Eclampsia: delivery decisions and immediate postpartum care

THE CONTEXT

Obstetric management considers seizure control, fetal status, gestational age and obstetric indications for cesarean delivery.

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Cesarean delivery is performed for obstetric indications such as malpresentation.

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Delivery is recommended in a setting with a Neonatal Intensive Care Unit (NICU). Steroid therapy is given when pregnancy is less than 34 weeks.

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Recurrent convulsions may cause IUFD.

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Conservative management in early pregnancy may improve perinatal outcome, but this benefit must be carefully balanced against maternal wellbeing.

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The pre-eclamptic process gradually subsides and spontaneous fetal expulsion eventually occurs; otherwise, medical induction is started.

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If anticonvulsants do not control fits within a reasonable period of 6–8 hours, termination of pregnancy should be undertaken.

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Low rupture of the membranes is performed, with oxytocin infusion added if needed. The uterus responds well to oxytocin in these cases.

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Cesarean delivery is performed when unfavorable factors are present.

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Eclampsia before 30 weeks with an unfavorable cervix is a listed indication for cesarean section.

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Oxytocin 10 units is given intramuscularly or slowly intravenously.

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Continued vigilance for postpartum hemorrhage is required.

NEETx

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