Re: Treatment for eclampsia
From: Efrain Ramirez (eramirezt@coqui.net)
Thu Jan 22 04:09:03 2004
Well said - I would have started her on MgS04 - why wait for lab
results?
>At Wed, 21 Jan 2004, Braun, R. Daniel wrote:
>
>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 <a href="http://get-certified.net?go=valium" onmouseover="window.status = 'goto: valium';return 1" onmouseout="window.status=''">Valium</a> 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
--
"The opposite of a correct statement is a false statement.
But the opposite of a profound truth may well be another profound truth."
Niels Bohr (1885 - 1962)
