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PIH Seizure ProphylaxisAka: PIH Seizure Management

Management: Seizure Prophylaxis
1. See Magnesium Sulfate
2. Magnesium Sulfate offers best PIH Seizure prevention
3. Reference
  1. Lucas (1995) N Engl J Med 333:201
Management: Seizure
1. Anticonvulsant Medications
  1. Magnesium Sulfate (if not already started)
    1. Loading dose: 6 grams IV over 15-20 minutes
    2. Maintenance: 2 grams per hour
    3. Consider rebolus of 2 grams if Seizure recurs
    4. Obtain Serum Magnesium level at 4 hours
  2. Anticonvulsant not recommended routinely in Eclampsia
    1. Magnesium Sulfate best option for Seizure control
    2. Concurrent anticonvulsant depresses respiration
  3. Consider anticonvulsant if Seizure prolonged
    1. Amobarbital 250 mg IV in 10cc NS over 3 minutes
    2. Diazepam 5-10 mg IV slow push
    3. Pentobarbital 125mg IV
2. Airway and respiratory management
  1. Protect airway from aspiration
    1. Place patient in left lateral decubitus position
    2. Suction oral secretions
  2. Anesthesia at bedside for possible intubation
  3. Consider Oral Airway
  4. Supplemental Oxygen
  5. Arterial Blood Gas
    1. Avoid Sodium Bicarbonate unless pH <7.10
3. Prevent injury
  1. Padding on side rails of bed
4. Other post-Seizure measures
  1. Foley Catheter
  2. Internal fetal monitor (Internal Scalp electrode)
  3. Consider central venous pressure catheter
Complications
1. Maternal mortality
  1. Mortality in U.S.: 0.4% of Eclampsia cases
  2. Mortality in Mexico: 14% of ecamplsia cases
2. Abruptio Placenta: 5.5 to 23% of Eclampsia cases
3. Fetal anoxia with severe neurologic deficits: 7%
  1. Sibai (1983) Am J Obstet Gynecol 146:307
References
1. Fontaine (2000) in ALSO, B:1-36
2. Sibai in Gabbe (2002) Obstetrics, p. 945-74
3. (2000) Am J Obstet Gynecol 183(1):S1
4. Zamorski (2001) Clin Fam Pract 3:329

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.