Nursing Component Task
Nursing procedures & clinical learning

Midwifery (RM)

Management of Severe Pre-Eclampsia

Severe pre-eclampsia is an obstetric emergency with risk of seizure, stroke, pulmonary oedema, renal or liver injury, placental abruption, and fetal compromise. Management requires stabilization, seizure prevention, blood-pressure control, fluid caution, specialist care, and delivery planning.

Purpose

  • Prevent seizure, stroke, organ failure, and maternal death
  • Stabilize the mother and assess the fetus
  • Coordinate urgent definitive management and delivery

Indications

  • Severe hypertension or severe maternal symptoms
  • Neurological, renal, hepatic, respiratory, haematological, or fetal complications
  • Worsening pre-eclampsia despite initial management

Equipment

  • Emergency call and resuscitation equipment
  • Validated blood-pressure and continuous monitoring
  • Magnesium sulphate and antihypertensive medicines as prescribed
  • IV, blood, catheter, oxygen, seizure, and fluid-balance supplies
  • Fetal monitoring and theatre or referral resources

Preparation

  • Check emergency drugs, monitoring, oxygen, suction, airway, catheter, blood, theatre, and neonatal readiness.
  • Use current local severe pre-eclampsia protocol.

Procedure steps

  • Call for senior obstetric, anaesthetic, neonatal, and laboratory help and place the woman in a safe position.
  • Assess airway, breathing, circulation, consciousness, neurological signs, symptoms, and fetal status.
  • Establish IV access, take urgent blood tests, insert urinary catheter if ordered, and monitor output.
  • Administer prescribed magnesium sulphate for seizure prophylaxis or treatment and monitor respiratory rate, reflexes, consciousness, and urine output.
  • Administer prescribed rapid-acting antihypertensive treatment and repeat blood pressure at required intervals.
  • Restrict and balance fluids according to protocol and monitor for pulmonary oedema.
  • Assess fetal wellbeing and administer corticosteroids or other treatment when indicated by the authorized team.
  • Prepare for delivery or transfer once stabilized; do not delay life-saving care for non-essential investigations.
  • Provide calm explanations and maintain privacy and safety.
  • Document assessments, medicines, observations, response, communication, and definitive plan.

Precautions

  • Monitor for magnesium toxicity and have calcium gluconate or local antidote pathway available.
  • Avoid fluid overload and monitor respiratory status closely.
  • Treat seizures, pulmonary oedema, severe hypertension, stroke symptoms, or fetal compromise as emergencies.
  • Do not leave the woman alone.

Aftercare

  • Continue high-dependency monitoring through birth and postpartum because risk persists.
  • Arrange postnatal blood pressure, medicine, and mental-health follow-up.

Nursing considerations

  • Use one-to-one observation and closed-loop communication.
  • Reassess after every medicine and clinical change.

Patient education

  • Explain the seriousness, medicines, monitoring, and need for urgent birth planning when stable.
  • Report headache, visual change, breathing difficulty, pain, reduced urine, or worsening symptoms.

Documentation

  • Record severe features, blood pressure, neurological and fetal findings, medicines and times, fluid balance, urine, response, communication, and plan.
  • Document transfer and delivery decisions.

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

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