Recognizing severe preeclampsia early saves lives in Nigerian maternity wards where resources might be stretched. Severe preeclampsia is diagnosed when a pregnant woman has a blood pressure of 160/110 mmHg or higher on two occasions at least four hours apart, alongside significant proteinuria or vital organ dysfunction.
Impending eclampsia refers to the dangerous window just before a convulsion occurs. Midwives must watch for specific warning signs:
When an eclamptic seizure strikes or severe preeclampsia threatens collapse, rapid emergency stabilization is paramount. Call for help immediately; never leave the patient alone. Place the patient in the left lateral recovery position to prevent maternal aspiration of vomitus and relieve aortocaval compression, which maintains placental blood flow.
Keep the airway clear, but do not force objects or padded tongue depressors into the patient's mouth during a seizure, as this causes dental damage and airway obstruction. Administer high-flow oxygen via a face mask at 8 to 10 liters per minute to correct maternal and fetal hypoxia. Secure intravenous access urgently using large-bore cannulas to draw baseline blood investigations while preparing emergency medications.
Extremely high blood pressure increases the risk of maternal stroke and cerebral hemorrhage. Antihypertensive therapy is indicated when blood pressure persistently equals or exceeds 160/110 mmHg. The goal is a controlled reduction—not a sharp crash—to protect uteroplacental perfusion.
Commonly used first-line agents in Nigerian clinical practice include:
Magnesium sulfate is the undisputed gold standard for preventing and treating eclamptic seizures. Unlike standard anticonvulsants, it does not work primarily by depressing the central nervous system cortex in a general sedative fashion.
Instead, magnesium acts as a calcium antagonist and blocks N-methyl-D-aspartate (NMDA) receptors in the brain. By competing with calcium ions at cellular binding sites, it reduces cerebral vasospasm and stabilizes neuronal membranes. This unique action prevents the runaway electrical discharges that culminate in generalized tonic-clonic convulsions while preserving maternal consciousness.
Calculating and administering magnesium sulfate accurately requires strict adherence to standardized regimens, such as the Pritchard or Zuspan protocols, to avoid underdosing or fatal toxicity.
| Regimen Step | Route & Dose | Details |
|---|---|---|
| Loading Dose | 4g IV over 5-10 mins + 10g IM | Total of 14g given immediately to reach therapeutic levels. |
| Maintenance Dose | 5g IM every 4 hours | Administered in alternating buttocks to prevent abscess formation. |
Before giving any maintenance dose, the midwife must perform mandatory safety checks: verify the presence of patellar reflexes, confirm a respiratory rate of at least 16 breaths per minute, and check that urine output is at least 30 mL per hour over the preceding four hours.
Magnesium has a very narrow therapeutic window, meaning the blood level that stops seizures is close to the level that causes toxicity. Midwives must remain vigilant for the sequential loss of physiological parameters as serum levels rise.
Always keep calcium gluconate (10%, 10 mL) immediately accessible at the bedside. If toxicity signs appear, stop magnesium infusion immediately and slowly inject 1 gram (10 mL of 10%) of calcium gluconate intravenously over 3 minutes to competitively displace magnesium at the receptor sites.
Witnessing an eclamptic convulsion can be frightening, but the attending midwife must remain calm and methodical. Protect the patient from physical injury by padding hard bed rails and removing dangerous objects nearby. Do not attempt to restrain thrashing limbs violently, as this can cause bone fractures or muscle tears.
After the convulsion subsides, suction oral secretions gently if required, administer supplemental oxygen, and check vital signs. Document the exact start and stop time of the seizure, the character of the movements, and the patient's recovery status. Reassure family members calmly while maintaining a focused, therapeutic environment.
Medical management with magnesium sulfate and antihypertensives only stabilizes the mother temporarily; the definitive cure for preeclampsia and eclampsia is the delivery of the placenta. Once maternal stabilization is achieved, planning for delivery must commence without unnecessary delay.
Gestational age dictates the approach: if the pregnancy is at or beyond 37 weeks, delivery is immediate. For preterm cases below 34 weeks, corticosteroids are given for fetal lung maturity if stability permits, but maternal deterioration—such as uncontrolled blood pressure, renal failure, pulmonary edema, placental abruption, or non-reassuring fetal status—demands immediate delivery regardless of gestational age.