Pre-eclampsia and eclampsia

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1. Definitions:

    1. >20weeks HTN ⇒ Gestational HTN

    2. <20weeks HTN ⇒ chronic HTN

        1. 30% chance of eclampsia

        2. check BP every 2-3 week till 30w then weekly

        3. check CBC, diff, AST, ALT, ALKP, Na, K, Ca, P, BUN, Cr, Urine 24hr (Protein and Cr), Acid uric

    3. BP<140/90 ⇒ is acceptable in pregnant pt

    4. 140/90<BP<160-100 ⇒ no treatment but may be a pre eclampsia

        1. Hx of blurred vision, headache, N/V, epigastric pain

        2. Check CBC, diff, AST, ALT, ALKP, U/A

            1. look for proteinuria, thrombocytopenia, abnormal LFT

        3. OB/GYN visit

2. Management of pre-eclampsia (BP>140/90 + symptomatic)

    1. mild:

        1. >37w ⇒ delivery

        2. <37w ⇒ watchful waiting

    2. severe: (severe headache is very important BP>16-/100, proteinuria>5gr/dl or +3)

        1. >34w ⇒ delivery

        2. 32w< <34w ⇒ 48 hours on steroids then delivery

        3. <32w ⇒ watchful waiting

3. BP treatment

    1. treat all BPs>160/100

    2. Amp labetalol 20mg IV

        1. repeat with 40mg IV and then 80mg IV (max 220mg)

        2. or Amp hydralazine 5-10mg IV

            1. repeat with 20 mg IV, max 30 mg

    3. goal of BP: SBP≥150, DBP≥100-90

    4. ACI are contraindicated

4. Eclampsia: seizure

    1. LLP

    2. O2 with mask 8-10 lit/min, oral airway

    3. DIAZEPAM IS CONTRAINDICATED

    4. Amp MgSO4 4-6gr in 100cc N/S over 20 mins then 2gr/hr for 24 hours

        1. vial 20%: 20cc

        2. max speed: 1gr/min

    5. Amp MgSO4 5gr IM + Lidocaine 0.5cc in each buttock

    6. if not stopped after 15 mins:

        1. Amp  MgSO4 2gr in 2 min IV

    7. if still not stopped

        1. Amp phenytoin 1gr in N/S over 1 hr (max 50mg/min) then 500mg po 10h later

5. If MgSO4 poisoning:

    1. decreased Patellar reflex

    2. Decreased BP

    3. Decreased RR

    4. Treat with;

        1. Resuscitation stuff

        2. Amp Ca Gluconate 10% bedside

        3. Amp MgSO4 2gr