MANAGEMENT OF ECLAMPSIA: IMMEDIATE MANAGEMENT

REQUIREMENTS #

1. Vital signs tray
2. Delivery tray
3. Induction tray
4. Oxytocin
5. Anticonvulsant e.g. Magnesium Sulphate
6. Intravenous line tray
7. IV Fluids e. g. Normal Saline or Ringer’s Lactate
8. Urethral Catheter and Urine Bag
9. Foetal monitor (manual /electronic)
10. Intake and Output chart
11. Oxygen Apparatus
12. Suction Apparatus
13. Perineal Pad
14. Theatre Gown and Cap
15. Consent Form
16. Patella Hammer
17. Urine Dipsticks
18. Blood and Urine sample bottles
19. Maternal and Child Health Record Book (Manual/Electronic)

STEPS #

1. Call for help and put patient on left lateral position in bed
2. Insert padded spatula in the teeth and the tongue to prevent bite of the tongue
3. Assess level of consciousness
4. Maintain airway, breathing and circulation
5. Protect client from injury but do not actively restrain her
6. Aspirate the mouth and throat as necessary
7. Monitor vital signs (quarter hourly for 1 hour, ½ hourly for 1 hour, and hourly until B.P is stable)
8. Set up IV line and infuse normal saline or Ringer’s lactate solution
9. Administer anticonvulsive drug (Protocol for Magnesium Sulphate)
10. Administer IV Antihypertensives; e.g. Labetalol
11. Pass indwelling urethral catheter to monitor urine output and protein
12. Monitor the amount of fluids administered and ensure there is no fluid overload
13. Auscultate the lung bases hourly for crepitation indicating pulmonary oedema. If they occur, withhold fluids and administer a diuretic such as frusemide 20 mg IV once
14. Monitor bed side clotting for coagulopathy
15. Arrange for fresh frozen plasma or whole blood
16. Monitor client closely for signs of toxicity
17. Arrange for NICU management for foetus
18. Deliver the foetus if client’s condition is stabilized as soon as possible and within 12 hours of the onset of convulsions, regardless of the gestational age
19. Monitor for contractions and perform vagina examination to ascertain cervical dilatation
20. Determine the stage of labour and monitor for possible vagina delivery
21. Induce labour if the cervix is favourable for easy induction (soft, thin, partly dilated)
22. Prepare for caesarean section if:
    • The cervix is unfavourable (firm, thick, closed) or delivery is not anticipated within 24 hours
    • There is evidence of foetal distress (thick meconium, foetal heart rate less than 100 or more than 160 beats per minute immediately after contractions and slow or irregular recovery to normal levels)
    • Coagulopathy has been ruled out
    • Safe anaesthesia is available
23. Communicate findings to client and family
24. Encourage client or significant others to sign consent form in case of surgery
25. Record and report all information in the Maternal and Child Health Book (Manual or Electronic)