Eclampsia: complication management and obstetric decisions
THE CONTEXT
Management includes treatment of renal and temperature disturbances, intensive multidisciplinary care, and delivery planning after maternal stabilization.
Renal dysfunction and hyperpyrexia
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The passage describes dopamine infusion for oliguria when CVP is above 8 mm Hg and notes that urine output may return to normal following delivery.
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Hyperpyrexia is difficult to control because it is central in origin. Cold sponging and antipyretics may be tried.
Intensive care and specialist involvement
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Multiple organ dysfunction requires admission to an intensive care unit.
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The team should include an obstetrician, obstetric nurse, anesthesiologist, neonatologist, and intensive care unit team to manage cardiac, renal, or pulmonary complications.
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Postpartum neurologic symptoms and focal deficit warrant neuroradiologic imaging.
Obstetric management
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In most cases of antepartum eclampsia, labor begins soon after convulsions.
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If labor does not begin, management depends on whether fits are controlled and on fetal maturity.
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The decision to deliver is made once the woman is stable. Epidural anesthesia can be used during labor and delivery.
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For induction when the cervix is favorable and vaginal delivery is not contraindicated, low rupture of the membranes is described; an oxytocin drip may be added if needed.
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When the cervix is unfavorable, cervical ripening with PGE2 gel or a pessary is described.