Preeclampsia/Eclampsia

Preeclampsia: HTN, proteinuria, and edema during pregnancy

Eclampsia: seizures during pregnancy

Note: PIH is HTN during pregnancy but without proteinuria

Clinical findings (preeclampsia)

• Onset: 20 weeks gestation (can continue 6 weeks postpartum)
• Neuro: hyperreflexia, clonus, HA, visual disturbances
• CV: SBP >140, DBP >90, edema, vasospasm
• GI/GU: RUQ/epigastric pain, nausea, vomiting; oliguria
• Severe preeclampsia: SBP >160 or DBP >110

EMT—basic/intermediate

• All hypertensive pregnant Pts should be considered high risk for eclampsia (seizures) until clinically proved otherwise
• Establish and manage ABCs per protocol
• Position mother on left side: relieves compression of IVC, enhances venous return and uteroplacental perfusion
• Minimize sensory stimulation (dim lights, gentle transport)
• Administer high-flow O₂, or manually ventilate as indicated
• Obtain finger-stick blood glucose level
• Transport to an appropriate facility for high-risk deliveries

Paramedic

• Start large-bore IV, titrate to SBP >90 mm Hg
• Assess edema, deep tendon reflexes, presence of clonus
• If condition deteriorates to eclampsia (maternal seizures):
• Magnesium sulfate: 1–4 g slow IV; or
• Lorazepam: 1–4 mg slow IV; or
• Diazepam: 5–10 mg slow IV