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Re: Treatment for eclampsiaFrom: Myer Bornstein (mborn@massmed.org)Wed Jan 21 13:16:33 2004
I agree with Dan, this patient has Pre-eclampsia. To me there is nothing wrong with starting MgSo4, and get the lab panel. Probably could have prevented the seizure. Here are some Thoughts from John Repke . Protect maternal airway, prevent patient injury . Wait for compulsion to abate . Maternal resuscitation: - Maximum oxygenation (mask or endotracheal 02) - IV access and judicial hydration . Fetal resuscitation: - Maternal oxygen, left lateral positioning - Continuous fetal heart rate monitoring . Maternal post-ictal assessment: - C. B.C., Platelets, electrolytes, glucose, calcium, magnesium, toxicology screen, blood type and antibody screen - Careful neurologic examination . Magnesium sulfate prophylaxis for subsequent seizures . Formulate delivery strategy . Delivery of the Eclamptic Patient .Avoid emergent (stat) cesarean section .Stabilize maternal and fetal oxygenation, hemodynamics .Start or reassess MGSO4 therapy .Assess cervix and maternal/fetal reserve .Vaginal delivery usury yields the best outcome over all .Normalize coagulation prior to cesarean section Transitory Changes Associated With Eclamptic Convulsions Uterine hyperactivity Increased frequency Increased tone Duration of 2-15 minutes Fetal heart rate changes Fetal bradycardia And transitory tachycardia Decreased the beat to beat variability Transient late decelerations
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