Drug of choice for the management of eclampsia?

KPSC Staff Nurse - 2018

Obstetrics & Gynaecology

Easy

Appeared in: KPSC Staff Nurse - 2018

Explanation

Magnesium sulphate is the established drug of choice for managing eclampsia, which involves seizures in a pregnant woman with pre-eclampsia.
Large-scale clinical trials, such as the Eclampsia Trial Collaborative Group study (1995), have demonstrated its superiority in preventing recurrent seizures compared to both diazepam and phenytoin.
In that trial, the seizure recurrence rate was significantly lower with magnesium sulphate (9.7%) than with diazepam (17%) or phenytoin (28%).
Magnesium sulphate also reduces the risk of maternal mortality associated with eclampsia.
Its primary action is as a central nervous system depressant and anticonvulsant, not as an antihypertensive agent.

Option A: Diazepam is a second-line agent. While it can terminate a seizure, it is associated with a higher rate of seizure recurrence and causes more significant maternal and neonatal sedation compared to magnesium sulphate.
Option B: Epsolin (phenytoin) has been proven to be significantly less effective than magnesium sulphate for controlling eclamptic seizures. Clinical trials show a much higher failure rate (i.e., recurrent seizures).
Option D: Labetalol is an antihypertensive medication, not an anticonvulsant. Its purpose in eclampsia management is to control dangerously high blood pressure (typically greater than 160/110 mmHg) to prevent complications like stroke.

Clinical Relevance

Nursing practice connection: Knowing Pharmacological management of eclampsia helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
The primary nursing responsibility during magnesium sulphate administration is vigilant monitoring for toxicity. The acronym BURP (Blood pressure, Urine output, Respiratory rate, Patellar reflex) can be a helpful memory aid.
Loss of the patellar reflex is the earliest sign of magnesium toxicity. If this occurs, the nurse must stop the infusion and notify the physician immediately.
The antidote, calcium gluconate (1g of 10% solution), must always be available at the bedside for immediate administration in case of respiratory depression or arrest.

How to Approach the Question

First, identify the core clinical problem in the question: 'management of eclampsia'.
Recall that eclampsia is defined by the presence of seizures in a patient with pre-eclampsia.
The primary goal of management is to control and prevent these seizures.
Evaluate the options based on their primary mechanism of action. Differentiate between anticonvulsants and antihypertensives.
Recall from evidence-based guidelines that magnesium sulphate is the first-line anticonvulsant for eclampsia, superior to other agents.
Eliminate Labetalol as it treats hypertension, not seizures. Eliminate Diazepam and Epsolin (phenytoin) as they are second-line or less effective options.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 33-54