828-1910)
