Magnesium Sulfate Administration Quiz

Severe Hypertension & Eclampsia

• This presentation covers diagnosis and management of hypertensive disorders during pregnancy.
• Objectives include recapping diagnosis and management, emergency management of severe hypertension, pre-eclampsia, and eclampsia, updates from NICE guidelines and MBRRACE-UK reports, and human factors considerations.
• The presentation highlights a 1:10 ratio of women with high blood pressure during pregnancy and an estimated 6% of UK pregnancies affected by pre-eclampsia.
• Case studies highlight the importance of baseline antenatal care, appropriate escalation, and midwife support.
• Maternal mortality rate is low (0.3/100,000) but higher than in 2012.
• Causes of maternal death, including intracranial hemorrhage, eclampsia/cerebral edema, pulmonary edema, hepatic rupture, etc., are detailed in tables and charts.

Recommendations

• Importance of baseline antenatal care; routine blood pressure checks, especially regarding proteinuria.
• Appropriate escalation of care with IWEWS charts to be used.
• Midwives should seek senior support with patient concerns about care.
• Use specific communication regarding blood pressure measurement.

Definitions

• Essential/Chronic Hypertension: Hypertension diagnosed before or less than 20/40 weeks of pregnancy.
• Gestational Hypertension: New diagnosis of hypertension after 20/40 weeks of pregnancy.
• Pre-eclampsia: New hypertension >20/40 weeks of pregnancy plus significant proteinuria (urinalysis ≥1+ protein or protein creatinine ratio ≥30 mg/mmol).
• Severe pre-eclampsia: Pre-eclampsia with severe hypertension (blood pressure ≥160/110 mmHg) and/or symptoms or biochemical or haematological impairment.
• Eclampsia: Convulsive condition associated with pre-eclampsia.

Signs and Symptoms

• Pre-eclampsia signs include: frontal headache, visual disturbances, vomiting, epigastric pain, swelling of the hands or face, reduced fetal movements, and abdominal pain with/without vaginal bleeding.
• Associated complications for pre-eclampsia include: intracranial hemorrhage, placental abruption, disseminated intravascular coagulation (DIC), eclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), renal failure, pulmonary edema, and acute respiratory arrest.

Intracranial Hemorrhage

• Still rare in pregnancy (15:1,000,000 pregnancies).
• However, high blood pressure (≥160/110 mmHg) is considered an emergency in pregnant/postnatal women.

Fetal Complications

• Fetal complications include intrauterine growth restriction, oligohydramnios, hypoxia from placental insufficiency, placental abruption, and preterm birth.

Aspirin Indications

• One high risk factor: hypertensive disorder in previous pregnancy, chronic kidney disease, autoimmune diseases, type 1 or type 2 diabetes, or chronic hypertension.
• Two or more moderate risk factors: primiparity, age 40 or older, pregnancy interval >10 years, BMI of 35 or more at booking visit, family history of pre-eclampsia, or multi-fetal pregnancies.

Severe Hypertension Management

• Admit and treat until blood pressure is stabilized.
• Follow NICE guidance or severe hypertension algorithms.
• Aim for blood pressure of 135/85 mmHg or less on treatment.
• Monitor blood pressure every 15-30 minutes until <160/110 mmHg.
• Daily urine dipstick for protein, while in the hospital setting.
• Weekly FBC, U&E, and LFT at diagnosis and then every 2 weeks.
• CTG (cardiotocography) at diagnosis and then every 2 weeks.
• PIGF-based testing one time if pre-eclampsia is suspected.

Severe Hypertension - Urgent Treatment Algorithm

• A detailed algorithm for managing severe hypertension, including various treatment options, routes of administration, and guidelines to follow during various situations.

Severe Pre-eclampsia Checklist and Management

• A checklist covering preparation, assessment, stabilization, monitoring, and planning for patients with severe pre-eclampsia.
• Detailed guidelines on steps to take for managing severe preeclampsia, including treatment algorithm and interventions.
• Include steps for ongoing monitoring, potentially involving critical care/ITU if required.

Eclampsia Emergency Box

• Essential equipment and medications.

Magnesium Sulfate

• Administration and management of Magnesium Sulfate for primary and secondary prophylaxis and seizures
• Safety monitoring should be conducted throughout treatment.

Postnatal Care

• Continued antihypertensives if previously administered.
• Postnatal check-ins, similar to the frequency of antenatal follow-up.
• Reducing medication if blood pressure falls below 130/80 mmHg.
• All women should have a postnatal care plan including who will provide the follow-up, frequency of blood pressure monitoring, thresholds for reducing or stopping treatment, indicating referral to primary care, and self-monitoring symptoms.

Case Summaries

• Case histories from MBRRACE-UK reports highlight crucial recommendations like providing additional postnatal checks and continuing antihypertensive medications until hypertension is resolved, especially following treatment during pregnancy or labor.

Test your knowledge on the administration and monitoring of Magnesium Sulfate, including toxicity signs and emergency procedures. This quiz covers essential dosages, fluid allowances, and precautions. Perfect for healthcare professionals looking to refresh their understanding of Magnesium Sulfate use.