Authors (including presenting author) :
Chan YYF(1), So PL(2), Ng P(1), Lau CL(1)
Affiliation :
(1) Department of Accident and Emergency, Tuen Mun Hospital (2) Department of Obstetrics and Gynaecology, Tuen Mun Hospital
Introduction :
Severe pre-eclampsia and eclampsia are uncommon but potentially fatal obstetric emergencies. Despite advances in early recognition and treatment, eclampsia remains a common cause of maternal morbidity and mortality. The management of pregnant ladies presenting to the emergency department with severe pre-eclampsia and eclampsia is complicated and requires collaboration of various specialists. Without a well-organized pre-set algorithm and workflow, it is difficult to achieve standardization and efficient management of this critical condition.
Objectives :
To conduct a service improvement program to setup standardized management protocol and logistic workflow when an eligible pregnant lady attends an Accident and Emergency department of New Territories West Cluster.
Methodology :
A working group was formed of emergency physicians, obstetricians, paediatricians and intensivists. A multidisciplinary protocol with workflow was established. When pregnant ladies present with eclampsia or severe pre-eclampsia with signs and symptoms of impeding fit (such as headache, epigastric pain, etc.), they will be triaged to the resuscitation room with eclampsia call activated. Notification will be delivered to on-duty senior obstetrician, intensivist, paediatrician, in addition to labor ward, neonatal intensive care unit and blood bank. The patients will be managed with a standard protocol by the conjoint resuscitation team, including blood pressure control, seizure treatment or prophylaxis, assessment and monitoring of maternal and fetal condition as well as preparation for delivery. Department of Radiology and Neurosurgery will be involved in the caring process if there is suspected maternal intracranial complications requiring neuroimaging and neuro-intervention.
Result & Outcome :
Since 8 July 2010, we have adopted the protocol which has been updated to further streamline the caring process. A series of training and drill have been conducted on commencement of protocol, and regularly refreshed throughout the years for staff familiarization. From 8 July 2010 to 25 November 2019, 9 eclampsia calls had been activated and patients were conjointly managed by the multidisciplinary team. There has been no maternal mortality though there were still fetal and maternal morbidities with this critical condition. A standardized protocol with interdepartmental collaboration has been implemented to streamline the multidisciplinary care for patients with severe pre-eclampsia and eclampsia, targeting to reduce morbidity and mortality.
