Once your blood pressure is stable, you are not having seizures, and you are well oxygenated, your doctor begins the delivery process-either by induction (when drugs are given to stimulate labor) or by caesarean section (C-section). During labor induction or caesarean section, a special catheter is inserted into your bladder so your urine can be measured hourly.

Which delivery method is used depends on several factors:

 

  • your condition;
  • your baby's condition;
  • how far along your pregnancy is;
  • whether you are in labor; and
  • the condition of your cervix (how soft, thin, and dilated it is).

 

If you are more than 30 weeks into your pregnancy, you will likely deliver vaginally. Medication, such as oxytocin (Pitocin) and dinoprostone (Cervidil), is used to stimulate contractions or to soften and shorten your cervix. If your baby is in distress, caesarean section is necessary.

If you are less than 30 weeks into your pregnancy and must deliver due to severe preeclampsia and eclampsia, caesarean section may be necessary since your cervix is not dilated enough and may not respond to oxytocin or other medications. In addition, your baby may not be able to withstand the labor process.

Management of Preeclampsia and Eclampsia During Delivery

 

  • Oxytocin, a hormone produced naturally in the body which stimulates uterine contractions, is often used to start and/or augment labor. Cervical ripening agents (substances which soften, thin, and initially dilate the cervix) such as dinoprostone or prostaglandin E2 (for example, Cervidil or Prepidil) may also be used to stimulate labor.
  • To prevent eclamptic seizures and control your blood pressure, you are given magnesium sulfate, intravenously, during labor and delivery.
  • Intravenous magnesium sulfate commonly causes flushing, sweating, and warmth usually when initially infused. Other common side effects include nausea, vomiting, headaches, and weakness. Your respiratory rate and knee reflexes are checked carefully to monitor your blood magnesium levels. Loss of knee reflexes is the first sign of hypermagnesemia (elevated magnesium levels in the blood). If not controlled, hypermagnesemia can lead to respiratory paralysis and cardiac arrest, which rarely occur with close monitoring. Calcium gluconate is used to decrease excessive blood levels of magnesium.
  • Your fluid levels are also closely monitored to make sure you do not develop edema (fluid) of the lungs-a rare but serious side effect of magnesium therapy.
  • Local anesthesia, epidural anesthesia, or intramuscular or intravenous narcotic analgesics can control pain during labor and delivery. Women with low platelet counts due to preeclampsia may not be able to have an epidural. Pain during labor and delivery must be controlled by other means.
  • If caesarean section is required, you may require a platelet transfusion, depending on your platelet counts. You may also need other blood products, depending on clinical and laboratory findings.