Managing Complications in Pregnancy and Childbirth: - IAWG

Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressureS-49- If response is inadequate (diastolic blood pressureremains above 110 mm Hg) after 10 minutes, give labetolol20 mg IV;- Increase the dose to 40 mg and then 80 mg if satisfactoryresponse is not obtained after 10 minutes of each dose;- OR nifedipine 5 mg under the tongue:- If response is inadequate (diastolic pressure remains above110 mm Hg) after 10 minutes, give an additional 5 mg under thetongue.Note: There is concern regarding a possibility for an interactionwith magnesium sulfate that can lead to hypotension.DELIVERYDelivery should take place as soon as the woman’s condition hasstabilized. Delaying delivery to increase fetal maturity will risk the livesof both the woman and the fetus. Delivery should occur regardless ofthe gestational age.In severe pre-eclampsia, delivery should occur within 24 hoursof the onset of symptoms. In eclampsia, delivery should occurwithin 12 hours of the onset of convulsions.• Assess the cervix (page P-18).• 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 vaginal delivery is not anticipated within 12 hours (for eclampsia)or 24 hours (for severe pre-eclampsia), deliver by caesarean section(page P-43).• If there are fetal heart rate abnormalities (less than 100 or morethan 180 beats per minute), deliver by caesarean section (page P-43).• If the cervix is unfavourable (firm, thick, closed) and the fetus isalive , deliver by caesarean section (page P-43).• If safe anaesthesia is not available for caesarean section or if thefetus is dead or too premature for survival:- Aim for vaginal delivery;