Table 2 Summary of stabilising the severely ill women with complications of Hypertension after admission to a High Care Obstetrics unit
Organ system | Acute management | Maintenance | Management of complications |
|---|---|---|---|
Fluid management | Start IV line give 300 ml fluid bolus: 100 ml Ringers lactate 200 ml normal saline with loading dose of magnesium sulphate Urinary Catheter | Give Ringers lactate 125 ml/hr iv. Start a fluid balance chart | If poor output repeat fluid bolus. If still poor output and positive fluid balance start low-dose dopamine infusion |
Magnesium Sulphate | 4 g magnesium sulphate in 200 ml saline over 20 min iv 5 g magnesium sulphate with 1 ml lignocaine im in each buttock | Maintenance: 5 g four hourly iv Check before next dosage: Urine output > 30 ml/hr Tendon reflexes present Respiratory rate more than 16/min | In case of magnesium sulphate overdose give calcium gluconate |
Blood pressure control | Repeat blood pressure after 20 min and if diastolic ≥ 110 or systolic ≥ 160 treat according to the antihypertensive drug protocol | Use either nifedipine or labetolol | |
Neurological status | If still confused check saturation and blood pressure | Abnormal saturation: Give oxygen via mask Abnormal blood pressure: treat with appropriate drugs | If both are normal: give haloperidol |