8. DRUG THERAPY FOR PPH
Misoprostol 1000ugm use by rectum
Tranexamic acid 1g/ml IV at 1ml per minute(administered over 10minutes)
Second dose of 1g IV if bleeding continues after 30minutes.
19. Management protocol for Eclampsia
• Management (carried out by a team):
Turn the patient on her side
Insure clear airway(section,mouth,gag)
Maintain IV access.
Stop fits mag.sul,diazepam
Control Bp (hydralazine,Labetalol)
Intake and output chart
Investigation(urine,FBC, RFT, LFT, clotting profile, cross match)
Monitor patient and her fetus
After stabilization (Bp controlled, no convulsions, hypoxia controlled)
deliver
20. . Loading dose
Give MgSO4, 4g+ 20ml NS or sterile
water I.V over 5-20 minutes Give 10g
(i.e. 20ml of 50% solution) 5g in
each buttock as deep I.M wih1ml
of 2% lignocaine in the same
syringe
INTRAMUSCULAR REGIMEN
Maintenance dose
MgSO4 5 g (i.e. 10ml of 50%
solution) + 1 ml lignocaine 2%, 4
hourly in alternate buttocks.
Ringer lactate or normal saline 30
drops/min. or 1 litre in 6-8 hrs.
Maternal glucocorticoid therapy
at 24-34 wk for foetal lung
maturation
Expedited delivery?
no?< 23 weeks: counseling for termination
of pregnancy
23-32 weeks: steroids,
antihypertensive medications, daily
maternal and fetal evaluation, delivery
at 34 weeks
32-33 weeks: amniocentesis immature
fluid steroids, delivery in 48 hours
N.P Hemolysis
o abnormal peripheral smear
o lactate dehydrogenase > 600 U/L
Elevated liver enzymes
o serum aspartate aminotransferase > 70 U/L
o lactate dehydrogenase > 600 U/L
low platelets
o platelet count < 100,000/mm3
Blood Should be sent for :
• Serum electrolytes
• Liver function tests
• Full Blood count
• Clotting test
• Group and save serum
• Renal function tests / urine acid test0
Management protocol for Eclampsia
21. Eclampsia - anticonvulsant therapy
Diazepam useful for status seizures mechanism of action facilitate the
binding of GABA to its receptor benzodiazepine receptors dosage - 10
mg at a rate of 5 mg per min may be repeated at 10 to 15 minute
intervals
