Managing Complications in Pregnancy and Childbirth: - IAWG

Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressureS-55• If convulsions continue (status epilepticus), infuse phenytoin 1 g(approximately 18 mg/kg body weight) in 50–100 mL normal salineover 30 minutes (final concentration not to exceed 10 mg per mL):Note: Only normal saline can be used to infuse phenytoin. Allother IV fluids will cause crystallization of phenytoin.- Flush IV line with normal saline before and after infusingphenytoin;- Do not infuse phenytoin at a rate exceeding 50 mg per minutedue to the risk of irregular heart beat, hypotension andrespiratory depression;- Complete administration within 1 hour of preparation.• If the woman is known to be epileptic, give her the same medicationthat she had been taking. Follow-up with her regularly and adjustthe dose of medication according to the response.• If the woman is known to be epileptic but cannot recall details ofher medication, give her phenytoin 100 mg by mouth three timesper day. Follow her up regularly and adjust the dose of medicationaccording to the clinical situation.• Folic acid deficiency may be caused by anticonvulsive drugs. Givefolic acid 600 mcg by mouth once daily along with antiepileptictreatment in pregnancy.• Phenytoin can cause neonatal deficiency of vitamin K-dependentclotting factors. This can be minimized by giving vitamin K 1 mgIM to the newborn.• Evaluation for underlying causes of convulsions is indicated ifconvulsions are of recent onset. This may be possible only at thetertiary care level.SEVERE/COMPLICATED MALARIASevere malaria in pregnancy may be misdiagnosed as eclampsia. If apregnant woman living in a malarial area has fever, headaches orconvulsions and malaria cannot be excluded, it is essential to treat thewoman for both malaria and eclampsia.