Difference between revisions of "Eclampsia"

 
 
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#Redirect[[Preeclampsia, Eclampsia, and HELLP]]
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==Background==
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*[[Preeclampsia]] and eclampsia are diagnosed after 20wks gestation and <4wk post-partum
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**May occur sooner with gestational trophoblastic disease
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*Suspect in any pregnant patient who is >20wk or <4wk postpartum who develops seizures
  
[[Category:OB/GYN]]
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==Differential Diagnosis==
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''[[Preeclampsia]]''
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{{Seizure DDX}}
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{{Postpartum emergencies DDX}}
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==Management==
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#[[Delivery]]
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#Seizure treatment
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#*[[Magnesium]]: Load 4-6 g IV over 15 min followed by 2-3 gm/hr
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#**Can give up to 10 gm IM (5 g in each buttock)
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#**Observe for loss of reflexes, respiratory depression
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#**Must adjust dose in patients with renal failure
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#*If seizures recur:
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#**Consider alternative diagnosis
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#**Consider other [[anticonvulsant]] drugs
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#***[[Lorazepam]], [[diazepam]], [[phenytoin]], [[levetiracetam]]
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#*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>:
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#**Severe [[renal failure]]
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#**[[Pulmonary edema]]
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#**[[Myasthenia gravis]]
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#BP Control
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#*Lower to Sys 130-150, dia 80-100
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#**[[Labetalol]]
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#***Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
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#***Option 2: Initial 20mg; then IV infusion of 1-2mg/min
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#**[[Hydralazine]]
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#***5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
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#Persistent seizure
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#*See [[status epilepticus]]
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#*Plan appropriately for delivery
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==Disposition==
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*Admit, emergent OB/GYN consultation
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==See Also==
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*[[Post-Partum Emergencies]]
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*[[Preeclampsia]]
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*[https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/19sm02a170703EclampsiaCheck1.pdf?dmc=1&ts=20190908T1328374017 ACOG Eclampsia Checklist]
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==References==
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<references/>
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*EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
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*Uptodate
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[[Category:OBGYN]]

Latest revision as of 22:28, 1 October 2019

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

3rd Trimester/Postpartum Emergencies

Management

  1. Delivery
  2. Seizure treatment
  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
  4. Persistent seizure

Disposition

  • Admit, emergent OB/GYN consultation

See Also

References

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