Management of eclampsia

Mrs AB was admitted in the 34th week of pregnancy with eclampsia. Prompt parenteral (intravenous and intramuscular) administration of magnesium sulfate arrested the convulsions and prevented additional seizures. Because of a dangerously elevated blood pressure, intravenous hydralazine was administered to reduce the blood pressure. Unfortunately, the hydralazine was given more frequently than recommended, and the blood pressure was decreased rapidly and too far. This resulted in the development of a serious fetal bradycardia secondary to reduced uteroplacental perfusion. Fortunately, the blood pressure spontaneously recovered as did the fetus. Three hours after admission, Mrs AB was awake and alert. Her fetus had also recovered from the effects of the convulsions and the treatment with hydralazine. Mrs AB's laboratory values had all been reported by this time, and her intravenous intake and urinary output were well regulated. Importantly, because of the presence of significant hemoconcentration (hematocrit at 32 weeks' was 36 and at 34 weeks', 44), a careful search for pulmonary edema was made. Additionally, fluid administration was conservative in order not to produce pulmonary edema. At this point, an induction of labor was commenced. The induction of labor was rapidly successful, and Mrs AB delivered a small but vigorous male infant who subsequently did well. Mrs AB was monitored hourly for the first 12 hours postpartum to ensure adequate blood pressure control and to prevent pulmonary edema. Her subsequent puerperal course was without adverse incident. She diuresed massively, and her blood pressure rapidly returned to normal.