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Eclampsia
From WikEM
Contents
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
- Non-epileptic seizure
- Meningitis
- Encephalitis
- Intracranial hemorrhage
- Alcohol withdrawal
- Eclampsia
- Neurocysticercosis
- Posterior reversible encephalopathy syndrome
- Impact seizure (head trauma)
- Seizure with VP shunt
- Toxic ingestion
- Intracranial mass
- Syncope
- Hyperventilation syndrome
- Migraine headache
- Movement disorders
- Narcolepsy/cataplexy
Postpartum Emergencies
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- Postpartum endometritis
- Postpartum headache
- HELLP syndrome
- Postpartum hemorrhage
- Mastitis
- Peripartum cardiomyopathy
- Preeclampsia
- Retained products of conception
- Uterine rupture
Management
- Delivery
- 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
- Magnesium: Load 4-6g IV over 15min followed by 2-3gm/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
Disposition
- Emergent OB/GYN consultation
See Also
References
- EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
- Uptodate
