Learning Objectives
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Recognize the presentation of eclampsia.
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Describe management priorities for a patient with eclampsia.
Eclampsia is defined as new-onset, generalized, tonic-clonic seizures or coma in a patient with preeclampsia. It is one of the several clinical manifestations of severe preeclampsia. Preeclampsia/eclampsia constitutes a common cause of maternal morbidity and mortality ( Fig. 20.1 ) .
Risk Factors
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Primiparity
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Personal or family history of preeclampsia or eclampsia
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Chronic hypertension
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Chronic renal disease
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History of thrombophilia
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Multifetal gestation
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In vitro fertilization
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Diabetes mellitus
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Obesity
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System lupus erythematosus
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Advanced maternal age
Diagnosis
Eclampsia is defined by new-onset grand mal seizures in a patient with preeclampsia. Diagnostic criteria for preeclampsia are as follows:
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Hypertension (BP greater than or equal to 140/90 on two occasions at least 4 hours apart) AND
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Proteinuria (more than 300 mg protein in 24-hour collection or protein:creatinine ratio greater than or equal to 0.3)
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In the absence of proteinuria, preeclampsia can still be diagnosed if there is new-onset hypertension and any one or more of the following:
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Platelet count less than 100 K/μL
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Serum creatinine greater than 1.1 mg/dL or twice baseline (in the absence of other renal disease)
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Liver transaminases elevated to twice normal
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Pulmonary edema
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Cerebral or visual symptoms
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Management
Supportive Care
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Most eclamptic seizures are self-limited
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Priority is protecting the mother’s airway, securing airway patency, and preventing recurrent seizures ( Fig. 20.2 )
Fig. 20.2 Supportive care during eclamptic seizure. Priority should be given to protecting patient and her airway during seizure and initiating magnesium sulfate to prevent recurrent seizures. - •
The patient should be placed in a left lateral position
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Supplemental oxygen (8–10 L/minutes) via nonrebreather face mask
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Suction should be available if needed to prevent aspiration
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Arrange environment to reduce risk from seizure (i.e., raise and pad bed rails, etc.)
Treatment of Hypertension
Antihypertensive therapy should be initiated for sustained systolic blood pressures ≥160 mmHg or diastolic pressures greater than 105–110 mmHg. Options for IV control of blood pressure include the following:
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Labetalol—begin with 20 mg IV push over 2 minutes. If no response after 10 minutes, escalate doses sequentially to 40, 80 mg ( Fig. 20.3 )
Fig. 20.3 Management of hypertension with IV labetalol. - •
Hydralazine—begin with 5–10 mg IV push over 2 minutes. If no response after 20 minutes, administer additional 10 mg IV ( Fig. 20.4 )
Fig. 20.4 Management of hypertension with IV hydralazine. - •
If IV access is not available, patient may be treated with the following:
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Nifedipine—begin with 10 mg PO. If no response in 20 minutes, give 20 mg PO. If no response in 20 minutes, repeat 20 mg PO. If no response in 20 minutes, switch to labetalol 20 mg IV ( Fig. 20.5 )
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