B/P and Seizures

Mr Midwife, BSN, RN · Mar 31, 2014

At 170/110 I'd be frogmarching the Drs to the bedside to start an IV labetalol infusion.

Has anyone sat down and had a frank talk with her about the risks to her and baby and with a BP that high some damage will have been done.

Katie71275 · Mar 31, 2014

At the point where hydralazine and labetalol aren't working, we give Mag. I've had a pt seize on me once before and it was the scariest thing that had ever happened to me. Her BP was slightly elevated but not in the "danger zone". You can never guess when a pt may seize(different patients have different seizure thresholds).

NurseNora, BSN, RN · Mar 31, 2014

A woman with pre eclampsia can seize at any blood pressure. With the kind of pressures your patient was running, I'd be worried about a stroke or an abruption. Labetolal drips usually require continuous cardiac monitoring, so in my hospital we use doses of IV hydrolozine tilt rated to the blood pressure. It sounds like this patient would have been a good candidate for transfer to a Level 3 facility, or at least a call from the provider with the nearest Perinatologist. This is the kind of case where I have used the Chain of Command in the past because I have not been comfortable with my patients care.

lovemyjoblandd · Apr 1, 2014

Those are some dangerous BPs. As said before, you never know at what point a patient may sieze because everyone is different. With BPs like that our docs would have already started mag and would have really pushed for delivery. What gestation was she? I would be questioning the management of this patient.

caregiver1977 · Apr 4, 2014

My b/p was 220/115 at my prenatal appointment and I didn't even know anything was wrong!! I just thought I was a little swollen. I had been to work that day. I intended to go to the appointment, and go back to work!! Needless to say, I was immediately transferred to the maternity ward for mag-sulfate and an induction.

Never came close to a seizure, but that is just my personal experience...

lovemyjoblandd · Apr 4, 2014

My b/p was 220/115 at my prenatal appointment and I didn't even know anything was wrong!! I just thought I was a little swollen. I had been to work that day. I intended to go to the appointment, and go back to work!! Needless to say, I was immediately transferred to the maternity ward for mag-sulfate and an induction.
Never came close to a seizure, but that is just my personal experience...

Oh, i bet you were much closer to a seizure than you were aware of, not to mention abruption... Glad you had an appt that day. We had a lady come in with pressures like that and ended up blind due to retinal detachment. Seizures are just one of the many dangers to a mother and fetus with increased BPs.

Katie71275 · Apr 7, 2014

I agree, you were much closer to a seizure than you think. They can seemingly come out of nowhere.

SanDiegoCaliRN · Apr 9, 2014

My b/p was 220/115 at my prenatal appointment and I didn't even know anything was wrong!! I just thought I was a little swollen. I had been to work that day. I intended to go to the appointment and go back to work!! Needless to say, I was immediately transferred to the maternity ward for mag-sulfate and an induction. Never came close to a seizure, but that is just my personal experience...[/quote']
Caregiver, thank goodness you had an appt that day, didn't cancel and had good prenatal care. That's a frightening BP for sure

caregiver1977 · Apr 14, 2014

Caregiver, thank goodness you had an appt that day, didn't cancel and had good prenatal care. That's a frightening BP for sure

You are right, and the people who have said that I was probably closer than what I thought to a seizure. I really should not have waited until Monday to go to the doctor; I should have gone to the ER. I didn't know better (then).

MKS8806 · Apr 24, 2014

Typically, when you are starting Mag for seizure prophylaxis, you need to be delivered. At our facility, we control BPs, with PO antihypertensive meds and IVP meds as needed. Once the pressure can no longer be controlled with that or their labs show otherwise, we mag them and deliver.