Managing Complications in Pregnancy and Childbirth: - IAWG

S-44 Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure- If the signs remain unchanged, keep the woman in thehospital. Continue the same management and monitor fetalgrowth by symphysis-fundal height;- If there are signs of growth restriction, consider earlydelivery. If not, continue hospitalization until term.• If urinary protein level increases, manage as severe pre-eclampsia(see below).Note: Symptoms and signs of pre-eclampsia do not completelydisappear until after pregnancy ends.GESTATION MORE THAN 37 COMPLETE WEEKSIf there are signs of fetal compromise, assess the cervix (page P-18) andexpedite delivery:• If the cervix is favourable (soft, thin, partly dilated), rupture themembranes with an amniotic hook or a Kocher clamp and inducelabour using oxytocin or prostaglandins (page P-17).• If the cervix is unfavourable (firm, thick, closed), ripen the cervixusing prostaglandins or a Foley catheter (page P-24) or deliver bycaesarean section (page P-43).SEVERE PRE-ECLAMPSIA AND ECLAMPSIASevere pre-eclampsia and eclampsia are managed similarly with theexception that delivery must occur within 12 hours of onset ofconvulsions in eclampsia. ALL cases of severe pre-eclampsia should bemanaged actively. Symptoms and signs of “impending eclampsia”(blurred vision, hyperreflexia) are unreliable and expectant managementis not recommended.MANAGEMENT DURING A CONVULSION• Give anticonvulsive drugs (page S-44).• Gather equipment (airway, suction, mask and bag, oxygen) andgive oxygen at 4–6 L per minute.• Protect the woman from injury but do not actively restrain her.• Place the woman on her left side to reduce risk of aspiration ofsecretions, vomit and blood.