Pre-eclampsia (292/1700)

A 27yo 34wk pregnant lady presents with headache, epigastric pain and vomiting. Exam:
pulse=115, BP=145/95mmHg, proteinuria ++. She complains of visual disturbance. What is the
best medication for the tx of the BP?

a. 4g MgSO4 in 100ml 0.9%NS in 5mins
b. 2g MgSO4 IV bolus
c. 5mg hydralazine IV
d. Methyldopa 500mg/8h PO
e. No tx

























answer: E, because it asks for BP control specifically! her BP is below the limit


Pre-eclampsia: It develops after 20 weeks and usually resolves within 10 days of delivery.
diagnosis: proteinuria and HTN during pregnancy

antihypertensive therapy (does nothing to prevent seizures) treat if BP >160/100
lowering BP decreases the risk of stroke

1. hydralazine 5-10 mg IV bolus over 5 min q15-30min as necessary
2. labetalol 20-50 mg IV q10min
3. 2nd line: nifedipine 10-20 mg PO q20-60min

 Seizures

• prophylactic magnesium sulfate: 4g (8mL of 50% solution) IVI over 15min in 100mL 0.9% saline ... if symptomatic e.g. vomiting and visual disturbance or very high proteinuria
• Treat a first seizure with 4g magnesium sulfate in 100mL 0.9% saline IVI
  over 5min + maintenance IVI of 1g/h for 24h.
• postpartum management :risk of seizure highest in first 24 h postpartum – continue MgSO4 for 12-24 h after delivery
• Stop magnesium sulfate IVI if respiratory rate <14/min or tendon reflex loss, or urine output <20mL/h. Have IV calcium gluconate ready in case of MgSO4 toxicity.

n.b.

pre existing HTN = > 140/90 before 20 weeks
gestational HTN = > 140/90 before 20 weeks