Eclampsia

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

Preeclampsia

Seizure

Postpartum Emergencies

Management

  1. Delivery
  2. Seizure treatment
    • 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 patients with renal failure
    • If seizures recur:
      • Consider other anticonvulsant drugs
      • Consider alternative diagnosis
  3. 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

Disposition

  • Emergent OB/GYN consultation

See Also

References


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