Managing Complications in Pregnancy and Childbirth: - IAWG

S-48 Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressureBOX S-4Diazepam schedules for severe pre-eclampsia and eclampsiaNote: Use diazepam only if magnesium sulfate is not available.Intravenous administrationLoading dose• Diazepam 10 mg IV slowly over 2 minutes.• If convulsions recur, repeat loading dose.Maintenance dose• Diazepam 40 mg in 500 mL IV fluids (normal saline or Ringer’s lactate)titrated to keep the woman sedated but rousable.• Maternal respiratory depression may occur when dose exceeds 30 mg in 1hour:Assist ventilation (mask and bag, anaesthesia apparatus, intubation), ifnecessary.Do not give more than 100 mg in 24 hours.Rectal administration• Give diazepam rectally when IV access is not possible. The loading dose is 20mg in a 10 mL syringe. Remove the needle, lubricate the barrel and insert thesyringe into the rectum to half its length. Discharge the contents and leave thesyringe in place, holding the buttocks together for 10 minutes to preventexpulsion of the drug. Alternatively, the drug may be instilled in the rectumthrough a catheter.• If convulsions are not controlled within 10 minutes, administer anadditional 10 mg per hour or more, depending on the size of the woman andher clinical response.ANTIHYPERTENSIVE DRUGSIf the diastolic pressure is 110 mm Hg or more, give antihypertensivedrugs. The goal is to keep the diastolic pressure between 90 mm Hg and100 mm Hg to prevent cerebral haemorrhage. Hydralazine is the drug ofchoice.• Give hydralazine 5 mg IV slowly every 5 minutes until bloodpressure is lowered. Repeat hourly as needed or give hydralazine12.5 mg IM every 2 hours as needed.• If hydralazine is not available, give:- labetolol 10 mg IV: