Eclampsia: Difference between revisions
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#**[[Pulmonary edema]] | #**[[Pulmonary edema]] | ||
#**[[Myasthenia gravis]] | #**[[Myasthenia gravis]] | ||
#BP Control | #BP Control (target Sys 130-150, Dia 80-100) | ||
#*{{MedicationDose|drug=Labetalol|dose=20 mg IV initial; then 20-80 mg q10min (max 300 mg total) OR 20 mg IV then infusion 1-2 mg/min|route=IV|context=BP control in eclampsia|indication=Eclampsia|max_dose=300 mg total}} | |||
#* | #*{{MedicationDose|drug=Hydralazine|dose=5 mg IV over 1-2 min; repeat 5-10 mg q20min PRN|route=IV|context=BP control in eclampsia|indication=Eclampsia|max_dose=30 mg total}} | ||
#* | |||
#Persistent seizure | #Persistent seizure | ||
#*See [[status epilepticus]] | #*See [[status epilepticus]] | ||
Revision as of 16:08, 20 March 2026
Background
- Preeclampsia and eclampsia are diagnosed after 20wks gestation and <4wk post-partum
- May occur sooner with gestational trophoblastic disease
- Suspect in any pregnant patient who is >20wk or <4wk postpartum who develops seizures
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)
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
Management
- Delivery
- Seizure treatment
- Magnesium 4-6 g load in 100 mL over 20-30 min, then 1-2 g/hr maintenance IV
- If no IV Access, give Magnesium sulfate 50% solution IM 10g Loading Dose (5g in each buttock), followed by 5 g IM q 4 hours
- Observe for loss of reflexes, respiratory depression
- If seizure responds and unable to urgently transport to Ob Unit: Monitor serum Mg Levels q 4 hours (therapeutic range: 4.9-8.5mg/dL) and obtain CTH
- Must adjust dose in patients with renal failure
- If seizures recur:
- Consider alternative diagnosis
- Consider other anticonvulsant drugs
- Contraindications to magnesium[1]:
- Magnesium 4-6 g load in 100 mL over 20-30 min, then 1-2 g/hr maintenance IV
- BP Control (target Sys 130-150, Dia 80-100)
- Labetalol 20 mg IV initial; then 20-80 mg q10min (max 300 mg total) OR 20 mg IV then infusion 1-2 mg/min IV (max 300 mg total)
- Hydralazine 5 mg IV over 1-2 min; repeat 5-10 mg q20min PRN IV (max 30 mg total)
- Persistent seizure
- See status epilepticus
- Plan appropriately for delivery
Disposition
- Admit, emergent OB/GYN consultation
See Also
References
- EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
- Uptodate