Acute fulminant pre-eclampsia: recognition and immediate management
THE CONTEXT
Acute fulminant pre-eclampsia, also called the pre-eclamptic state, involves acute onset or rapid deterioration with a constant threat of serious complications.
Presentation and threats
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Pre-eclamptic manifestations may arise acutely as a new presentation, or established pre-eclampsia may deteriorate rapidly with severe hypertension over a short period.
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All features of severe pre-eclampsia are intensified.
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Threatened complications include convulsion, cerebral hemorrhage, cardiac failure, pulmonary edema and placental abruption.
Initial care and transfer
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When detected at home or a primary health care facility, the patient should be adequately sedated.
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The stated sedation options are midazolam 1–2 mg intravenously, which may be repeated after 5–10 minutes, or diazepam 10 mg by slow intravenous administration.
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Give prophylactic magnesium sulfate before transfer.
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A doctor or midwife should accompany the patient during transfer to hospital.
Hospital management and monitoring
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Keep the patient in an eclampsia room under close supervision.
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Continue prophylactic anticonvulsant therapy with intramuscular or intravenous magnesium sulfate using the regimen specified for eclampsia.
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Stabilize blood pressure with parenteral antihypertensive drugs; intravenous labetalol or intravenous hydralazine are listed as first-line options.
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Carefully assess treatment response through frequent monitoring of blood pressure, urinary output, proteinuria and hematological parameters.