Acute management of the

obstretic patient with

1.-acute hypertensive crisis
2.-impending/imminent eclampsia
3.-eclampsia

Acute hypertensive crisis

#BP 170/110 or MAP 125mmHg
1.Labetolol IV given
---dilute 200mg labetalol in 50ml normal
saline (use infusion pump)
---start infusion at 40mg/hour
(10ml/hour) and
double every 30
minutes till satisfactory reponse
(diastolic BP of 90-100mmHg) or dosage
of 160mmHg/hour (40ml/hour)is reached.

 2.Nifedipine--orally
---oral nifedipine of 10mg start dose
is used esp in postpartum women
with acute hypertensive crisis
---sublingual nifedipine is not
recommended

 3.Hydralazine(Apresoline)
---another alternative
---IV injection(IV 5mg stat,then 510mg every 20-30 minutes are
required)
---IV injection given as slow boluses
over one minutes

Impending/Imminent Eclampsia
Use of anti-hypertensive agents and
anti-convulsant agents as prevention
of eclampsia
Anti hypertensive agents is initiated
if diastolic BP is presistently 100
mmHg

Eclampsia
Use of anti hypertensive agents and anti convulsant agents to
abort eclamptic fit
MANAGEMENT
1.RED ALERT
2.Place the patient in left lateral position(recovery position)
3.Secure airway-patent
Breathing-8L/min oxygen
Circulation-2 large bre IV lines
4.Send blood for investigation : FBC,GXM,coagulation profile,renal
profile,liver function test
5.Admit to HDU
-fluid management
-antihypertensive therapy
-MgSO4(loading and maintanence) as in protocol

5.Monitoring in
-- I/O chart
--PE chart-BP monitoring
--Fit chart-toxicity
--Fetal movement chart
6.Plan:time and mode of delivery once stable
and adequate analgesia ,call pediatrician
7.Monitoring in HDU for next 24-48 hours
---MgSo4,antihypertensive,fluid replacement
---Active management after delivery