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Dr.Niraj Mahajan
Dr.Niraj Mahajan
Dr.Niraj Mahajan



By AdminPosted On 05-Oct-2016

1. Eclamptic Seizure

Appropriate response to an initial eclamptic seizure include all of the following EXCEPT:

a) Attempt to abolish the seizure by administrating I.V. diazepam.

b) Maintain adequate Oxygenation.

c) Administer Mg sulphate to prevent recurrent convulsion

d) Prevent maternal injury.

e) Monitor the fetal heart rate.

Correct Answer: a) Attempt to abolish the seizure by administrating I.V. diazepam. Magnesium sulphate for women with eclampsia reduces the risk ratio of maternal death and of recurrence of seizures, compared with diazepam.

2. Eclampsia

Pregnant woman referred for eclampsia and develops seizure in front of you. The immediate management would be

a) Phenytoin

b) Diazepam

c) Airway patency

d) Magnesuim sulphate

e) Induction of labour

Correct Answer: c) Airway patency.

1) Ensure a patent airway by turning the woman onto her left side and by suctioning the mouth to clear any saliva, mucous, blood and/or vomitus. This prevents aspiration following an eclamptic seizure. Avoid vigorous suction as it may induce vomiting.

2) Administer 100% oxygen at 6-8 litres/minute via a Hudson face mask. Apply oxygen saturation monitoring as soon as possible. During the seizure hypoventilation and respiratory acidosis may occur.

3) Protect the woman from injury, do not restrain the woman, do not place tongue or airway guards into the mouth during the seizure.

Anticonvulsant drus never control the current seizure, it is given to prevent recurrent convulsion from occuring.

For this patient Magnessium Sulpate should be given after clearing airway and next step would be induction of labor.

3. Eclampsia Patient

Eclampsia patient referred to you within 2 hour, after receiving Inj. Diazepam 10 mg IV. What would be your next line of management?

a) Wait for 1 hr more and administer Inj. Magsulf full dose(14 gm)

b) Administer curtailed dose (2gm IV and 4 gm IM) of Inj. Magsulf directly at admission

c) Wait for 4 hrs to administer full dose (14 gm) of Inj. Magsulf

d) Continue with Diazepam therapy

e) Start Phenytoin therapy with 600mg loading dose

Correct Answer: b) Administer curtailed dose (2gm IV and 4 gm IM) of Inj. Magsulf directly at admission. This situation does not happen in western countries. That is the reason you wont find any article to this effect in the international literature. I had publication to this effect in the international literature. Most have answered correctly what I practice i.e. to give curtailed dose to reduce the additive effect of Diazepam or Phenargan.

4. Acute Renal Failure in Pregnancy

What is the most common cause of acute renal failure in pregnancy ?

a) Drug abuse.

b) SLE.

c) Pre-eclampsia and eclampsia.

d) Sickle cell disease.

e) Placenta previa.

Correct Answer: c) Pre-eclampsia and eclampsia. The prerenal causes are more common in the earlier stage of pregnancy due to hyperemesis gravidarum or acute tubular necrosis in the context of septic abortion. Most important causes of kidney injury in late pregnancy are preeclampsia and the associated disorders eclampsia and HELLP syndrome. Acute fatty liver of pregnancy, hemolytic uremic syndrome (HUS) and sepsis are other common causes in late pregnancy.

5. In Eclampsia : Which is true?

a) Caesarean section must be carried out in all cases

b) Hypotensive drugs should not be used

c) Urinary output is increased

d) Antidiuretic drugs are essential in all cases

e) Ergometrine should be avoided in the third stage of labor

Correct Answer: e) Ergometrine should be avoided in the third stage of labor. Ergometrine may enhance the blood pressure raising effect of vasoconstrictors. It stimulates contractions of uterine and vascular smooth muscle. Like other ergot alkaloids, ergometrine produces arterial vasoconstriction by stimulation of alpha-adrenergic and serotonin receptors and inhibition of endothelial-derived relaxation factor release. It is contraindicated in eclampsia, preeclampsia or a history of hypertension and in patients with peripheral vascular disease or heart disease.

6. Magnessium Sulfate

Likely contributory mechanism of the anticonvulsant action of Mg sulphate includes all the following EXCEPT:

a) Neuronal Ca-channel blockade.

b) Peripheral neuromuscular blockade.

c) Reversal of cerebral arterial vasoconstriction.

d) Inhibition of platelet aggregation.

e) Release of endothelial prostacyclin.

Correct Answer: None. MgSO4 has been shown to be an effective treatment option for the prevention of eclampsia. Its mechanism of action is likely multi-factorial, encompassing both vascular and neurological mechanisms. Being a calcium antagonist, its effect on vascular smooth muscle to promote relaxation and vasodilation may have a role in lowering total peripheral vascular resistance. In addition, MgSO4 may have an effect on the cerebral endothelium to limit vasogenic edema by decreasing stress fiber contraction and paracellular permeability via calcium-dependent second messenger systems such as MLC kinase. It may act as an anticonvulsant via neuronal calcium-channel blockade and antagonism of the glutamate N-methyl-D-aspartate (NMDA) receptor providing anticonvulsant activity by increasing the seizure threshold. It causes release of endothelial prostacyclin thereby inhibiting platelet aggregation. Magnesium sulfate reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction.

7. Magnessium Sulfate Toxicity

Early clinical evidence of magnessium sulfate toxicity would show:

a) Flushing

b) Diplopia

c) Decreased oxygen saturation

d) Loss of deep tendon reflexes

e) Decreased respiratory rate

Correct Answer: d) Loss of deep tendon reflexes. The first warning of impending toxicity in the mother is loss of the patellar reflex at plasma concentrations between 3.5 and 5 mmol/L. Respiratory paralysis occurs at 5 to 6.5 mmol/L. Cardiac conduction is altered at greater than 7.5 mmol/L, and cardiac arrest can be expected when concentrations of magnesium exceed 12.5 mmol/L.

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Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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