Preeclampsia & Eclampsia

• Load MgSO₄ 4–6 g then run 1–2 g/h for seizure prophylaxis and treatment; repeat a 2–4 g bolus for recurrent seizures.
• At BP ≥160/110 give labetalol, hydralazine, or nifedipine urgently to prevent stroke, targeting 130–150/80–100.
• Definitive fix is delivery; HELLP (platelets falling, hemolysis, LFTs rising): deliver, Mg, platelets if bleeding/<20.
• Watch Mg toxicity via reflexes and RR; antidote is calcium gluconate 1 g IV.

Treatment of Severe Preeclampsia/Eclampsia

• Begin neuroprophylaxis — MgSO₄ 4–6 g IV load over 20 min (phenytoin in ARF). Delivery is the definitive treatment
• NEUROLOGIC — seizures: repeat MgSO₄ 2–4 g IV bolus over 15 min (most eclamptic seizures self-terminate; lorazepam or levetiracetam if MgSO₄ fails) · if onset delayed several days postpartum or persistent/recurrent: head CT or MRI to exclude other diagnoses
• RENAL — oliguria/acute renal failure: pulmonary edema? — Yes: lasix 10 mg IV plus afterload reduction when hypertension is severe; No: 500 mL bolus → urine output stays <30 mL/hr → consider PA catheter: ↓PCWP ↑SVR → repeat the bolus · ↑PCWP ↑SVR ↓LV function → reduce afterload and restrict fluids · ↑PCWP normal SVR → reduce afterload
• CARDIOPULMONARY — SBP >160 mm Hg or DBP >110 mm Hg: labetalol 20–80 mg IV q10 min OR hydralazine 5–10 mg IV q15–20 min OR nifedipine 10–20 mg PO q20 min · goals: SBP 140–160 mm Hg, DBP 90–100 mm Hg
• HEPATIC — subcapsular hematoma and/or rupture: hepatic artery embolization ± laparotomy for life-threatening hemorrhage; otherwise supportive care
• HEMATOLOGIC — hemolysis/thrombocytopenia/DIC/hemorrhage: transfuse blood, plasma, and platelets as needed (target >50,000/mL when surgery is planned) · dexamethasone 10 mg IV q12h may shorten HELLP syndrome recovery
• FETAL — nonreassuring fetal status/placental abruption: emergent cesarean delivery once the mother is stabilized · watch for hemorrhage and DIC
• After the magnesium load, continue MgSO₄ 2 g/hr adjusted for therapeutic magnesium levels (4–7 mEq/L, 4.8–8.4 mg/dL). lorazepam or diazepam IV can be considered with careful attention to respiratory depression