Lecture on Eclampsia Management

Overview

• Discusses diagnosis and incidence of eclampsia
• Stepwise approach to management of eclampsia
• Treatment of severe acute hypertension
• Delivery considerations
• Alternative diagnoses

Case Presentation

• Patient: 32-year-old pregnant woman, G7, 35 weeks, 3 days
• Symptoms: Loss of consciousness after seizure
• No history of seizures, epilepsy, or substance abuse
• Blood pressure: 160/95, Temperature: 37.5, Heart rate: 80, Respiratory rate: 22, O2 saturation: 97%
• Diagnosis: Likely eclampsia

Eclampsia

• Definition:
  • New onset tonic-clonic seizures without other causes in setting of preeclampsia
  • Can occur without prior hypertension or proteinuria in 20-38% of cases
• Incidence:
  • 1.9% in preeclampsia patients
  • 3.2% in patients with severe preeclampsia

Management of Eclampsia

• Checklist for Acute Seizure Management
  • Call for assistance
  • Designate roles (team leader, checklist reader, primary nurse)
  • Secure side rails, protect airway, administer oxygen
  • Consider intubation
  • Continuous fetal monitoring
  • Draw preeclampsia labs, place large-bore IV
  • Start magnesium; administer antihypertensive if needed
  • Discuss delivery planning
  • Debrief post-stabilization

Treatment Protocol

• Administer magnesium sulfate:
  • Initial dose: 6 g bolus, then 2 g/hr maintenance
  • If no IV access, use 10 g IM regimen
• Contraindications:
  • Use benzodiazepine or phenytoin if magnesium is contraindicated
• Hypertension Treatment
  • Acute severe hypertension defined as >160/110 mmHg for 15 minutes
  • Medications: IV labetalol, IV hydralazine, oral nifedipine
  • Avoid nifedipine/hydralazine if risk of reflex tachycardia

Monitoring and Delivery Considerations

• Watch for fetal bradycardia; monitor fetal status post maternal stabilization
• Avoid immediate cesarean unless no recovery in fetal heart rate
• Factors for delivery:
  • Maternal stability, coagulation status, gestational age, fetal conditions
  • Cervical exam/Bishop score, labor status

Postpartum Eclampsia

• Occurs in 33% of cases postpartum; 79% >48 hours after delivery
• Prodromal symptoms: headache, dyspnea, visual changes, GI symptoms
• Diagnostic imaging: MRI for postpartum headache to rule out alternative diagnoses
• Continue magnesium sulfate for 24 hours postpartum; monitor blood pressure

Conclusion

• The definitive treatment for eclampsia is delivery
• Mode of delivery depends on multiple maternal and fetal factors
• Post-delivery monitoring and management are crucial to prevent complications