Table 1 Summary of criteria for optimal management of eclampsia and severe pre eclampsia at the labour ward, Muhimbili National Hospital
1 | The patient should be seen (by a resident/registrar) within 1 hour of arrival in eclampsia ward and thorough history documented including age, parity, gestational age, number of fits, time of first fit, source of admission, current pregnancy history and past medical history. |
2 | General clinical state (pulse, blood pressure, temperature etc.) on admission should be recorded by a senior admitting nurse including documentation of treatments received or came with and time it started and any treatment given as emergency before doctor’s order |
3 | A specialist or consultant obstetrician should be involved in planning the management by reviewing the resident’s plan within 1 hour |
4 | Anti-hypertensive treatment should be given to all patients with severe hypertension (diastolic blood pressure (BP) ≥110mmHg) |
5 | The treatment and prophylaxis of seizures should start immediately with magnesium sulphate and continue for 24 hours after last fit or delivery depending on which comes first (Dose as per eclampsia treatment protocol) |
6 | Respiratory rate and tendon reflexes should be monitored every half an hour when magnesium sulphate is used |
7 | Ante/intrapartum fluid balance chart should be maintained and input output recorded |
8 | Full blood count, renal, and liver function tests as well as urinalysis should be done at least once (Full blood picture, urine for albumin test, serum creatinine, urea, liver enzymes (Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST) and Alkaline phosphatise)) |
9 | The foetal heart rate should be monitored every 30 minutes in all undelivered patients |
10 | Steroid therapy should be given in all pregnancies where gestational age is 28–34 completed weeks in case of a need for prolongation of pregnancy |
11 | The patient should be delivered within 12h of the first convulsion |
12 | Monitoring BP and urine output should continue for at least 48 hours after delivery |