Another serious complication of preeclampsia is development of seizures or coma. This is known as eclampsia. Eclampsia occurs in approximately 0.2% of pregnancies and

Box 21-7 Magnesium Sulfate Protocol for Preterm Labor

1. Continuous electronic fetal and contraction monitoring.

2. Patient in lateral recumbent position.

3. Nothing by mouth initially; then clear liquids if muscle tone adequate to prevent aspiration.

4. Intravenous fluids begun with lactated Ringer's 5% dextrose solution.

5. Four grams (range, 2-6) of MgSO4^7H2O in 500 mL of 5% dextrose administered over 15 minutes as loading dose.

6. Continuous infusion of 1 to 3 g/hr of MgSO4^7H2O after initial load.

7. Calcium gluconate readily available.

8. Accurate intake and output.

9. Frequent assessment of deep tendon reflexes.

10. Frequent examination of lungs for early signs of pulmonary edema.

11. Plasma magnesium levels monitored as clinically indicated.

12. Continue protocol for 24 hours. Change to oral beta-adrenergic agent if needed.

terminates 1 in 1000 pregnancies. The seizures and mental status changes of eclampsia are thought to result from hypertensive encephalopathy. Perinatal mortality is 2.0% to 8.6% (Sibai et al., 1981). Maternal mortality is less than 2%, with intracranial hemorrhage the major cause.

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