From the Guidelines
Eclampsia is characterized by new-onset seizures in a woman with preeclampsia, with key signs including tonic-clonic seizures, loss of consciousness, and postictal confusion, and should be treated as a medical emergency with immediate administration of magnesium sulfate and control of blood pressure. The key signs of eclampsia include:
- Tonic-clonic seizures
- Loss of consciousness
- Postictal confusion These seizures typically occur after preeclampsia symptoms have developed, which include:
- Severe headache
- Visual disturbances (blurred vision, seeing spots)
- Right upper quadrant or epigastric pain
- Significant hypertension (blood pressure ≥140/90 mmHg) 1 Physical examination may reveal:
- Hyperreflexia
- Clonus
- Edema, particularly in the face and hands Laboratory findings often show:
- Proteinuria
- Elevated liver enzymes
- Low platelets
- Potentially hemolysis Immediate treatment involves:
- Administering magnesium sulfate (4-6g IV loading dose over 15-20 minutes, followed by 1-2g/hour maintenance) to prevent further seizures 1
- Controlling blood pressure with medications like labetalol or hydralazine 1
- Delivering the baby if the pregnancy is at term or if the mother's condition is unstable 1 Eclampsia is a medical emergency requiring prompt intervention as it can lead to serious complications including stroke, placental abruption, and maternal or fetal death if not treated quickly.
From the Research
Signs of Eclampsia
The signs of eclampsia, a severe complication of preeclampsia, include:
- New-onset seizures or coma in women with preeclampsia 2
- New-onset generalized tonic-clonic seizures 2
- Neurologic symptoms such as severe or atypical headache, visual disturbances 2
- Non-neurologic symptoms such as severe abdominal pain or proteinuria 2
- Hypertension after 20 weeks gestation with or without signs of end organ dysfunction 2
Diagnosis and Treatment
Eclampsia can be diagnosed through laboratory testing, including complete blood cell count, renal and liver function panels, electrolytes, glucose, coagulation panel, fibrinogen, lactate dehydrogenase, uric acid, and urinalysis, as well as imaging such as head computed tomography 3. Treatment involves:
- Prompt administration of intravenous magnesium sulfate 3, 2
- Securing the airway if necessary and administration of intravenous antihypertensive medications 2
- Definitive management is by prompt delivery of the fetus if the mother is still pregnant 3, 2
Management and Prevention
Magnesium sulfate is the drug of first choice used in the treatment of eclampsia seizure, and treatment with antihypertensive drugs and proper blood pressure control is one of the most important factors effectively reducing the risk of deaths or acute complications and poor pregnancy outcomes 4. The use of magnesium sulfate has been shown to reduce the risk of maternal death and recurrence of seizures compared to diazepam 5.