PEMBERIAN MGSO4 PADA IBU PEB

Summary

In this educational session, Umi, a midwife at Dr. H Kusnadi Bondowoso General Hospital, explains the administration of MgSO4 to pregnant women with severe preeclampsia. She covers the definition of preeclampsia, criteria for its diagnosis, and the necessary conditions for MgSO4 administration. Umi discusses the importance of monitoring maternal vital signs, the required doses, and the proper preparation for MgSO4, including dilution and the availability of calcium gluconate as an antidote for potential toxicity. The session emphasizes proper care protocols and practical advice for health workers in managing such cases.

Takeaways

• 😀 Pre-eclampsia is a condition in pregnant women after 20 weeks of pregnancy, characterized by high blood pressure and organ dysfunction.
• 😀 A diagnosis of pre-eclampsia can be made if blood pressure is above 140/90 mmHg, and/or there is protein in the urine or organ dysfunction like thrombocytopenia.
• 😀 Severe pre-eclampsia is defined when there are additional complications such as pulmonary edema, blurred vision, or pain in the upper abdomen.
• 😀 MgSO4 (Magnesium Sulfate) is used to treat severe pre-eclampsia, but certain conditions must be met before its administration.
• 😀 Prerequisites for administering MgSO4 include normal breathing (12–20 breaths per minute), positive patellar reflex, and normal urine production (30cc/hour or 100cc/4 hours).
• 😀 Calcium gluconate should be available in case of suspected MgSO4 toxicity, which could cause symptoms like difficulty breathing, lethargy, or a slow heart rate.
• 😀 MgSO4 comes in two concentrations: 40% (400 mg per 1cc) and 20% (200 mg per 1cc).
• 😀 It is important to monitor urine production and install a catheter during MgSO4 treatment, as the drug can cause oliguria (low urine output).
• 😀 The full dose for MgSO4 includes 4 grams intravenously and 5 grams intramuscularly, with 5 grams split between the right and left buttocks.
• 😀 To calculate the correct amount of MgSO4, the concentration must be adjusted using diluents like aquabides. For example, to administer a 4-gram dose intravenously, 10cc of the 40% solution must be diluted.
• 😀 For 20% MgSO4, the amount needed is higher: for 4 grams, 20cc is required, and for 5 grams, 25cc is necessary for intramuscular injection.

Q & A

What is preeclampsia, and how is it identified?

Preeclampsia is a condition in pregnancy after 20 weeks, characterized by high blood pressure and organ dysfunction. It can be identified if the mother's blood pressure exceeds 140/90 mmHg or if there is protein in the urine. Severe preeclampsia is diagnosed when additional symptoms like thrombocytopenia or pulmonary edema are present.

What are the main criteria for administering MgSO4 (Magnesium Sulfate) to pregnant women with severe preeclampsia?

The criteria for administering MgSO4 include normal respiratory rate (12-20 breaths per minute), positive patellar reflex, normal urine output (30 cc per hour or 100 cc per 4 hours), and the availability of calcium gluconate in case of MgSO4 toxicity.

Why is calcium gluconate necessary when administering MgSO4?

Calcium gluconate is an antidote for magnesium sulfate toxicity. It is used when symptoms of toxicity are observed, such as respiratory distress after MgSO4 administration.

What are the signs of MgSO4 toxicity, and what should be done if they occur?

Signs of MgSO4 toxicity include respiratory distress, shortness of breath, and other symptoms like dizziness or blurred vision. In such cases, calcium gluconate (1 gram) should be administered slowly through an intravenous line.

What are the two types of MgSO4 preparations available in Indonesia, and what are their differences?

In Indonesia, MgSO4 is available in two concentrations: 40% and 20%. The 40% concentration contains 400 mg of MgSO4 per 1 cc, while the 20% concentration contains 200 mg per 1 cc.

What should be done before administering MgSO4 to ensure accurate dosage?

Before administering MgSO4, a catheter should be placed to monitor urine output. Additionally, the concentration of MgSO4 must be checked, and if necessary, it should be diluted with water to maintain a concentration below 20%.

How is the correct dosage of MgSO4 calculated based on the available concentrations?

For a 40% concentration, 1 cc contains 400 mg, so for a 4-gram dose, 10 cc of MgSO4 should be taken and diluted with 10 cc of aquabides. For a 20% concentration, 1 cc contains 200 mg, so for a 4-gram dose, 20 cc should be used.

How is MgSO4 administered intramuscularly, and what precautions should be taken?

For intramuscular administration, 5 grams of MgSO4 should be injected into the right and left buttocks, 2.5 grams per site. Lidocaine should be added to reduce pain at the injection site.

What is the maintenance dose of MgSO4, and how is it administered?

The maintenance dose of MgSO4 is 1 gram per hour, and it is usually administered intravenously in hospital settings for continuous management of severe preeclampsia.

What role does MgSO4 play in the treatment of severe preeclampsia?

MgSO4 is used in the treatment of severe preeclampsia to prevent seizures (eclampsia) and to manage high blood pressure and organ dysfunction associated with the condition.