Discuss the management of antepartum eclampsia in a 25-year-old primigravida with 32 weeks of pregnancy.
Management of Antepartum Eclampsia at 32 Weeks
Antepartum eclampsia is an obstetric emergency requiring immediate maternal stabilization and delivery planning.
Initial Stabilization: Ensure airway patency, position the patient on her left side, and provide oxygen. Control seizures with magnesium sulfate (loading 4–6 g IV over 15–20 minutes, maintenance 1–2 g/hour), monitoring for toxicity; keep calcium gluconate ready. Manage severe hypertension (BP ≥160/110 mmHg) using IV labetalol, hydralazine, or oral nifedipine, targeting 140–150/90–100 mmHg. Restrict fluids to prevent pulmonary edema.
Fetal Assessment: Continuous fetal heart rate monitoring and ultrasound/biophysical profile. Administer antenatal corticosteroids (betamethasone or dexamethasone) to accelerate fetal lung maturity.
Delivery Planning: Stabilize mother before delivery. Mode depends on maternal-fetal status and cervical favorability; Cesarean is indicated for severe compromise. Aim for delivery within 6–12 hours of stabilization.
Postpartum Care: Continue MgSO4 for 24 hours, monitor BP, urine output, and maternal complications closely.
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