Eclampsia: Difference between revisions
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== Background == | == Background == | ||
*Preeclampsia and eclampsia are diagnosed after 20wks gestation and <4wk post-partum | *[[Preeclampsia]] and eclampsia are diagnosed after 20wks gestation and <4wk post-partum | ||
**May occur sooner w/ gestational trophoblastic disease | **May occur sooner w/ gestational trophoblastic disease | ||
*Suspect in any pregnant pt who is >20wk or <4wk postpartum who develops seizures | *Suspect in any pregnant pt who is >20wk or <4wk postpartum who develops seizures | ||
==Differential Diagnosis== | |||
*Standard [[seizure]] | |||
*[[Preeclampsia]] | |||
{{Postpartum emergencies DDX}} | |||
==Treatment== | ==Treatment== | ||
#Delivery | #[[Delivery]] | ||
#Seizure Tx | #Seizure Tx | ||
##Magnesium: Load 4-6g IV over 15min followed by 2-3gm/hr | ##[[Magnesium]]: Load 4-6g IV over 15min followed by 2-3gm/hr | ||
###Can give up to 10gm IM | ###Can give up to 10gm IM | ||
###Observe for loss of reflexes, respiratory depression | ###Observe for loss of reflexes, respiratory depression | ||
| Line 16: | Line 22: | ||
#BP Control | #BP Control | ||
##Lower to Sys 130-150, dia 80-100 | ##Lower to Sys 130-150, dia 80-100 | ||
###Labetalol | ###[[Labetalol]] | ||
####Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg | ####Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg | ||
####Option 2: Initial 20mg; then IV infusion of 1-2mg/min | ####Option 2: Initial 20mg; then IV infusion of 1-2mg/min | ||
###Hydralazine | ###Hydralazine | ||
####5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg | ####5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg | ||
==Disposition== | ==Disposition== | ||
Revision as of 17:02, 10 January 2015
Background
- Preeclampsia and eclampsia are diagnosed after 20wks gestation and <4wk post-partum
- May occur sooner w/ gestational trophoblastic disease
- Suspect in any pregnant pt who is >20wk or <4wk postpartum who develops seizures
Differential Diagnosis
- Standard seizure
- Preeclampsia
3rd Trimester/Postpartum Emergencies
- Acute fatty liver of pregnancy
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- HELLP syndrome
- Mastitis
- Peripartum cardiomyopathy
- Postpartum endometritis (postpartum PID)
- Postpartum headache
- Postpartum hemorrhage
- Preeclampsia
- Resuscitative hysterotomy
- Retained products of conception
- Septic abortion
- Uterine rupture
Treatment
- Delivery
- Seizure Tx
- Magnesium: Load 4-6g IV over 15min followed by 2-3gm/hr
- Can give up to 10gm IM
- Observe for loss of reflexes, respiratory depression
- Must adjust dose in pts w/ renal failure
- If seizures recur:
- Consider other anticonvulsant drugs
- Consider alternative diagnosis
- Magnesium: Load 4-6g IV over 15min followed by 2-3gm/hr
- BP Control
- Lower to Sys 130-150, dia 80-100
- Labetalol
- Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
- Option 2: Initial 20mg; then IV infusion of 1-2mg/min
- Hydralazine
- 5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
- Labetalol
- Lower to Sys 130-150, dia 80-100
Disposition
- Emergent OB/GYN consultation
See Also
Source
- Tintinalli
- EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
- Uptodate