What is the drug of choice, specifically for the management of convulsions in eclampsia?

Appeared in: DSSSB -28 August 2019 (Shift-2)

Explanation

Magnesium sulphate is the internationally recognized drug of choice for both treating and preventing seizures in eclampsia, a life-threatening complication of pregnancy.
Large-scale clinical trials, such as the Magpie Trial and the Eclampsia Trial Collaborative Group study, have definitively proven its superiority over other anticonvulsants like diazepam and phenytoin.
It works by acting as a cerebral vasodilator and membrane stabilizer, reducing neuronal excitability without causing significant maternal or fetal sedation.
Compared to other agents, magnesium sulphate significantly reduces the risk of recurrent seizures and has been shown to lower maternal mortality rates.

Option A: Diazepam is considered a second-line agent and is significantly less effective than magnesium sulphate for eclamptic seizures.
Option B: Pethidine is an opioid analgesic used for pain relief.
Option D: Ampicillin is a penicillin-class antibiotic used to treat bacterial infections.

Clinical Relevance

Nursing practice connection: Knowing Pharmacological management of eclamptic seizures helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
The nurse's primary role is the safe administration of MgSO₄ and vigilant monitoring for signs of toxicity, which can progress rapidly to respiratory and cardiac arrest.
Before administering any maintenance dose, the nurse MUST assess for: presence of patellar reflex, a respiratory rate greater than 12 breaths/min, and a urine output of at least 100 mL in the past 4 hours.
The antidote, 10% Calcium Gluconate (10 mL IV over 10 minutes), must be immediately available at the bedside for emergency reversal of magnesium toxicity.

How to Approach the Question

First, identify the core clinical condition presented in the question: 'convulsions in eclampsia'. This is a life-threatening obstetric emergency.
Next, recall the first-line, evidence-based treatment for this specific condition. Nursing education heavily emphasizes the management of hypertensive disorders of pregnancy.
Evaluate the given options based on their drug class and primary mechanism of action.
Magnesium sulphate is the primary anticonvulsant for eclampsia. Diazepam is also an anticonvulsant but is second-line. Pethidine is an opioid analgesic. Ampicillin is an antibiotic.
Based on established guidelines and evidence of superior efficacy and safety, select the option that is the undisputed drug of choice for managing eclamptic seizures.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 33-54

Practise the full DSSSB -28 August 2019 (Shift-2)

Attempt every question from this paper in a timed mock, then review the full solution for each one.