1. Obstetric Case Presentation
Nick Harper

2. Ms X
• 17 yo
• G1 P0
• 38 weeks gestation
• Admitted in early labor
• Discharged

3. 4X tonic-clonic seizures
Presenting Complaint

4. History of Presenting Complaint
• 8/10 pain headache
• 8/10 pain abdo pain
• 4X tonic-clonic seizures
• Witnessed by boyfriend and sister
• Admission via Ambulance

5. Obstetric History
• 38/40
• 1+ protein seen from 28/40
•BP 92/50 @ 25 weeks
•BP 130/80 @ 37 weeks

6. Differential Diagnosis
• Eclampsia
• Epilepsy
– 1/3 have inc. seizures
– Decreased drug levels
• Severe hypoglycaemia

7. Initial management
Diazepam 10mg IV (ambulance)
MgSO4 (St Michaels)

8. Investigations
• BP 200/120 (<140/90)
• Creatinine 123 (60-100)
• Uric Acid 0.66 (0.19-0.36)
• ALT 145 (5-40)
• Platelets 435 (150-400)
• Hb 11.0 (12-16)

9. •“Shining Forth”
•One or more convulsions superimposed
on pre-eclampsia
Eclampsia
Diagnosis
•Severe pre eclampsia5:1000
•Eclampsia 5:10,000
•14 deaths (2000-2002)

10. Risk Factors

11. Signs & Symptoms

12. Management - BP
• BP >160/110
• Hydralazine 5mg IV unless pulse >120
• Labetolol 20mg IV (total 200mg)
• Restrict fluids 90mL/h

13. Management - Seizures
• Magnesium sulphate 4g IVI 5 min
• Magnesium sulphate 1g/h IVI 24 hrs
•Magnesium sulphate 2g IVI 5 min
•Diazepam 5mg IV
•Stop MgSO4 if RR <14 or lose tendon reflex
•Calcium Gluconate

14. Ms X
• MgSO4 commenced
• MgSO4 maintenance infusion
• 190mg Labetolol given in 25mg boluses
• Into theatre
• Spinal
• Forceps delivery, 2nd
degree tear
• Healthy baby

15. Important points
• BP not a good measure
• Do not ignore 1+ of protein
• Delivery is only cure
• 44% of fits are post partum
• Inform intensive care facilities early