Prompt

A woman at 34 weeks has severe pre-eclampsia with headache, BP 180/115, hyperreflexia and platelets 95 x 10^9/L. Outline BP management, exact magnesium regimens, monitoring for toxicity, and your anaesthetic plan for urgent caesarean including uterotonic cautions.

Model answer

BP and seizure prophylaxis (6). Treat severe hypertension with labetalol/hydralazine/nifedipine per protocol; start MgSO4 — Pritchard 4 g IV + 10 g IM then 5 g IM q4h, or Zuspan 4 g IV then 1–2 g/h; monitor reflexes/RR/urine; antidote calcium gluconate 1 g IV.^[1]^[4]

Anaesthesia (5). Prefer spinal if coags OK and platelets acceptable locally; if GA: difficult airway, obtund laryngoscopy, fluid restrict; avoid ergometrine postpartum.^[4]

Disposition (4). HDU, continue Mg post-delivery per protocol, watch pulmonary oedema and postpartum eclampsia.^[7]

References7Show

[1]Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet, 2002.PMID 12057549
[2]The Eclampsia Trial Collaborative Group Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet, 1995.PMID 7769899
[3]Duley L, Gülmezoglu AM, Henderson-Smart DJ, et al. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev, 2010.PMID 21069663
[4]ACOG Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol, 2020.PMID 32443079
[5]Magee LA, Singer J, von Dadelszen P, et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med, 2015.PMID 26061848
[6]Mushambi MC, Kinsella SM, Popat M, et al. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia, 2015.PMID 26449292
[7]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.

Model answer

Anaesthesia (5). Prefer spinal if coags OK and platelets acceptable locally; if GA: difficult airway, obtund laryngoscopy, fluid restrict; avoid ergometrine postpartum.^[4]

Disposition (4). HDU, continue Mg post-delivery per protocol, watch pulmonary oedema and postpartum eclampsia.^[7]

References7Show

[1]Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet, 2002.PMID 12057549
[2]The Eclampsia Trial Collaborative Group Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet, 1995.PMID 7769899
[3]Duley L, Gülmezoglu AM, Henderson-Smart DJ, et al. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev, 2010.PMID 21069663
[4]ACOG Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol, 2020.PMID 32443079
[5]Magee LA, Singer J, von Dadelszen P, et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med, 2015.PMID 26061848
[6]Mushambi MC, Kinsella SM, Popat M, et al. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia, 2015.PMID 26449292
[7]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.

Severe pre-eclampsia: MgSO4 regimens and anaesthetic plan for caesarean

Model answer

Severe pre-eclampsia: MgSO4 regimens and anaesthetic plan for caesarean

Model answer