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Simulation Study Assessing Knowledge of Preeclampsia/Eclampsia Management in a Tertiary Referral Center
Abstract Number: S 19
Abstract Type: Original Research
Introduction: Preeclampsia/eclampsia is a leading cause of direct maternal deaths.1 ACOG guidelines (2011) detail key interventions and emphasize administration of antihypertensive medication in the setting of acute severe preeclampsia to reduce cerebral complications, and magnesium for seizure prophylaxis/treatment.2 The aim of this study was to assess the knowledge of labor and delivery staff at a tertiary referral center in the management of preeclampsia/eclampsia using simulation.
Methods: 13 multidisciplinary teams consisting of obstetricians, anesthesiologists and nurses participated in this IRB-exempt study. Each group encountered the same scenario that involved a preeclamptic parturient who progressed to eclampsia with a recurrent non-terminating seizure. Time points of key interventions were recorded. The participants were unaware of the scenario topic prior to the drill and that interventions were timed. 7/13 of the groups were randomized to have a cognitive aid available throughout the drill. Participants were made aware of the cognitive aid immediately prior to the drill, however the aid was not reviewed prior to the drill.
Results: Key interventions are outlined in the Table. 11/13 groups attempted to lower the blood pressure, however only 7/11 of the groups used the correct 1st-line antihypertensive medication (labetalol 20 mg IV or hydralazine 5-10 mg IV) per ACOG guidelines. All groups requested and administered the correct bolus dose of magnesium (4-6 g IV) following the onset of the first seizure. Only 2/13 groups took appropriate action to lower the blood pressure to a ‘safe range’ prior to induction of anesthesia and 4/13 anesthesiologists made drug modifications for induction of anesthesia and intubation. None of the 7 groups randomized to have a cognitive aid utilized it.
Discussion: Our results suggest excellent magnesium utilization, however the use of antihypertensive medication is not universally appreciated or compliant with current guidelines. The importance of blood pressure management to reduce maternal morbidity and mortality in the setting of preeclampsia needs to be emphasized during staff education. Interestingly, availability of a cognitive aid does not ensure its utilization in an emergency. This study suggests that for cognitive aids to be utilized and effective, it is essential that physicians and nurses are familiar with them prior to an event.
References: 1)BJOG 2011;118(Supp.1):1–203 2)Obstet Gynecol 2011;118:1465–8