EMERGENCY PROTOCOL FOR MANAGEMENT OF ECLAMPSIA

1. Call for Help

2. Secure IV line
3. Keep in a bed with side rails
4. Put a padded mouth gag
5. Give Anticonvulsant (MgSO4)
6. Give Antihypertensive
7. Sedation if required
8. Insert urinary Catheter
9. Take blood samples for BUN and urine for protein
10. Check FHR
11. Obtain high risk consent.

DOSE OF MgSO4

Loading Dose:
4gm of MgSo4 20% diluted in 100ml IV fluid over 15-20mins. Followed by 10gm
of 50% solution, 5gm in each buttock (IM)

Maintenance Dose:
5gm of 50% solution Q4hrly in alternate buttock till 24 hrs after delivery of last
seizure whichever is later.

Antihypertensive Dose:
- 40 mg Labetolol IV stat if BP > 160/110 mm of Hg.
- Repeat one more dose after 10-15 min if BP still high.
- Keep BP in the range of 140/90 – 160/100

MANAGEMENT DURING A CONVULSION

- Give anti convulsive drugs

- Keep the equipment ready (airway, suction, mask, bag, oxygen) & give oxygen
- Protect the women from injury but do not actively restrain her
- Place the women on her left side to reduce risk of aspiration of
secretions/vomitus.
- After the convulsion, aspirate the mouth and throat as necessary.
Anti-convulsant drugs:
Give adequate anti-convulsant drugs.
Magnesium sulfate is the drug of choice for preventing and treating convulsions in
severe pre-eclampsia and eclampsia.

Loading dose:
 Magnesium sulphate 20% solution, 4gm IV over 5 min.
 Follow immediately with 10 gm of 50% solution, 5gm in each buttock deep
IM with 1ml of 2% lignocaine in the same syringe. Inform the woman that
she might feel warm.
 If convulsions recur after 15min, give 2gm magnesium sulfate (50%
solution) IV over 5min.

Maintenance dose:
* 5gm of 50% solution + 1ml 2% lignocaine IM every 4 hours into alternate
buttocks.
* Continue treatment with MgSO4 for 24 hrs after delivery or the last convulsion.

Before repeating the dose check:

* Respiratory rate
* Patellar reflexes
* Urine output

Do not give if any one of the following is seen:

* Respiratory rate falls below 16 per min
* Patellar reflexes are absent.
* Urine output is less than 30ml over 4hrs.

In case of respiratory arrest:

* Assist ventilation with mask and bag or intubation
* Give calcium gluconate 1gm (10ml solution IV over 10 min)