Eclampsia: Difference between revisions
(Convert magnesium to MedicationDose template with SMW; dosing verified per ACOG) |
(Strip excess bold) |
||
| (2 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*[[Preeclampsia]] | *New-onset [[Seizure|seizures]] in a patient with [[Preeclampsia|preeclampsia]], not attributable to other causes | ||
*Occurs after 20 weeks gestation or up to 6 weeks postpartum<ref name="acog">ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia. ''Obstet Gynecol''. 2020;135(6):e237-e260. PMID 32443079.</ref> | |||
* | *May occur earlier with [[Gestational trophoblastic disease|gestational trophoblastic disease]] | ||
*Can occur without preceding hypertension or proteinuria in up to 20% of cases | |||
*Maternal mortality ~1% in developed countries; leading cause of maternal death worldwide<ref name="duley">Duley L. The global impact of pre-eclampsia and eclampsia. ''Semin Perinatol''. 2009;33(3):130-137. PMID 19464502.</ref> | |||
==Clinical Features== | |||
*Generalized tonic-clonic seizures (typically self-limited, 60-90 seconds) | |||
*Often preceded by: | |||
**Severe [[headache]] (occipital or frontal) | |||
**Visual disturbances (blurred vision, scotomata, cortical blindness) | |||
**Epigastric or RUQ pain | |||
**Hyperreflexia / clonus | |||
*Hypertension (SBP >=160 or DBP >=110), though may be absent | |||
*Peripheral [[edema]], facial edema | |||
*May progress to [[Status epilepticus|status epilepticus]], [[HELLP syndrome]], [[Placental abruption|abruption]], or [[DIC]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Seizure DDX}} | {{Seizure DDX}} | ||
==Evaluation== | |||
*Labs | |||
**CBC with platelets (thrombocytopenia suggests [[HELLP syndrome]]) | |||
**CMP (creatinine, LFTs, uric acid) | |||
**LDH, haptoglobin, peripheral smear (evaluate for hemolysis) | |||
**Urinalysis (proteinuria) | |||
**Coagulation studies (PT/INR, fibrinogen) | |||
**Type and screen | |||
*Imaging | |||
**CT head if atypical features, focal deficits, or prolonged postictal state | |||
*Fetal assessment — continuous cardiotocography | |||
==Management== | ==Management== | ||
===Seizure Treatment=== | |||
*[[Magnesium sulfate]] — first-line for eclamptic seizures<ref name="magpie">The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? ''Lancet''. 2002;359(9321):1877-1890. PMID 12057549.</ref> | |||
**Loading: 4-6 g IV over 15-20 min | |||
**Maintenance: 1-2 g/hr IV infusion | |||
**If no IV access: 10 g IM (5 g in each buttock), then 5 g IM q4h | |||
**Monitor for toxicity: loss of deep tendon reflexes, respiratory depression | |||
**Therapeutic range: 4.8-8.4 mg/dL | |||
**Antidote for Mg toxicity: [[Calcium gluconate]] 1 g IV | |||
*If seizures recur despite magnesium: | |||
**Additional 2 g MgSO4 IV bolus | |||
**If refractory: [[Lorazepam]] 4 mg IV, or [[Diazepam]] 5-10 mg IV | |||
===Blood Pressure Control=== | |||
*Target: SBP 130-150, DBP 80-100 | |||
*[[Labetalol]] 20 mg IV, then 40 mg, then 80 mg q10-20 min (max 300 mg) | |||
*[[Hydralazine]] 5 mg IV over 1-2 min, repeat 5-10 mg q20 min (max 30 mg) | |||
*[[Nicardipine]] infusion 5 mg/hr, titrate by 2.5 mg/hr q5-15 min (max 15 mg/hr) | |||
===Delivery=== | |||
*Definitive treatment is delivery | |||
*Emergent OB/GYN consultation | |||
*Stabilize mother before delivery | |||
*Continue magnesium 24-48 hours postpartum | |||
==Disposition== | ==Disposition== | ||
*Admit | *Admit to ICU or labor and delivery | ||
*Emergent OB/GYN consultation | |||
==See Also== | ==See Also== | ||
*[[Preeclampsia]] | *[[Preeclampsia]] | ||
*[ | *[[HELLP syndrome]] | ||
*[[Status epilepticus]] | |||
*[[Hypertensive emergency]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:OBGYN]] | [[Category:OBGYN]] | ||
Latest revision as of 09:35, 22 March 2026
Background
- New-onset seizures in a patient with preeclampsia, not attributable to other causes
- Occurs after 20 weeks gestation or up to 6 weeks postpartum[1]
- May occur earlier with gestational trophoblastic disease
- Can occur without preceding hypertension or proteinuria in up to 20% of cases
- Maternal mortality ~1% in developed countries; leading cause of maternal death worldwide[2]
Clinical Features
- Generalized tonic-clonic seizures (typically self-limited, 60-90 seconds)
- Often preceded by:
- Severe headache (occipital or frontal)
- Visual disturbances (blurred vision, scotomata, cortical blindness)
- Epigastric or RUQ pain
- Hyperreflexia / clonus
- Hypertension (SBP >=160 or DBP >=110), though may be absent
- Peripheral edema, facial edema
- May progress to status epilepticus, HELLP syndrome, abruption, or DIC
Differential Diagnosis
Seizure
- Epileptic seizure
- First-time seizure
- Seizure with known seizure disorder
- Status epilepticus
- Temporal lobe epilepsy
- Non-compliance with anti-epileptic medications
- Hyponatremia
- INH toxicity
- Non-epileptic seizure
- Meningitis
- Encephalitis
- Brain abscess
- Intracranial hemorrhage
- Alcohol withdrawal
- Benzodiazepine withdrawal
- Barbiturate withdrawal
- Baclofen withdrawal
- Metabolic abnormalities: hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, hypoglycemia, hyperglycemia, hepatic failure, uremia
- Eclampsia
- Neurocysticercosis
- Posterior reversible encephalopathy syndrome
- Impact seizure (head trauma)
- Acute hydrocephalus
- Arteriovenous malformation
- Seizure with VP shunt
- Toxic ingestion (amphetamines, anticholinergics, cocaine, INH, organophosphates, TCA, salicylates, lithium, phenothiazines, bupropion, camphor, clozapine, cyclosporine, fluoroquinolones, imipenem, lead, lidocaine, metronidazole, synthetic cannabinoids, theophylline, Starfruit)
- Psychogenic nonepileptic seizure (pseudoseizure)
- Intracranial mass
- Syncope
- Hyperventilation syndrome
- Migraine headache
- Movement disorders
- Narcolepsy/cataplexy
- Post-hypoxic myoclonus (Status myoclonicus)
Evaluation
- Labs
- CBC with platelets (thrombocytopenia suggests HELLP syndrome)
- CMP (creatinine, LFTs, uric acid)
- LDH, haptoglobin, peripheral smear (evaluate for hemolysis)
- Urinalysis (proteinuria)
- Coagulation studies (PT/INR, fibrinogen)
- Type and screen
- Imaging
- CT head if atypical features, focal deficits, or prolonged postictal state
- Fetal assessment — continuous cardiotocography
Management
Seizure Treatment
- Magnesium sulfate — first-line for eclamptic seizures[3]
- Loading: 4-6 g IV over 15-20 min
- Maintenance: 1-2 g/hr IV infusion
- If no IV access: 10 g IM (5 g in each buttock), then 5 g IM q4h
- Monitor for toxicity: loss of deep tendon reflexes, respiratory depression
- Therapeutic range: 4.8-8.4 mg/dL
- Antidote for Mg toxicity: Calcium gluconate 1 g IV
- If seizures recur despite magnesium:
Blood Pressure Control
- Target: SBP 130-150, DBP 80-100
- Labetalol 20 mg IV, then 40 mg, then 80 mg q10-20 min (max 300 mg)
- Hydralazine 5 mg IV over 1-2 min, repeat 5-10 mg q20 min (max 30 mg)
- Nicardipine infusion 5 mg/hr, titrate by 2.5 mg/hr q5-15 min (max 15 mg/hr)
Delivery
- Definitive treatment is delivery
- Emergent OB/GYN consultation
- Stabilize mother before delivery
- Continue magnesium 24-48 hours postpartum
Disposition
- Admit to ICU or labor and delivery
- Emergent OB/GYN consultation
See Also
References
- ↑ ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2020;135(6):e237-e260. PMID 32443079.
- ↑ Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33(3):130-137. PMID 19464502.
- ↑ The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? Lancet. 2002;359(9321):1877-1890. PMID 12057549.