**1.5.1 Fluid and electrolyte balance (Maynard et al, 2010)**

Timely recognition of the events and adequate replenishment of the fluid volume is essential to prevent more dreaded complication of acute tubular necrosis (ATN). Eventually when AKI ensues management depends on the underlying cause of renal dysfunction. To avoid/ correct hypovolaemia and ascertain fluid balance is important at every stage. Where bleeding is the cause of hypovolaemia, measures to stop bleeding should precede all other procedures, this may necessitate termination of pregnancy, preterm delivery of the foetus and blood transfusion. Efforts should be made not to incite further insult by avoiding or minimising the use of nephrotoxic agents including radio-contrast dyes and various drugs as much as possible. If they have to be used; adjustment of the dose will be required. Equal attention has to be paid to ensure adequate electrolyte balance. Of all potassium requires regular monitoring. Hyperkalaemia demands urgent medical management and if persistent may be an indication for renal replacement therapy.

#### **1.5.2 Appropriate management of sepsis**

When infection coexists; use of appropriate antibiotics empirically is justified. Ensuring the safety of antibiotics during pregnancy is of utmost importance. Initial choice of antibiotics may vary according to the hospital protocol and prevalence of antibiotic resistance for the suspected organism. Antibiotic spectrum will often have to be broadened according to the severity of infection.

#### **1.5.3 Management of preeclampsia/eclampsia/HELLP syndrome**

Management of these syndromes is usually supportive and revolves around blood pressure control, use of magnesium sulphate to prevent seizures and timing of delivery. There are various guidelines proposed by different obstetric societies around the globe in regards to management. Of interest however are the emerging concepts on its long term cardiovascular and renal consequences (Mc Donald et al, 2008). Similarly acute fatty liver of pregnancy (AFLP) also demands supportive care and prompt delivery. Thrombotic thrombocytopenic purpura; which creates a diagnostic dilemma together with HELLP and AFLP is managed using plasma exchange. Studies have shown significant improvement in maternal mortality rates since its introduction (Martin et al, 2008).
