Magnesium Sulphate in Obstetric Care

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Questions and Answers

When should Magnesium Sulphate be considered for primary prophylaxis?

In women with severe pre-eclampsia where birth is planned within the next 72 hours

In women experiencing mild hypertension during pregnancy

In women with a history of seizures unrelated to pregnancy

In women with severe pre-eclampsia where birth is planned within the next 24 hours (correct)

What is the purpose of administering the loading dose of Magnesium Sulphate?

To help with fetal heart rate stabilization

To provide hydration during labor

To lower blood pressure immediately

To prevent seizures in women with severe pre-eclampsia (correct)

How long should Magnesium Sulphate be administered after an eclamptic fit?

Until the patient is symptom-free for 6 hours

For 48 hours after the fit regardless of delivery

For 24 hours after delivery or the last seizure, whichever is later (correct)

For 12 hours only

What is the maintenance dose of Magnesium Sulphate after the loading dose?

$1 g/hr for 24 hours Signup and view all the answers

What is the antidote to Magnesium toxicity?

Calcium Gluconate IV Signup and view all the answers

What is a critical sign of magnesium toxicity?

Double vision Signup and view all the answers

What should be done if magnesium toxicity is suspected?

Stop the infusion and take blood for MgSo4 levels Signup and view all the answers

Which of the following monitoring parameters should be checked hourly when administering magnesium sulfate?

Deep tendon reflexes Signup and view all the answers

What is the maximum fluid input restriction when managing magnesium sulfate to prevent complications?

1ml/kg/hr or 80ml/hr Signup and view all the answers

Which emergency treatment can be administered in cases of confirmed magnesium toxicity?

Calcium gluconate Signup and view all the answers

What is a recommended action for midwives when they have concerns about patient care?

Seek senior support Signup and view all the answers

Which of the following best describes the maternal mortality rate for hypertensive disorders as of 2022?

0.3/100,000 Signup and view all the answers

What was a noted factor that potentially impacted the care of some women who died from hypertensive disorders during 2020?

Remote consultation challenges Signup and view all the answers

Which condition was associated with two of the eight maternal deaths from hypertensive disorders of pregnancy in 2020?

HELLP syndrome Signup and view all the answers

What is an important intervention recommended for eligible women starting from 12 weeks of pregnancy?

Commence aspirin administration Signup and view all the answers

During the antenatal clinic visit, what was the woman's blood pressure upon presenting at 32 weeks?

210/140 Signup and view all the answers

What is a common misconception regarding the management of severe hypertension in pregnancy?

All women need hospitalization Signup and view all the answers

What was a major finding in the MBRRACE report regarding the management of hypertensive disorders in 2019?

Care improvements could have impacted outcomes Signup and view all the answers

What condition experienced a notable increase in mortality rates between 2012 and 2022?

Pregnancy-induced hypertension Signup and view all the answers

What factor contributed to the decision not to provide one-to-one care to the patient observed in the case history?

Staff shortages Signup and view all the answers

What is the primary focus of the MBRRACE-UK reports?

Investigating maternal deaths and morbidity Signup and view all the answers

Which organization published the guideline for the management of hypertension in pregnancy?

National Institute for Health and Care Excellence Signup and view all the answers

What is the recommended urine output measurement to be monitored hourly?

100 ml/4 hrs Signup and view all the answers

What should be considered as an alternative diagnosis for fits during management of seizures?

Hypocalcemia Signup and view all the answers

What type of disorders does the MBRRACE-UK hypertensive disorders chapter specifically address?

Hypertensive disorders in pregnancy Signup and view all the answers

What is a key recommendation for reducing the risk of hypertensive disorders in pregnancy?

Regular monitoring and early interventions when necessary Signup and view all the answers

Which medication is NOT recommended during the third stage of labour?

Ergometrine Signup and view all the answers

What was one of the objectives of the MBRRACE-UK reports from 2018-2020?

Informing maternity care through confidential enquiries Signup and view all the answers

What is the appropriate action to take when eclampsia is suspected?

Commence MgSO4 Signup and view all the answers

Postnatally, which type of medication should be avoided to reduce risks?

Non-Steroidal Anti-Inflammatory medications Signup and view all the answers

How frequently should blood pressure checks be conducted for women treated with antihypertensives during pregnancy?

Postnatal checks are required for additional monitoring until resolved Signup and view all the answers

What is the recommended position for a mother experiencing eclampsia?

Left lateral position Signup and view all the answers

Which of the following is essential for monitoring maternal critical care during severe conditions?

Continuous CTG if not delivered Signup and view all the answers

What is the recommended action if a woman’s blood pressure (BP) falls below 130/80 after childbirth?

Reduce the medication dosage. Signup and view all the answers

Which of the following is NOT included in a care plan for women postnatally?

Cost of medications. Signup and view all the answers

What is the leading cause of death related to hypertensive disorders in pregnancy?

Intra-cerebral hemorrhage. Signup and view all the answers

What alternative method of blood pressure monitoring should be considered if automated systems underestimate systolic BP?

Conduct a manual BP measurement. Signup and view all the answers

What should be done if a pregnant woman experiences a new onset headache with atypical features?

Perform a neurological examination. Signup and view all the answers

Which of the following statements regarding thrombocytopenia and VTE prophylaxis is true?

Low molecular weight heparin should not be given in cases of thrombocytopenia. Signup and view all the answers

When should aspirin be commenced for women at risk during pregnancy?

From 12 weeks of gestation (12/40). Signup and view all the answers

What is an important consideration when monitoring blood pressure in antenatal care?

Measure both BP and urine at each interaction. Signup and view all the answers

Study Notes

Severe Hypertension & Eclampsia

This presentation covers diagnosis and management of hypertensive disorders in pregnancy, including severe hypertension, pre-eclampsia, and eclampsia.
Recaps diagnosis and management strategies for hypertensive disorders of pregnancy.
Details emergency management for severe hypertension, severe pre-eclampsia, and eclampsia.
Includes updates from the 2019 NICE guideline on hypertension in pregnancy and MBRRACE-UK reports and recommendations (2019 & 2023).
Highlights human factors considerations.

Scope of Problem

One in ten pregnant women experience high blood pressure.
Up to 6% of UK pregnancies are affected by pre-eclampsia.

Case Study

A woman, at 30 weeks pregnant, presented with 3+ proteinuria. Blood pressure was not recorded. At 32 weeks, she reported feeling unwell and reduced fetal movement. BP was recorded at 210/140 with 3+ proteinuria. She was treated with nifedipine and transferred.
Critical care was not provided immediately.
Blood pressure was not recorded for three hours later.
No MOEWS chart was completed.
She died from an intracranial hemorrhage.
Recommendations include baseline antenatal care with routine BP checks, appropriate escalation using IWEWS charts, and seeking senior support if concerns arise about patient care.

Maternal Mortality

Maternal mortality remains low (0.3/100,000) but is four times higher than in 2012 (MBRRACE 2022).
Causes of maternal deaths include COVID-19, cardiac disease, sepsis, neurological conditions, other indirect causes, hemorrhage, early pregnancy deaths, pre-eclampsia, amniotic fluid embolism, malignancies, anesthesia, and psychiatric disorders.

MBRRACE-UK 1997-2020 Data

Causes of death related to pre-eclampsia between 1997 and 2020 are detailed, showing frequencies for intracranial hemorrhage, eclampsia/cerebral oedema, pulmonary oedema, hepatic rupture, hepatic necrosis/HELLP, and AFLP.

MBRRACE-UK 2018-2020 Data

Eight women died from hypertensive disorders during or up to six weeks after their pregnancies.
Two women died following intracranial hemorrhage in association with HELLP syndrome.
Two died of acute fatty liver of pregnancy, and two died of eclamptic seizures.
Two died from pulmonary edema (neither death was associated with intravenous fluid administration).
The care of three women who died was potentially impacted by pandemic-related issues.

MBRRACE-UK 2019 Data

6 women died from hypertensive disorders between 2015-2017.
Improved care could have made a difference in their outcomes.
Comnencing aspirin from 12 weeks is important for eligible women.

Indications for Aspirin from 12 Weeks

High Risk factor: Hypertensive disorder in previous pregnancy, chronic kidney disease, autoimmune disease (e.g., SLE or antiphospholipid syndrome), type 1 or type 2 diabetes, or chronic hypertension.
Moderate risk factors (two or more): Primip, age 40 or older, pregnancy interval >10 years, BMI of 35 or more at booking, family history of pre-eclampsia, or multi-fetal pregnancy.

Definitions (Essential/Chronic Hypertension, Gestational Hypertension, Pre-eclampsia, Severe Pre-eclampsia, Eclampsia)

Clear definitions are provided for each term regarding blood pressure levels and proteinuria.

Pre-eclampsia Signs and Symptoms

Common pre-eclampsia symptoms include frontal headache, visual disturbances (blurring or flashing), vomiting and epigastric pain, sudden swelling of face, hands, or feet, reduced fetal movements, and abdominal pain with or without vaginal bleeding.

Maternal and Fetal Complications

Presents a range of possible maternal and fetal complications associated with preeclampsia, including intracranial hemorrhage, placental abruption and DIC, eclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), renal failure, pulmonary oedema, and acute respiratory arrest; fetal complications include restricted growth, oligohydramnios, hypoxia from placental insufficiency, abruption, and preterm birth.

Intracranial Haemorrhage

Still rare in pregnancy but for every 100 women who experience a hemorrhage, 96 will have a blood pressure >160/110 mm Hg.
BP of 160/110 mm Hg in a pregnant or postpartum woman is considered an emergency.

Managing Severe Gestational Hypertension

Treatment protocols and monitoring guidelines for severe gestational hypertension (BP ≥ 160/110) are provided, including admission, treatment stabilization, blood pressure monitoring, urine testing, and other tests.
Detailed information on the management of the disease during pregnancy are provided.
Guidance on the management of severe pre-eclampsia is provided.

Managing Severe Pre-eclampsia

Provides a checklist for managing severe pre-eclampsia, including preparation, assessment, stabilization, monitoring, and planning.

Eclampsia Emergency Box

Essential items for managing eclampsia in an emergency setting are listed.

Stabilizing Eclampsia

Steps to stabilize patient condition, including blood pressure control and seizure prevention.