PRE-ECLAMPSIA AND ECLAMPSIA

 

The decision to deliver should be made once the woman is stable and with appropriate senior personnel present. If the fetus is less than 34 weeks of gestation and delivery can be deferred, corticosteroids should be given, although after 24 hours the benefits of conservative management should be reassessed. Conservative management at very early gestations may improve the perinatal outcome but must be carefully balanced with maternal wellbeing.

The mode of delivery should be determined after considering the presentation of the fetus and the fetal condition, together with the likelihood of success of induction of labour after assessment of the cervix. The third stage should be managed with 5 units intramuscular Syntocinon? (Alliance) or 5 units intravenous Syntocinon given slowly. Ergometrine or Syntometrine? (Alliance) should not be given for prevention of haemorrhage, as this can further increase the blood pressure.

The delivery should be well planned, done on the best day, performed in the best place, by the best route and with the best support team. A few hours? delay in delivery may be helpful if it allows the neonatal unit to be more organised or to transfer a mother to a place where a cot is available. This assumes the mother is stable before delivery and prior to transfer. If the gestation is greater than 34 weeks, delivery after stabilisation is recommended. If less than 34 weeks and the pregnancy can be prolonged in excess of 24 hours, steroids help to reduce fetal respiratory mortality.⁰⁷⁰¹ Prolonging the pregnancy at very early gestations may improve the outcome for the premature infant but can only be considered if the mother remains stable.^{9401, 0003, 0401} 

In all situations, a carefully planned delivery suiting all professionals is appropriate. Vaginal delivery is generally preferable but, if gestation is below 32 weeks, caesarean section is more likely as the success of induction is reduced. After 34 weeks with a cephalic presentation, vaginal delivery should be considered. The consultant obstetrician should discuss the mode of delivery with the mother. Vaginal prostaglandins will increase the chance of success. Anti-hypertensive treatment should be continued throughout assessment and labour.