Contact Perinatal Emergency Referral Service (PERS) on 1300 137 650 for advice (via clinician)
Pre-eclampsia and Eclampsia is a time critical emergency requiring early diagnosis, intervention and prompt transport to reduce peri-natal and maternal mortality
• Signs and symptoms of preeclampsia include:
- headache
- visual disturbances (flashing lights, shimmering)
- nausea and/or vomiting
- heartburn/epigastric or abdominal pain
- hyper-reflexia
• Uterine pain and/or PV bleeding may signify abruption
• The most common cause of seizure in pregnancy is pre-existing epilepsy. New onset seizures in the latter half of pregnancy are most commonly Eclampsia
• Seizures may occur during or post birth, usually within 48 hours of birth
• There are no reliable clinical indicators to predict Eclampsia
• The only definitive treatment is birth of the baby
• Notify the receiving hospital early
Inter hospital transfer
Management of this condition may involve the pharmacological control of hypertension and neurological instability/prevention of seizures. This may include:
Nifedipine:
- Initial dose of 10mg orally given by hospital. Can repeat if inadequate response at 30 minutes
MICA only IHT drugs:
- Loading doses and infusions should be established prior to transport
IV Magnesium Sulphate:
- Indicated for severe pre-eclampsia and for seizure prophylaxis. Infusion via a dedicated line and controlled infusion device with ECG monitoring insitu. A usual loading dose is 4mg IV over 10 to 15 minutes or via IM with maintenance infusion usually at 1g/h (4mmol/h) until at least 24 hours post delivery or last seizure
IV Labetolol:
- Initial IV bolus of 20mg given slowly over 2 minutes. This can be repeated each 10 minutes until optimal blood pressure is achieved or max. dose of 300mg delivered. Alternatively a 20 – 160mg.hr infusion can follow the initial bolus titrated to achieve optimal BP.
IV Hydralazine:
- Initial IV bolus (usually 5 – 10 mg) over 5 – 10 minutes. This can be repeated two more times at 30 minute intervals. Maintenance infusion run at 5mg/h. Adjust rate to maintain BP between 140 to 160 over 90 to 100mmHg. The BP should not fall below 140/80 as the placental circulation will have adapted to a higher BP
The severity of the disease will dictate the escorts scope of practice – MICA, AAV MICA, midwife / obstetrician escort, ARV