Eclampsia

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

Treatment

1. Delivery
2. Seizure Tx
   1. Magnesium: Load 4-6g IV over 15min followed by 2-3gm/hr
      1. Can give up to 10gm IM
      2. Observe for loss of reflexes, respiratory depression
      3. Must adjust dose in pts w/ renal failure
   2. If seizures recur:
      1. Consider other anticonvulsant drugs
      2. Consider alternative diagnosis
3. BP Control
   1. Lower to Sys 130-150, dia 80-100
      1. Labetalol
         1. Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
         2. Option 2: Initial 20mg; then IV infusion of 1-2mg/min
      2. Hydralazine
         1. 5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg

Prevention

• The USPSTF recommends the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia. ( B recommendation)

Disposition

• Emergent OB/GYN consultation

See Also

• Post-Partum Emergencies
• Preeclampsia

Source

• Tintinalli
• EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
• Uptodate