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 | **May occur sooner with gestational trophoblastic disease | ||
*Suspect in any pregnant | *Suspect in any pregnant patient who is >20wk or <4wk postpartum who develops seizures | ||
== | ==Differential Diagnosis== | ||
#Delivery | ''[[Preeclampsia]]'' | ||
#Seizure | |||
# | {{Seizure DDX}} | ||
# | |||
# | {{Postpartum emergencies DDX}} | ||
## | |||
# | ==Management== | ||
## | #[[Delivery]] | ||
### | #Seizure treatment | ||
#*[[Magnesium]]: Load 4-6 g 10% magnesium sulfate in 100ml solution IV over 20-30 min, then start maintenance dose: 1-2 g/hr | |||
#**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 | |||
#***[[Lorazepam]], [[diazepam]], [[phenytoin]], [[levetiracetam]] | |||
#*Contraindications to magnesium<ref>Eclampsia Checklist. ACOG. https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/hy04bF140807EclampsiaChecklist.pdf?dmc=1&ts=20170620T1844454355.</ref>: | |||
#**Severe [[renal failure]] | |||
#**[[Pulmonary edema]] | |||
#**[[Myasthenia gravis]] | |||
#BP Control | #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 | ||
#Persistent seizure | |||
#*See [[status epilepticus]] | |||
#*Plan appropriately for delivery | |||
==Disposition== | ==Disposition== | ||
* | *Admit, emergent OB/GYN consultation | ||
==See Also== | ==See Also== | ||
*[[Post-Partum Emergencies]] | *[[Post-Partum Emergencies]] | ||
*[[Preeclampsia]] | *[[Preeclampsia]] | ||
*[https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/19sm02a170703EclampsiaCheck1.pdf?dmc=1&ts=20190908T1328374017 ACOG Eclampsia Checklist] | |||
==References== | |||
<references/> | |||
*EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies | *EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies | ||
*Uptodate | *Uptodate | ||
[[Category: | [[Category:OBGYN]] | ||
Latest revision as of 09:58, 20 June 2025
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: Load 4-6 g 10% magnesium sulfate in 100ml solution IV over 20-30 min, then start maintenance dose: 1-2 g/hr
- 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: Load 4-6 g 10% magnesium sulfate in 100ml solution IV over 20-30 min, then start maintenance dose: 1-2 g/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
- 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