Eclampsia

Eclampsia is the encephalopathic complication of severe or imminent pre-eclampsia (PET) and is defined by the occurrence of seizures or altered consciousness.

It typically presents with:

• Generalized seizures
• Coma or altered conscious state

Associated complications may include renal, hepatic, and hematological dysfunction. Eclampsia can occur antepartum, intrapartum, or postpartum (up to 10 days).

See also

• Preeclampsia
• HELLP Syndrome

Pathophysiology

• Thought to result from hypertensive encephalopathy and cerebral vasospasm
• For detailed pathophysiology, refer to PET document

---

Complications

1. Acute renal failure
2. Hypertensive emergencies (e.g., SAH, ICH)
3. Coagulopathy:
   • DIC
   • HELLP syndrome
4. Hepatic impairment/failure
5. Fetal complications:
   • Placental abruption
   • IUGR
   • IUFD

---

Clinical Features

Diagnosis is clinical: Seizures + signs of PET (hypertension, proteinuria).

• Eclampsia can occur without prior severe PET signs
• Seizures are usually self-limited to a few minutes

Differential diagnoses must be considered: epilepsy, stroke, space-occupying lesion, metabolic disturbance

---

Investigations

Bloods:

• FBE
• U&Es, glucose
• LFTs
• Coagulation profile
• Calcium
• Uric acid
• Group and hold / crossmatch

Urine:

• FWT
• MSU for M&C

CTG:

• Fetal monitoring

CT Brain:

• Indicated if:
  • Focal neurological deficits
  • Prolonged seizures/coma
  • Suspected hemorrhage or preexisting pathology

---

Management

1. Immediate Stabilization

• ABCs, IV access
• Left lateral position
• Calm, quiet environment
• Bedside glucose

2. Seizure Control

• IV Diazepam: For immediate control
• Magnesium Sulphate (MgSO4): First-line for prevention and treatment
  • Loading: 4 g IV over 10–20 min
  • Infusion: 2 g/hr for at least 24 hrs post-delivery
  • Repeat bolus if seizures recur
  • Therapeutic Mg level: 2.0–3.5 mmol/L (Toxic >3.5 mmol/L)

Antidote: 10–20 mL of 10% calcium gluconate IV slowly

Monitoring:

• Conscious state, BP, RR (<16), temperature
• Deep tendon reflexes
• ECG
• Serum Mg levels

3. Monitoring

• ECG, pulse oximetry
• BP (NIBP or arterial line)
• IDC (urine output ≥0.5 mL/kg/hr)
• Continuous CTG (fetal monitoring)
• Consider CVC if fluid balance is critical

4. Fluid Resuscitation

• Pre-eclamptic women are intravascularly depleted despite edema
• Cautious fluid management: Max 2 L/day maintenance
• 250–500 mL boluses for:
  • Prior to antihypertensive use
  • Prior to epidural or delivery
  • Hypotension/oliguria

Avoid diuretics

5. Hypertension Management

• Initiate only after IV fluid resuscitation
• Preferred agents:
  • IV Labetalol (first-line)
  • IV Hydralazine (if beta-blockers contraindicated)

6. Coagulopathy

• FFP and platelets as indicated

7. Steroids

• Given for fetal lung maturation if <34 weeks

8. Delivery

• Definitive management of eclampsia
• Timing and mode individualized:
  • Urgent Caesarean for unstable cases
  • Vaginal delivery may be considered if stable, over 12–24 hrs
  • Delay up to 48 hrs if steroid cover needed and both mother and baby are stable

9. Postpartum Care

• Continue MgSO4 for 24 hrs post-delivery
• Convert to oral antihypertensives as needed
• Eclamptic seizures can occur up to 10 days postpartum

---

Disposition

Notify urgently:

• ED Consultant
• Obstetrics Unit
• ICU
• Anaesthetics
• Haematologist (if coagulopathy)
• Paediatrics

Postpartum follow-up:

Important in early/recurrent PET or eclampsia cases

Assess for underlying chronic hypertension or renal disease

---

References

FOAMed

• Nickson C. Pre-eclampsia and Eclampsia. CCC
• Nickson C. Eclampsia. CCC
• Hiller J, Yarwood L. Eclampsia. FFS
• Yarwood L, Hiller J. Pre-eclampsia. FFS
• Flower O. Emergency management of Pre-eclampsia. CODA

Publications

• Hypertension in pregnancy: diagnosis and management. NICE guideline [NG133]
• King Edward Memorial Hospital. Hypertension in pregnancy: Medical management. November 2017.