Midwives Leading The Way with Quality Care



Midwives Leading The Way
with Quality Care


Eclampsia remains to be among the two top main causes of direct maternal death and disability
in the Philippines. Eclampsia is defined as new onset of grand mal seizure activity and/or
unexplained coma during or after the 20th week of gestation or postpartum in a woman with
signs or symptoms of preeclampsia. However, eclampsia can occur even in the absence of
hypertension with proteinuria based on a study in the UK. Similarly, hypertension was absent in
some cases of eclampsia in a review done in the United States.
Most cases of eclampsia presents in the third trimester of pregnancy, with about 80% of
eclamptic seizures occuring intrapartum or within the first 48 hours following delivery. Early
detection of preeclampsia is important to identify its clinical manifestations like hypertension
and proteinuria and even some coexisting systematic abnormalities involving the kidneys, liver
or blood. The fetal manifestations of preeclampsia are fetal growth restriction, reduced amniotic
fluid, and abnormal fetal oxygenation.
Delivery of the fetus is the only cure for severe preeclampsia. Magnesium sulfate (MgSO4) for
seizure prophylaxis, antihypertensive management, induction of labor or cesarean section are
treatment options. Although delivery is appropriate for the mother, it may not be optimal for
the premature fetus. Antenatal corticosteroid injection given to the mother promotes lung
maturity of the preterm fetus.
In the Philippines the use of MgS04 is the mainstay in the treatment of eclamptic convulsion and
for seizure prophylaxis for severe preeclampsia. Injection of a loading dose of MgSO4 is among
the signal functions of Basic Emergency Obstetrics and Newborn Care (BEmONC) for those
practicing in areas remote from the hospital. The use of this life saving drug by midwives is
guided by a Philippine Department of Health Administrative Order (DOH A.O. No. 0020-2015).
However, the DOH A.O. specifies that the drug should be given by a midwife who is trained on
its use, the presence of an obstetrical emergency that warrants it and that there is no doctor.
Because the Midwifery Act of 1992 regulates midwifery practice that focuses on normal
pregnancy, labor and childbirth, a standing order by the back-up doctor in a health facility is
required. MgSO4 injected to the mother is also known to provide neuroprotection to the
newborn baby.

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