Obstetrical Emergencies

No patient weight set. Open Pediatric Weight, Age, Height, or Length Tape to enable dose calculations.

Magnesium toxicity — rescue protocol

Therapeutic Mg level for eclampsia prophylaxis: 4-8 mg/dL. Toxicity correlates with serum level — but treat the patient, not the number.

Symptoms / signs present
Calcium gluconate — rescue dose
1-2 g IV (10-20 mL of 10%)

Adult: 1 g (10 mL of 10%) over 5-10 min; repeat to 2 g if no improvement. Use 2 g for severe / arrest.

set wt
  • • Push slowly — rapid IV calcium → bradycardia/arrest
  • • Avoid same line as ceftriaxone (precipitation)
  • • Calcium chloride 1 g = ~3× elemental Ca vs gluconate (use only via central line if available)

TXA timing calculator (3-hr window)

0 min1 hr (best)3 hr (cutoff)
120 min remaining in window
Recommendation
GIVE 1 g IV NOW

Maximum mortality benefit when given within the first hour (CRASH-2/WOMAN trials).

Standard TXA dose
  • • 1 g IV over 10 min (over ~1 mL/min for trauma; faster acceptable in PPH)
  • • May repeat 1 g if bleeding continues after 30 min
  • • Pediatric: 15 mg/kg (max 1 g) over 10 min

Pregnancy Wheel / Dating Calculator

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