Prevention, Identification and Management of

Pre-eclampsia and Eclampsia

 Learning Objectives

By the end of this session, the learners will be able

to:
• Define various terms in hypertensive disorders of
pregnancy
• Describe supportive care of woman with
eclampsia during a fit
• Describe the dose and route of administration of
injection magnesium sulphate for the
management of pre-eclampsia and eclampsia

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Pre-eclampsia/Eclampsia is the Second Leading Cause of
Maternal Mortality – Globally and in India

Pre-eclampsia/Eclampsia can
be prevented and managed
Others 31% Haemorrhage by:
27%
• Recording and monitoring of
Sepsis 11% BP and urine protein
examination of all labouring
Abortion 8% women
• Timely identification of
Obstructed
labour 9% danger signs
Hypertensive
Source- WHO 2014 • Giving inj MgSO₄ in all
disorders 14%
mothers having Severe pre-
eclampsia and Eclampsia
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 Definitions- Hypertensive disorders of pregnancy
 Hypertension: BP >=140/90 TWO consecutive readings 4 hours apart
 Chronic Hypertension: Hypertension before 20 weeks of pregnancy
 Pregnancy Induced Hypertension (PIH): Hypertension after 20 weeks
 Pre-eclampsia (PE): >=140/90 but <160/110 with proteinuria trace, 1+ or
2+
 Severe pre-eclampsia (Severe PE):
 >= 160/110 with proteinuria 3+ or 4+
 PE with presence of any symptoms like headache, blurring of vision,
epigastric pain or oliguria and abnormal oedema over face, hands,
abdomen and vulva
 Eclampsia (E): Convulsions with >=140/90 and proteinuria more than
trace

NOTE- Convulsions in pregnancy, labour and postpartum

period should be considered ‘Eclampsia’ unless proved
otherwise.
 Need for MgSO4
Management with Inj. MgSO4 should be given in
following conditions:
 Eclampsia
 Severe PE:
 >= 160/110 with proteinuria 3+ or 4+
 PE with presence of any symptoms like headache,
blurring of vision, epigastric pain or oliguria and
abnormal edema over face, hands, abdomen and
vulva

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 Management of Severe PE/E

Role of anti-
hypertensive

Nursing care Management Role of

of severe PE/E MgSO4

Termination
of pregnancy

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 Role of Anti-hypertensive
• Anti - Hypertensive need to be given if Diastolic BP > 100
mm Hg (as per GoI protocol poster on Pre-Eclampsia)

• Tab Alpha-Methyl Dopa or tab Labetalol can be used for

controlling BP

• Target should be to maintain diastolic BP between 90-100

mm Hg

• In case of severe Pre eclampsia, use of tab Nifedipine or Inj.

labetalol is recommended for initial control of BP

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 Administration of MgSO4
 First dose (at Non-FRU level): Total 10 grams
 5 g (10mL) magnesium sulphate deep IM in each buttock
 Patient should reach FRU in 2 hours for further
management
 Loading dose (at FRU level): Total 14 grams
 4 g (8mL) magnesium sulphate diluted with 12 ml NS or
distilled water in 20 ml syringe i.e. 20%, and given slow IV in
5-10 minutes
 5 g (10mL) magnesium sulphate with 1 ml 2% lignocaine
deep IM in each buttock

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 Administration of MgSO4- Maintenance Dose

 5 g (10mL) magnesium sulphate with 1 ml 2%

lignocaine deep IM in alternate buttock every 4
hours

 To be given for 24 hours after last convulsion or

delivery- whichever occurs later

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 Administration of MgSO4- Toxicity Signs

 Watch for toxicity signs before every maintenance dose

 Urine output: < 25-30 ml/hour
 Deep Tendon Reflex (knee jerk): Absent
 Respiratory rate: < 16/minute

NOTE- With hold the next dose in case of presence of any

toxicity sign
Give antidote Inj Calcium gluconate (10 ml 10 % in 10
minutes) slow IV for respiratory toxicity

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 Magnesium Sulphate is a Safe Drug to Use
• GoI recommends use of magnesium sulphate by nurses in cases of
severe pre eclampsia and eclampsia (first dose)
• Magnesium sulphate is a very safe drug and can be easily used with
monitoring of toxicity signs
• Even in case where any sign of toxicity is seen, generally
withholding the next dose is sufficient to address it
• Antidote may only be needed in case of respiratory toxicity which
is very rare at the usual recommended doses with close monitoring
• Give antidote – Inj. Calcium gluconate 10 ml 10 % in 10 minutes slow
IV for respiratory toxicity.

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 To Identify What Nursing Care Needed
Pregnant
Women Nursing Care
DIAGNOSIS Scenario Description
require
(Irrespective of gestational
age)

Presenting in Admit and treat as per

GESTATIONAL Labour progress of labour
HYPERTENSION Presenting Follow up in OPD
Without Labour once a week
Presenting in Admit and treat as per
Labour Progress of labour
PRE-ECLAMPSIA Follow up in OPD
Presenting
Without Labour twice a week
Presenting in Admit and give
Labour MgSO4 & do needful
SEVERE PRE-ECLAMPSIA
Presenting Admit and give
Without Labour MgSO4 & do needful
Presenting in Stabilize convulsions, position
in left lateral, Mouth gag, Do
ECLAMPSIA Labour suctioning, clear secretion,
Start oxygen, catheterize, give
Presenting MgSO4 & terminate
Without Labour pregnancy within 12 hrs
 To Terminate the Pregnancy or Not
If she is already in labour, let her progress in labour
Pregnancy
Pregnancy of Pregnancy of 24- Pregnancy of 35-
DIAGNOSIS of >37
<23 Weeks 34 Weeks 36 Weeks
Weeks

GESTATIONAL
HYPERTENSION

PRE-ECLAMPSIA

If unstable, give If unstable, do not give

antenatal antenatal corticosteroids
SEVERE PRE- corticosteroids and and terminate within
ECLAMPSIA terminate within 24hrs 24hrs

If stable If stable

ECLAMPSIA

In all cases of eclampsia terminate pregnancy within 12 hrs

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 Calcium Supplementation for Prevention of
Pre-Eclampsia/Eclampsia (PE/E)
• WHO recommends calcium supplementation for prevention of PE/E
in populations whose diets are deficient in calcium
GoI recommendations
• Every woman would be given calcium supplementation for 6
months during ANC period after 1 st trimester and for 6 months
during lactation.
• Two calcium tablets would be given daily
• Each tablet shall contain 500mg elemental Calcium and 250 IU
Vitamin D3
• To be implemented at all levels of contact of the pregnant women
with the health system.
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 Key Messages
• Pre-eclampsia/Eclampsia is the major killer, deaths from which can
be prevented through proper ANC and if this happens can be
managed with timely administration of inj. MgSO4

• Proper nursing care and timely inj. MgSO4 administration is key

in management of eclampsia case

• MgSO4 is a safe drug for mother and can be given without

hesitation. Toxicity of MgSO4 is very rare.

• At sub Centre ANM can safely give first dose of 5-5 gms deep IM on
each buttock and refer to higher facility for further management.

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