problem solving in gynecology and obstetrics part 2 PE and Eclampsia

important notes for management of eclampsia and severe PE
? Magnesium sulfate is the best agent for the prevention of seizures or recurrent seizures related to eclampsia.
? In up to 25% of cases of eclampsia, the blood pressure will be less than 140/90 mm Hg or there will be no proteinuria .
? The management of eclampsia includes stabilization of the mother, treatment and prevention of seizures, lowering of severe high blood pressure, and delivery of the baby, preferably vaginally.
? Seizures occurring greater than 48 hours postpartum should initiate a complete neurologic evaluation.
? The rate of eclampsia recurring in a subsequent pregnancy is 2%
CASE NUMBER 1
A 29-year-old G1P0 African American female at 34 weeks’ gestation
arrives at the hospital via ambulance with a history of a seizure at home
witnessed by her husband. She has a history of chronic hypertension.
The husband reports that over the preceding 2 days, she has been complaining
about a worsening frontal headache, unrelieved by acetaminophen.
On arrival to labor and delivery, she is postictal. Her blood
pressure at admission is 180/116 mm Hg, with 4+ proteinuria. Her fundal
height is 31 cm. After arrival, she has another tonic-clonic seizure
involving both the upper and lower extremities. An ultrasound shows a
fetus with an estimated fetal weight of 2000 g at the fifth percentile for
gestational age.
? What is the most likely diagnosis?
? What are the next management steps?
? What are the potential complications of the patient’s condition?