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    MOET Algorithm

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    Ali Alison
    This document provides an algorithm for treating pre-eclampsia/eclampsia that begins with placing the patient in a semi-prone position, calling for help from obstetric and anesthesia specialists, and informing consultants. It then outlines steps to protect the airway, control seizures with magnesium sulfate, control hypertension with drugs like hydralazine and labetalol, deliver the baby if postpartum, and closely monitor vital signs and urine output.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    MOET Algorithm

    Uploaded by

    Ali Alison
    173 views1 page
    This document provides an algorithm for treating pre-eclampsia/eclampsia that begins with placing the patient in a semi-prone position, calling for help from obstetric and anesthesia specialists, and informing consultants. It then outlines steps to protect the airway, control seizures with magnesium sulfate, control hypertension with drugs like hydralazine and labetalol, deliver the baby if postpartum, and closely monitor vital signs and urine output.

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    This document provides an algorithm for treating pre-eclampsia/eclampsia that begins with placing the patient in a semi-prone position, calling for help from obstetric and anesthesia specialists, and informing consultants. It then outlines steps to protect the airway, control seizures with magnesium sulfate, control hypertension with drugs like hydralazine and labetalol, deliver the baby if postpartum, and closely monitor vital signs and urine output.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    173 views1 page

    MOET Algorithm

    Uploaded by

    Ali Alison
    This document provides an algorithm for treating pre-eclampsia/eclampsia that begins with placing the patient in a semi-prone position, calling for help from obstetric and anesthesia specialists, and informing consultants. It then outlines steps to protect the airway, control seizures with magnesium sulfate, control hypertension with drugs like hydralazine and labetalol, deliver the baby if postpartum, and closely monitor vital signs and urine output.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    3013 MOET (new edition)

    15/2/07

    9:25 AM

    Page 150

    Algorithm 16.1 Pre-eclampsia/eclampsia

    Place in semi-prone position


    Call for HELP duty obstetric and
    anaesthetic SpRs; senior midwife
    Inform consultants obstetrician and
    anaesthetist

    Do not leave
    patient alone

    Airway
    Assess
    Protect airway
    Ventilate as required
    Loading dose MgSO4:
    4 g MgSO4 in 20% solution IV over
    1015 minutes. Add 8 ml of 50%
    MgSO4 solution to 12 ml
    physiological saline
    Maintenance dose MgSO4: 1 g per
    hour infusion. Add 25 g MgSO4
    (50 ml) to 250 ml physiological saline
    1 g MgSO4 = 12 ml per hour IV
    If seizures continue or recur: MgSO4
    2 g 70 kg; 4 g 70 kg IV as per
    loading dose over 510 minutes. If this
    fails: diazepam 10 ml IV or
    thiopentone 50 mg IV paralyse and
    intubate
    Monitor: Hourly urine output,
    respiratory rate, O2 saturation &
    patellar reflexes every 10 minutes for
    first 2 hours and then every 30
    minutes
    Check serum magnesium if toxicity is
    suspected on clinical grounds
    Stop infusion: Check magnesium
    levels and review management with
    consultant if:
    Urine output < 100 ml in 4 hours
    or if Patellar reflexes are absent
    or if Respiratory rate < 16/minute
    or if Oxygen saturation < 90%
    Always get suppression of reflexes
    before respiratory depression
    Antidote: 10% calcium gluconate
    10 ml IV over 10 minutes
    OBSERVATIONS
    Pulse oximeter
    BP
    Respirations
    Temperature
    ECG
    Test urine for protein
    Hourly urine output
    Fluid balance charts
    FHR monitor continuously

    150

    Breathing

    Circulation

    Control seizures

    Control
    hypertension

    Assess
    Maintain patency
    Apply oxygen
    Evaluate pulse and BP
    If absent, initiate CPR and call the
    arrest team
    Secure IV access as soon as safely
    possible
    Treat hypertension if systolic BP
    > 170 mmHg or diastolic BP
    > 110 mmHg or MAP >125 mmHg
    Aim to reduce BP to around
    130140/90100 mmHg Beware
    maternal hypotension and FHR
    abnormalities monitor FHR with
    continuous CTG
    HYDRALAZINE 10 mg IV slowly
    Repeated doses of HYDRALAZINE
    5 mg IV 20 minutes apart may be
    given if necessary
    Close liaison with anaesthetists: may
    require plasma expansion
    LABETALOL 50 mg IV slowly if BP
    still uncontrolled
    If necessary repeat after 20 minutes or
    start IV infusion: 200 mg in 200 ml
    physiological saline at 40 mg/hour,
    increasing dose at half-hourly
    intervals as required to a maximum of
    160 mg/hour

    If not
    postpartum . . .
    Deliver

    INVESTIGATIONS
    FBC & platelets
    U&Es
    Urate
    LFT
    Coagulation screen
    Group & hold serum
    MSSU
    24-hour urine
    collections for:
    total protein &
    creatinine clearance
    catecholamines

    The continuation of pregnancy is not


    an option if eclampsia occurs
    STABILISE THE MOTHER BEFORE
    DELIVERY
    DELIVERY
    IS A TEAM EFFORT

    involving obstetricians, midwives,


    anaesthetists and paediatricians
    Ergometrine should not be used in
    severe pre-eclampsia and eclampsia
    Consider prophylaxis against
    thromboembolism
    Maintain vigilance as the majority of
    eclamptic seizures occur after
    delivery

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