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THE PREGNANT Patient• Fitting• Diastolic BP ≥ 110 and proteinuria: treat as pre-eclampsia• Diastolic BP ≥ 90 and headache, blurred vision or abdominal pain: treat asimminent eclampsia• Temperature ≥ 38ºC and headache, weakness or back pain• Difficulty breathingManagement:• If fitting or having difficulty breathing give 40% face mask oxygen. See below.• If BP < 90/60 give IV sodium chloride 0.9% rapidly until BP > 90/60.Recognise the pregnant patient needing urgent attention:• Swollen red calf• Vaginal bleeding• Decreased/no fetal movements• Preterm labour: painful contractions, 3 per 10 minutes < 37 weeks• Preterm prelabour rupture of membranes < 34 weeks• If temperature ≥ 38ºC give ceftriaxone 1 1g IM/IV, if unavailable amoxicillin 1g orally. If also a vaginal discharge in 2nd or 3rd trimester, give metronidazole 400mg orally as well.• Manage further according to problem and refer same day:Preterm labourDetermine duration of pregnancy.Preterm prelabourrupture of membranesSevere pre-eclampsia/imminent eclampsiaFitting< 26 weeks 26–33+ weeks ≥ 34 weeksRefer intoMOU.• Givebetamethasone12mg IM, recordtime given inreferral letter.• Give sodiumchloride 0.9%300ml IV.• Then givenifedipine 20mgoral, then 10mgafter 30 minutes,then 10mg4 hourly untiltransferred.• Refer same day.Allow labourto continue.• Confirm amnioticfluid leak with sterilespeculum, liquor isalkaline.• Avoid digital vaginalexamination.• Give betamethasone12mg IM, recordtime given in referralletter.• Refer same day.• Give sodium chloride0.9% 200ml slowly IV.• If diastolic BP still ≥ 110,give nifedipine 10mg toswallow (not chew).• Repeat BP after 30minutes. If diastolicBP still ≥ 110, repeatnifedipine 10mg.• If imminent eclampsia:give magnesium sulphateloading dose and infusionbefore referral.• Place patient in a lateral lying position.• Avoid placing anything in the mouth.• Give 40% facemask oxygen.• Check glucose. If < 3.5 or unable to measure,give 50ml of 50% dextrose IV.• Give dextrose 5% in sodium chloride 0.9% IVslowly (30 drops per minute).• Manage further according to gestation:≥ 20 weeks - up to 1 week postpartum:Patient has eclampsia.• Give magnesium sulphate 4g in 200ml sodium chloride 0.9% IVover 20 minutes and 5g IM in each buttock. Repeat 5g IM 4 hourly inalternate buttocks till transferred to hospital.• Insert urethral catheter.• Stop magnesium sulphate if urine output < 100ml in 4 hours orrespiratory rate < 16 breaths/minute.• Refer urgently.< 20weeks2Provide routine antenatal care to the pregnant patient not needing urgent attention 94.1Do not mix Ringer's lactate and IV ceftriaxone. Flush IV line with sodium chloride 0.9% before and after IV ceftriaxone.93