A 35 year old female is 39 weeks pregnant. Her pregnancy has been complicated by hypertension and proteinuria. Her blood pressure is 160/120 mm Hg. You are called to the labour ward when she suffers a generalised (“grand mal”) convulsion. Outline your overall plan of management.
Terminate the seizure
a. Diazepam 5-10mg or Mg 4g IV up to 8 g
Monitors / investigations
Management of Hypertension
(Other agents are acceptable – late in pregnancy – increasing trend to use
Treatment of convulsions
MgSO4 bolus followed by maintenance MgSO4
(Shown to be more effective than phenytoin or diazepam in preventing recurrent seizures)
Addition of Benzodiazepine / Barbiturate if recurrent seizures despite MgSO4
Planning for delivery
Brief period of resuscitation once seizures controlled
Post partum management
Continue anti-convulsants until patient improves (diuresis, fall in BP)
This question closely resembles Question 23 from the first paper of of 2011.
Also, that's not how you spell hydralazine.
Anyway, the management should look like this:
Heres an article by Baha Sibai, who came up with the Tennessee classification for the HELLP syndrome:
Sibai, Baha M. "Diagnosis, prevention, and management of eclampsia."Obstetrics & Gynecology 105.2 (2005): 402-410.