Preeclampsia || Obstetric Emergencies in EMS

Preeclampsia is a pregnancy complication that typically affects patients after the 20th week of pregnancy. It is characterized by hypertension that can wreak havoc on the liver and kidneys. Preeclampsia can be dangerous for both the mother and the baby. 

A major concern EMS providers should have with preeclamptic patients is the condition actually turning into eclampsia. The important distinguishing factor between the two is seizures. Eclampsia is an extremely dangerous medical emergency that in some serious cases can lead to a stroke and even death. 

As EMS providers, how do we spot preeclampsia and how do we manage it? An important mnemonic to remember is PRE. P - Proteinuria (protein in the urine) R- Rising BP (hypertension) E - Edema (swelling). Along with these symptoms, our patients may complain of intense headaches, vision changes, shortness of breath or even right upper quadrant abdominal pain.

Each department/EMS service is different in how they determine "treatable" preeclampsia. It can be a combination of the above symptoms and a blood greater than 140 systolic or greater than 90 diastolic (follow your protocols). The important thing to remember is that we want to prevent this condition from turning into eclampsia and this can take aggressive treatment. The EMS treatment (paramedic level) to be considered in serious cases of preeclampsia is magnesium sulfate (with supportive care).

Be aware that magnesium sulfate is a central nervous system depressant, it can cause hypotension and respiratory depression. If your patient is showing signs of a magnesium sulfate overdose, calcium chloride or calcium gluconate can be considered. 

*Interesting Side Note* Patients can actually suffer from preeclampsia up to 6 weeks postpartum.