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ESSAY 134 - OBSTETRIC EMERGENCY

Posted by Sarwat F.
This woman has developed eclampsia which is a life threatening obstetric emergency. Management of this case will involve initial stabilization of the patient; securing airway, breathing and circulation and further treatment including termination of pregnancy.
I will organize my team so that one of the midwives will be sent to call for help. She will call anesthetist, hematologist, and biochemist for urgent bloods. Management must involve senior obstetrician and anaesthetist. She will also inform NICU doctors, paediatrician ,theatre staff for the possibility of delivery in addition to explaining the situation to patient’s relatives. The other midwife will get the eclampsia box and will help me in stabilizing the patient, positioning her left lateral, placing mouth gag securing airway patency, administering oxygen, suction of mouth and catheterizing the woman. SHO will administer IV line and will help in preparing and administering MgSulphate and arranging for investigations. After the anaesthetist will arrive, he will help in maintaing airway, preparing for caesarean section as well as deciding about fluid balance.
After initial stabilization, principles underlying subsequent management include administration of antihypertensive and anticonvulsant medications with appropriate monitoring and termination of pregnancy. Patients relatives will need explanation and counseling at every stage. Regarding anticonvulsant magnesium sulphate is the drug of choice. It is administered as a loading dose of 4 grams diluted in 20% solution IV over 10 to 15 min. This is prepared by adding 8 ml of 50%MgSO4 to 12 ml of normal saline. Maintainance dose is 1 gm per hour IV. If seizures recur MgSO4 2 gm can be repeated IV as per loading dose. With MgSO4 urine output, respiratory rate and patellar reflexes are monitored. Regarding antihypertensves, IV diluted hydralzine 10 mg can be given. An alternative is labetolol. Aim is to keep systolic blood pressure between 130 to 140 mm Hg and diastolic BP between 90 to 100 mm Hg. Blood pressure is carefully controlled as sudden hypotension can result in fetal distress. Monitoring of the patient will include pulse oximeter, blood pressure, respiratory rate, temperature, urine output, proteinuria patellar reflexes, ECG, fetal cardiotocography. Investigations will be sent including full blood picture, platelet count, serum urea, creatinine , electrolytes, serum uric acid, urine for protein , LFTs, coagulation screen and group and save serum. As the patient is already admitted it is checked that she is already given two doses of steroid. Mode of termination of pregnancy will be decided after reviewing the history and doing examination. Important points in history include parity of the patient, any complain of reduced fetal movement, any evidence of fetal growth restriction, past obstetric history including any history of growth retriction or perinatal deaths, mode of previous deliveries. Previous antenatal record is reviewed to assess fetal growth or any evidence of oligohydramnios. Then examination is done including abdominal and vaginal examination. Abdominal examination will help in assessing the presentation of the fetus. Vaginal examination will be done to assess bishops score. As the gestation is not full term and patient was not in labour, bishops may not be favourable. If such is the case, then patient is best delivered by abdominal route. However, as it is known that the best route of delivery is vaginal, if the bishops score is favourable as might be in case of a multipara , then ARM is done and labour is induced. Patients relatives are properly explained and informed consent taken. Thromboembolism prophylaxis is given. NICU is informed regarding delivery of preterm baby and a paediatrician must be present at the time of delivery. If neonatal care facilities are not available then patient can be transferred after initial stabilization to a tertiary care centre having proper neonatal care. In case of further deterioration of patients condition, high dependency unit may be needed.Patients monitoring continues after delivery and MgSO4 continued till 24 hrs after delivery or after last fit. After the patients condition improves detailed counseling regarding her condition, its complications and implications for future pregnancies should be provided.
Posted by uma M.
Iwill attend the call urgent in the mean time i would ask the SHO to stabilize the patient by putting her to LLP, giving oxygen, securing airway,& IV line. I will ensure that patient is stabilised & start evaluating the patient check her BP ,PR, RR, Level of consciousness.In the mean time I will ask midwife to call for further help, inform consultant, inform anaesthesist, theatre persnnel, Paediatrician, NICU, LABORATORY FOR URGENT INVESTIGATIONS. Patient relatives should be explained of what is happening.After initial quick evaluation I will ask SHO to give loading dose of Magsulf 4 gm IV slowly over 5-10 min. If patient is still fitting repeatedly IV diazepam can be given.
After initial stabilization further management involves control of BP, fluid management, investigations to detect any complications of eclampsie, deliivery .Anti hypertensives should be given for acute control of BP, but none of the available anti HTN\'S have been shown to be superior over other. Principle behind use of these is to reduce further risk of convulsions &to reduse the risk of cerebro vascular accidents.Hydrallazine in the dose of 5 mg every 20 min for acute control of BP is commonly used This ppt feteldistress & so Cont EFM should be used. BP monitored every 15 min.I wold cathetrize the patient, monitor strictly Input output. Fluid adminstration should be restricted to about 85 ml/hr of maintanance crystalloid. Rationale of strict fluid balance to avoid fluid overload , ther by pulmonary edema which is major complication. I would continue maintainance dose of Magsulf IV 1mg/hr infusion.This treatment modality have been shown to reduce reduse recurrent seizures by relieving cerebral vasospasm. How ever Magnesium toxicity should be monitored by deep tendon reflexes, RR, urine output. If toxicity develops Calciun gluconate should be given 1gm IV slowly over 10 min. Investigations should aim to detect complications of eclampsia like DIC, HELLP, ARDS, Pulmonary edeme, IUD, Abruption .I would ask for FBC, Coagulation profile, RFT LFT, Oxygen saturation. If any neurological deficets noted then I would order for CT/MRI to exclude cerebral haemorrhage.
Delivery is the treatment for eclampsia as this will end the process of this progressive disease. I would deliver the patient by caesarean section because at 32 weeks she is most likely to have unfavourable cervix after patient is stable _ HTN controlled , seizures controlled, hypoxia corrected.After delivery she should be monitored in HDU , for at least 24 hrs as this is the period of greater risk of pulmonary edema. As eclampsia is a preventable complication of preeclampsia when managed appropriately this happening might be due to sub standard care and so require incident form filling, risk management.
Posted by vijaya L.
A fit during the antenatal period is regarded as eclamsia unless proved otherwise, especially on the background of pre-eclamsia.
Eclampsia is an obstetric emergency with an incidence of 1 in 2000 pregnancies and a death rate of 2% of the affected women.
Most of the hospitals have strict protocols in place for the management of the situation and many conduct regular fire drills and also have eclampsia box which contains all the resuscitation equipment necessary for the immediate management of this situation like airway, venflons, iv sets, magnesium sulfate etc. the basic principles of management are stabilizing airway, breathing and circulation; treatment and prevention of convulsions; management of blood pressure; fluid management; early delivery with thromboprophylaxis and close postnatal follow up with appropriate neonatal management.
I would reach the place at the earliest and quickly absorb the situation by asking for a brief history, regarding general condition of the patient and resuscitation measures already attempted, and do a quick examination of the patient to see whether she is positioned properly and to assess airway, breathing and circulation.
I would deploy SHO to secure wide-bore intravenous line and take blood for FBC, Urea, Creatinine, Electrolytes, Uric acid, Platelet count and liver function tests and start intravenous magnesium sulfate 4gm diluted in 20 ml to be given over 20 mts.
I would ask one midwife to arrange for the oxygen and pulse-oximeter and monitor pulse, blood pressure and urine output.
I would ask another midwife to insert an indwelling urinary catheter and inform the consultant and anaethetist about the situation.
I would check to see whether she is in labour and check condition of the fetus with a cardiotocogram.
I would check the records to see the investigations done already to assess the severity of the pre-eclampsia and any utrasonograms or dopplers done for the condition of the fetus.
Magnesium sulfate is not an antihypertensive and hypertension should be managed separately. Nefedepine can cause severe hypotension when given along with magnesium sulfate. HDU and theater should be informed of the probable need of their services.
Once her vital have settled and hypertension is under control then I would arrange for an early delivery. Obstetric examination and per vaginal examination is done. Induction of labour may be considered if the bishop score is favorable.
Corticosteroid administration is controversial as we cannot wait till 24 hrs after the last dose and this can increase the blood pressure and the risk of pulmonary edema. Hence the four dose (6mg 12th hrly) dexamethasone regimen is better along with close monitoring of the blood pressure, but delivery usually happens before the course is completed.
Magnesium should be continued as an intra venous infusion at 1gm per hr and in case she develops another fit 2gm can be repeated if the urine output is atleast 30ml/hr.
Vaginal delivery would be aimed for with electronic fetal monitoring and one to one monitoring of the mother for blood pressure, urine output and tendon reflexes.
Rarely HELLP and abruption can complicate the situation and will warrant monitoring for DIC as well.
Mother should be explained about the situation as soon as she is conscious enough
Senior Pediatrician should be present for the delivery due prematurity and probable growth restriction.
Through out the above management she should not receive more than 80 to 100ml of iv fluids per hr. Caesarean section may carried out in case of uncontrolled convulsions or foetal compromise.
Mother should be managed closely in the postnatal period as the blood pressure can take up to 4 weeks to come to normal state.
A incident form should be filled in.




Posted by SWATI M.
This woman is suffering from eclamptic convulsion which is an obstretric emergency. Hypertensive disorders in pregnancy and its complications are one of the leading causes of maternal death .
Eclampsia increases maternal morbidity due to complications such as abruptio placenta, disseminated intravascular coagulation, multiorgan failure, increased operative delivery. Perinatal morbidity and mortality increases due to iatrogenic prematurity (as need to terminate pregnancy),fetal distress.
Available personnel should be assigned particular task to optimise the maternal and fetal outcome. I will maintain airway by suction, preventing tongue fall back and start oxygen adminstration. Having done start intravenous access, collecting laboratory samples, administering anticonvulsants, indwelling catheterization. SHO to help for this along with monitoring vitals of mother and oxygen saturation .After dealing acute situation I will examine her to decide for mode of delivery. One midwife to assigned to provide supplies- intravenous fluid , IV canula ,catheter, drugs, start cardiotocography. Another midwife assigned to contact consultant obstretrician, neonatalogist , anaesthetist, alert laboratory and porters for urgency. Keep informed neonatal intensive care unit and operting theatre about the patient. Having done that help in filling laboratory forms .
Principles of management -
Maintain airway and oxygen saturation by oropharyngeal suction ,prevent tongue fall back with use of Rudels airway, administrating oxygen. Monitor oxygen saturation with pulse oxymeter.
Management of the patient in High dependent unit care .
Control of convulsion by using intravenous 10 mg diazepam if patient is having a convulsion at examination. Administration of Magnesium sulphate to prevent recurrent convulsions. Magnesium sulphate has a better efficacy and fewer recurrent convulsion than diazepam or phenytoin. Watch for magnesium toxicity by monitoring respiration and deep tendon reflexes.
Control hypertension with intravenous hydralazine or labetolol to prevent cerebrovascular accidents in acute hypertension .Aim to maintain blood pressure , systolic less than 160 and diastolic less than 110 mm of Hg.
Maintain circulation by intravenous fluid preferably by colloids .Avoid overload to prevent development of pulmonary edema.
Monitoring vitals of mother every 10-15 minutes by pulse blood pressure , urinary output by cathetterisation , respiratory rate.Watch for deep tendon reflex.Fetal monitoring by continous cardio tocography.
Expediate delivery by vaginal or caeserean delivery.Vaginal delivery if woman is in established labour,fetus in good condition.Curtailing second stage by ventose or forceps deliovery.Caeserean section is indicated if fetal distress,recurrent convulsions, unfavourable cervix and other obstetric indication.
Management of third stage of labour with oxytocin and avoiding use of ergometrine.
Deatyecting complications early and their management –
Acute renal failure – by monitoring urine output every 1 hourly , strict input output chart. If renal failure developes - Treatment by involving renal physician.
High index of clinical suspician for abruptio placentae .
Early detection and treatment of abruption to avoid further complications of DIC and ARF.
Vigilance for DIC by platelet count and coagulation profile and its treatment by FFP, and cryoprecipitate with the help of a hematologist.

Posted by Nibedita R.
Considering the situation as an obstetric emergency and assuming fits to be eclamptic, especially with the background of pre-eclampsia, I will attend the call immediately.
One midwife will be sent to call for senior obstetrician and anaesthetist help urgently and the other midwife to bring eclampsia pack quickly. The SHO and myself will start stabilising the woman to prevent injury and put her in left lateral position with head down to prevent aspiration. Airway is to be secured by an airway tube and gentle oropharyngeal suction is to be done. I will check breathing and give oxygen by face mask. I will ensure basic life support is taken care of. I will ask the SHO to put a wide bore cannula for venous access and collect blood for FBC, U&E, creatinine, clotting, LFT, grouping and cross matching. The SHO will talk to the biochemist for urgent blood reports and to the haematologist regarding the requirement of blood. One midwife will be asked to put an indwelling foley?s catheter and then inform the theatre staff, paediatrician and NICU about the possibility of caesarean section. The other midwife should monitor BP and pulse oxymeter.

Principles of subsequent management include control of fits, control of hypertension, intensive monitoring to prevent complications and expediate delivery. Labour ward must have an agreed protocol, which should be followed. MgSo4 is the anticonvulsant of choice. Loading dose of 4gm (50%) diluted in 12 ml distilled water to make a 20% solution and given slowly over 5-10 minutes and maintenance infusion of 1gm/hr continued. A further 2gm IV bolus dose can be given for seizure recurrence.

If repeated seizure occurs despite MgSo4, she should be transferred to high dependency unit for intensive care. Further seizure may be managed by diazepam (10mg IV). Intubation to secure airway and muscle relaxant may be required which will be managed by senior anaesthetist.

MgSo4 therapy should be monitored by respiratory rate every 15 minutes, tendon reflexes (knee jerk) and urine output hourly. Serum magnesium levels are to be checked if oliguric or repeated dose administered for recurrent seizure. If signs of toxicity (absent knee reflex, urine output <30ml/hr and respiratory rate <14/min) present MgSo4 should be withheld and calcium gluconate 10ml 10% should be administered over 10 mins.

Blood pressure must be controlled to prevent CVA and hypertensive cardiac failure by use of rapidly acting drug. If BP >160/110mm Hg, hydralazine/ labetalol is to be given IV. Both may precipitate hypotension and foetal distress. Therefore, monitoring BP and continuous foetal heart rate monitoring is necessary. Preloading the circulation with 400-500ml colloid prior to that may reduce the risk of hypotension and foetal distress.

Close monitoring of fluid intake and output is mandatory. Oliguria may complicate renal failure and fluid overload may precipitate pulmonary oedema. The fluid therapy should be maintained by crystalloid 85ml/hr or urine output in preceding hour plus 30ml. CVP line may be instituted. No clear evidence that diuretics or plasma expander is beneficial in eclampsia patient.

Eclampsia is a part of multisystem disorder and complications like ARDS, renal failure, cardiac failure, DIC, HELLP, CVA and abruption placentae may follow.
Frequent monitoring of FBC, U&E, creatinine, urine for proteinuria, clotting factors, platelets, LFT together with oxygen saturation with pulse oxymetry. CT/MRI of brain may be required if complicated by unconsciousness or neurological deficit. If the woman develops signs of complications, multidisciplinary input must be arranged in her care.

The condition must be informed at all times to the patient (if conscious) and her family members.

The definitive treatment of eclampsia is delivery. However, it is inappropriate to deliver an unstable patient even if there is foetal distress. Once seizures are controlled, severe hypertension treated and hypoxia corrected, delivery can be expediated. Corticosteroids to promote surfactant production should be given if not received earlier. NICU must be informed and experienced paediatrician must be present at the time of delivery. Vaginal delivery should be considered if Bishops score is favourable and in mutiparous woman. ARM followed by syntocynon augmentation may be required. Caesarean section is likely to be required in primigravidae/ unfavourable cervix/ malpresentation. It should be done by experienced obstetrician and third stage should be managed actively to prevent PPH.

After delivery, high dependency care should be continued for a minimum of 24 hours and MgSo4 therapy continued for 24 hours of delivery. Clear documentation of timing and frequency of seizures, drugs/ fluids administered as well as assistance requested and filling the incident form is important for risk management.
Posted by Iman B.
The most obvious diagnosis is eclampsia and the patient is managed as such.
With three persons to assist, one would go immediately to call for further assistance. The presence of the senior obstetric consultant and anesthetist on call is mandatory. The neonatology department need to be informed of the imminent delivery of a thirty two week neonate, and the high dependency unit (HDU)or intensive care unit need to know that as soon as the fit resolves the patient will be transferred there.
Another person will be preparing four milligrams of mgso4 in ten or twenty cm syringes ready to administer the bolus starting dose.

The patient must be moved to her left lateral position and the airway established by either inserting a mouth gag or airway tube whichever is available. If oxygen is present in her room then it should be administered by nasal canula or mask.
Vital signs must be taken and better taken auscultatory as oscillatory methods tend to give a lower reading than the original.

Once the fit has abated the patient must be transferred to the HDU. The delivery needs to be speeded up, naturally, since eclampsia is a multisystem complication the possibility of awaiting fetal maturity is not feasible, the only way to stop the pathology is by delivery.
Delivery is not possible until the maternal condition is stable. Maternal acidosis will also mean fetal acidosis and the possibility of fetal CNS depression.
A CVP line is inserted in the HDU and a urinary catheter, and fluid input and output must be closely monitored.
Investigations including liver enzymes, full blood count, and kidney function tests and electrolytes must be taken and followed up regularly.
Magnesium level is monitored in the event that patient becomes oliguric or decreased respiratory rate or loss of knee reflex(normal=2-4mmol/dl)
A pulse oximeter is put in place, to monitor oxygen saturation and treat the hypoxia.
A CTG is brought from the maternity ward and fetus is continuously monitored.
Magnesium So4 maintenance is kept at a rate of 1-2mg/hour, in colloidal solution. MgSo4 causes vasodilatation, and should counter the cerebral ischaemia which originally caused the cerebral oedema, and fits. Failure for the patient to respond to MGSo4 calls for valium 10mg IV bolus, or thiopental 50mg IV slowly or even intubation with positive pressure ventilation and muscle relaxant.
Continuous blood pressure, pulse, respiratory monitor, blood pressure may be controlled either using labetalol, or hydralazine. Urine output should be at least 100ml/4 hours.
Betamethasone twelve mg intramuscular dose should be given, and the neonatal team informed prior to transfer to OR(operation room).
At this gestation the bishop score in all likelihood will be poor. There is no role for attempted induction, and once the acidosis and electrolytes and blood pressure have returned to near normal, the patient is transferred to the OR for cesarean section.
Following delivery, the patient returns to the HDU and should remain there under close surveillance for 24-48 hours at least, or 24 hours after the last fit.
Fluid charts are continued to avoid fluid overload. The possibility of oliguria postdelivery should not cause one to hydrate the patient or push fluids, the cvp should still be in place and fluids administered cautiously.
The majority of fits occur postnatally, so mgso4 continues, and a standby of 10mg calcium gluconate kept beside the patients bedside in case of mg overdose.
Frequent analysis of liver enzymes, kidney function tests(urea and creatinine) and electrolytes to diagnose deterioration.
Patient kept in hospital for at least a week, after release from the HDU, and her blood pressure monitored for six weeks after delivery, to detect those who will continue hypertensive.
Aldomet is not used, for fear of depression, either, ace inhibitors or calcium channel blockers or beta agonists are alternatives.


Posted by Vaijayanti R.



I will attend the call immediately ? Eclampsia is an Obstetric Emergency that is associated with significant maternal and fetal morbidity/ mortality
One midwife is despatched to call for help ? the senior obstetrician, anesthetist and neonatologist must be informed. She will also inform the HDU , OT, NICU and the blood bank.The other midwife is instructed to record vital signs , then to open the Eclampsia pack and start loading the drugs to be adminstered.Either midwife will assist the SHO in establishing IV access, collecting blood ( LFT,RFT,CBC, coagulation profile, grouping and cross matching) and catheterizing the bladder. They will also fill in the laboratory requisitions while the SHO informs the lab of the urgency of the results.I will institute emergency resuscitative measures ( airway ? breathing ? circulation), rapidly review antenatal / ward notes,carry out an complete physical ( consiounness, focal neurological deficits)and obstetric examination( labor / associated complications like abruption, and fetal viability)

Every labour room has its own protocol for management of Eclampsia , and the same should be strictly followeed.
The principles are based on preventing convulsions, controlling blood pressure and maintaining fluid balance.
Anticonvulsant of choice is Magnesium Sulphate ( proved by Colloborative Eclampsia trial). 2gms IV loading dose followed by 1 ? 2 gms/ hr as IV infusion.This should be continued for atleast 24 hrs after the last convulsion. Serum therapeutic levels are to be maintained between 4 to 6 mEq/ l .Watch for signs of toxicity ? depressed respiration, low urine output. Depressed DTJ.
Antihypertensives used for acute control of BP are Hydralazine or labetolol. IV adminstration of either should be continued to maintain MAP at < 125 mmHG.
Fluid balance must be strictly maintained. Crystalloids are usually given at 1ml/kg/hr. Avoid fluid/ diuretic challenges in cases of Oliguria( < 30ml/hr) If necessary opinion of a Renal Physician must be sought
Nursing is carried out in a quiet darkened room to avoid any triggers for convulsions.Records of Blood pressure, RR, DTJ, intake and output is maintained hourly basis. Once the crisis is overcome, cardiotocograph is done.Prophylactic steroids must be given 12mg Betamethasone x 2 doses 24 hrly/ single dose of 24 mg may be associated with a further rise in blood pressure
The patient is also transferred to a HDU for intensive nursing, anticonvulsants are continued for atleast 24 hrs after the last episode.
If the patient continues to remain unstable, ( recurrent convulsions, uncontrollable hypertension) delivery must be considered . If the Bishops score is favourable, vaginal delivery may be permitted ; there is a low threshhold for Caeserean Section
Regional anesthesia is adminstered by a senior anesthetist, GA is avoided due to the rise in BP associated with endotracheal intubation. Prophylactic Magnesium sulphate is adminstered during delivery as this reduces the risk of recurrent convulsions ( Magpie Trial). A senior neonatologist attends the delivery
Intensive care is necessary for atleast 48 hrs post delivery. The patient is monitored for atleast 1 week before being discharged.Advice regarding appropriate antihypertensives ( Ace inhibitors/ beta blockers) is given if necessary. A review appointment is planned in the post natal clinic 6 weeks later

At all stages, the patient and her relatives are counselled regarding the proposed management plans and the risks involved; any procedure is done with informed consent


Posted by narmin B.
A 30-year-old woman at 32 weeks gestation is an inpatient because of pre-eclampsia. You have been called because the woman is fitting. An experienced SHO and 2 senior midwives are already present. How would you organise your team (5 Marks) and what principles underlying your subsequent management (15marks)


This is a case of eclampsia, which is an obstetrics emergency. For organising the management team I would ask a consultant obstetrician and anaesthetist to attend immediately. Obstetrician is needed to see the patient and make a plan of management. Anaesthetist is required, since intratracheal Intubation, assisted ventilation and further control of fit with general anaesthesia may be required. Registrar should start resuscitation of the patient immediately, while SHO is needed to insert a venfulon and take bloods. Midwives need to monitor vital signs, put an indwelling catheter, check fetal heart rate and also communicate with laboratory, theatre and special baby care unit.


The fundamentals of the management are resuscitation of the patient, control of fits, lowering blood pressure, make a plan for delivery and post delivery care.

Resuscitation must be started immediately. Patient should be placed in left lateral position and an open airway should be secured by placing a Goudel’s mouthpiece or other device. Then nasal and oral secretions should be suctioned and oxygen should be administered via an intranasal tube or facial mask. Two large bore cannulae must be inserted to have ready access to the veins. For controlling of fits the best method is administration of MGSO4. Randomised controlled studies have shown that this agent is more effective than diazepam or phenytoin. The first dose of MGSO4 is 4 grams in 20 mls of normal saline, which is given intravenously. Repeat dose of 2 grams can be given if fits were not controlled with the first dose. Maintenance dose of MGSO4 is one gram per hour via an infusion pump. This should be continued 24 hours after delivery. Toxicity to MGSO4 may be seen in the form of respiratory depression. By close monitoring of the respiratory rate, urinary output, and deep tendon reflexes toxicity can avoided.


Another important principal is lowering the blood pressure as it may cause cerebrovascular accident and maternal death. Hydralazine or labetalol can be used. Hydralazine 5-10 mg can be given intravenously. It can be repeated if blood pressure was still high after 20 minutes. Alternatively, labetalol can be given via an infusion pump. Maintenance dose of antihyper tensive should be continued in the form of oral labetalol 200 mgs twice a day or methyldopa 500 three or four times a day.


Since delivery of the baby is the definite treatment of eclampsia, therefore steroids should be given to the mother to reduce the rate of respiratory distress and intracranial haemorrhage in the neonate after delivery. The usual dose is Dexamethasone 12 mgs 12 hours apart which is given intramuscularly.


When the patient becomes stable then, the baby should be delivered. As the cervix is usually unfavourable at this stage of pregnancy, caesarean section is required in most of the cases. However a vaginal examination can be performed to assess the cervix and if it was favourable then induction of labour can be considered. But prolonged induction is not advisable in this case, as there is a risk of recurrent fits and maternal and fetal mortality. Although regional anaesthesia can be given for caesarean section, but general anaesthesia may be required due to fetal distress, or failure of regional anaesthesia.

In some cases where patient’s condition is critical it may be necessary to transfer the patient to intensive care unit for close monitoring her conditions. Blood pressure, pulse, urinary output, fluid intake should be checked frequently. It may be necessary to put a CVP line to control fluid intake and prevent pulmonary oedema due to fluid overload. Also frequent blood tests are required to check renal, liver and clotting.

After delivery patient should be seen to explain antenatal events and the steps that have been taken.


Posted by narmin B.
Dear Paul,

I posted my reply for obstetric emergency on 8th on Jan. I would be grateful for if you could mark it for me.


Many thanks

Narmin