Eclamptic seizure on the antenatal ward — emergency management station

Team-based emergency station: first-episode eclampsia on the antenatal ward with no intravenous access and a post-ictal fetal bradycardia. Tests the doorway bundle in order, the Zuspan magnesium regimen with monitoring and antidote, severe-range blood pressure control, resisting premature caesarean, recurrent-seizure management, escalation, and communication with a terrified partner. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

It is 03:20. A 19-year-old G1P0 at 32+6 weeks was admitted eight hours ago with a blood pressure of 156/100 mmHg and a headache; bloods were sent and are still pending. You are the registrar. The midwife pulls the emergency buzzer: the woman is rigid, then jerking, with her eyes deviated and frothing at the mouth. The cardiotocograph, which was normal, now shows a prolonged deceleration to 70 beats per minute. There is no intravenous access. The consultant is at home, 25 minutes away. The anaesthetist is coming from theatre.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar on night duty. Two midwives are with you; the consultant is 25 minutes away and the anaesthetist is on the way from theatre. The assessor runs the clock and feeds new observations. ^[1]

Candidate instruction. Lead the management of this emergency. Verbalise your actions, your drug orders with dose and route, your escalation triggers, and your communication with the team and the family. ^[1]^[4]

References9Show

[1]American College of Obstetricians and Gynecologists Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 Obstet Gynecol, 2020.PMID 32443079
[2]Eclampsia Trial Collaborative Group Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial Lancet, 1995.PMID 7769899
[3]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
[4]Shanmugalingam R, Barrett HL, Beech A, et al. A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline Med J Aust, 2024.PMID 38763516
[5]Knight M Eclampsia in the United Kingdom 2005 BJOG, 2007.PMID 17617191
[6]Diaz V, Long Q, Oladapo OT Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia Cochrane Database Syst Rev, 2023.PMID 37815037
[7]Roberts D, Brown J, Medley N, Dalziel SR Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Cochrane Database Syst Rev, 2017.PMID 28321847
[8]Martin JN Jr, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification Am J Obstet Gynecol, 1999.PMID 10368474
[9]Magee LA, Nicolaides KH, von Dadelszen P Preeclampsia N Engl J Med, 2022.PMID 35544388

Eclamptic seizure on the antenatal ward — emergency management station

Station brief

References9Show

[1]American College of Obstetricians and Gynecologists Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 Obstet Gynecol, 2020.PMID 32443079
[2]Eclampsia Trial Collaborative Group Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial Lancet, 1995.PMID 7769899
[3]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
[4]Shanmugalingam R, Barrett HL, Beech A, et al. A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline Med J Aust, 2024.PMID 38763516
[5]Knight M Eclampsia in the United Kingdom 2005 BJOG, 2007.PMID 17617191
[6]Diaz V, Long Q, Oladapo OT Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia Cochrane Database Syst Rev, 2023.PMID 37815037
[7]Roberts D, Brown J, Medley N, Dalziel SR Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Cochrane Database Syst Rev, 2017.PMID 28321847
[8]Martin JN Jr, Rinehart BK, May WL, Magann EF, Terrone DA, Blake PG The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification Am J Obstet Gynecol, 1999.PMID 10368474
[9]Magee LA, Nicolaides KH, von Dadelszen P Preeclampsia N Engl J Med, 2022.PMID 35544388