History:

 

• Past medical history
• Hypertension medications
• Prenatal care
• Prior pregnancies/births
• Gravida/para

 

Significant Findings:

 

• Vaginal bleeding
• Abdominal pain
• Hypertension
• Severe Headache
• Blurred vision
• Edema of hands and face
• Seizures
• Dizziness
• Confusion

 

Differential:

 

• Preeclampsia/eclampsia
• Placenta previa (placenta covers cervical opening)
• Placenta abruption (separation of placenta from uterine wall) Spontaneous abortion
• Ectopic pregnancy

 

Treatment:

 

• Oxygen

• Initiate IV

• 12-Lead EKG

 

Eclampsia:

 

Seizure or seizure-like activity ?

 

• Yes

 

• • Obtain BGL

• • 50% Dextrose (D50) 25 grams IV if needed

• • Midazolam (Versed) 10 mg/2 mL IM or 2.5 - 5 mg/0.5 - 1 mL IV

• • Magnesium Sulfate 4 grams/8 mL IV over 2-3 mins

 

Improvement ?

 

• No

 

• • Midazolam (Versed) 10 mg/2 mg/2 mL IM or 2.5 - 5 mg/0.5 - 1 mL IV

 

• Yes

 

• • Transport left lateral recumbent and notify receiving facility or contact Medical Control

 

Pre-Eclampsia: ?

 

• • Severe headache
  • Vision changes
  • RUQ pain
  • Hypertension
  • Edema of hands and feet
  • Sudden weight gain

 

• Yes

 

• • Continue to monitor

 

• • Transport left lateral recumbent and notify receiving facility or contact Medical Control

 

PEARLS:

 

• Typically seen after the 20th week of pregnancy.
• If seizure occurs prior to EMS arrival, give Magnesium Sulfate IV or IM. Withold Versed unless active seizures.

• If IV is unobtainable Magnesium Sulfate can be administered IM. Administer 4 grams / 8 mL in each dorsogluteal muscle (upper buttocks) for a total of 8 grams /16 mL (5 mL max each site). Multiple sites are necessary.

• Magnesium Sulfate can cause hypotension and respiratory depression; be prepared to aggressively manage the patient's airway and blood pressure.

• If Midazolam (Versed) is unavailable, consider Lorazepam (Ativan) 1-4 mg slow IV push.
• If Lorazepam (Ativan) is unavailable consider Diazepam (Valium) 1-10 mg IV

• In the setting of pregnancy, hypertension is defined as a systolic blood pressure greater than 160 or diastolic blood pressure greater than 90, or a relative increase of 30 systolic and 20 diastolic from the patient's normal (pre-pregnancy) blood pressure.

 

Placenta Abruptio

 

• usually occurs after 20 weeks gestation.

• S/S: painful 3rd trimester dark red vaginal bleeding, hypotension, tachycardia.

 

Placenta Previa

 

• can occur during 2nd and 3rd trimester.

• S/S: painless bright red vaginal bleeding, possible hypotension, tachycardia.

 

Physiologic changes during pregnancy:

 

• Tachycardia
• Tachypnea
• T wave changes in II, avF, avL.