Managing Complications in Pregnancy and Childbirth: - IAWG

Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressureS-59- 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.MAINTENANCE DOSE• Give phenytoin 100 mg IV slowly over 2 minutes or by mouth every8 hours beginning at least 12 hours after the loading dose.FLUID BALANCE• Maintain a strict fluid balance chart and monitor the amount offluids administered and urine output to ensure that there is no fluidoverload. Assess clinical status regularly.Note: Women with severe malaria are prone to fluid overload.• If pulmonary oedema develops:- Prop the woman up;- Give oxygen at 4 L per minute by mask or nasal cannulae;- Give frusemide 40 mg IV as a single dose.• If urine output is poor (less than 30 mL per hour):- Measure serum creatinine;- Rehydrate with IV fluids (normal saline, Ringer’s lactate).• If urine output does not improve , give frusemide 40 mg IV as asingle dose and monitor urine output.• If urine output is still poor (less than 30 mL per hour over 4 hours)and the serum creatinine is more than 2.9 mg/dL, refer the womanto a tertiary care centre for management of renal failure.HYPOGLYCAEMIAHypoglycaemia is common and occurs at any time during the illness,especially after initiation of quinine therapy. There may be nosymptoms.• Monitor blood glucose levels using a stix test every 4 hours.