Eclampsia:
is an acute disorder characterized by clonic and tonic convulsions that are
🔹Clinical course:
caused in some way by hypertension induced or aggravated by pregnancy.
Depending on whether convulsions first appears before labor , during labor ,
or in the puerperium, eclampsia is designated as antepartum (25%),
🔹Frequency:
intrapartum (50%), or postpartum (25%).
Approximately 5% of pregnancies are complicated by preeclampsia. Of
these patients, 0.5-2% progress to eclampsia. The incidence is increased in
🔻
women of low socioeconomic status, extremes of age, and primigravid state.
Both preeclampsia and eclampsia account for significant maternal and
fetal morbidity and mortality.
Clinical course:
Almost without exception, preeclampsia precedes the outset of convulsions.
Headache, visual disturbance, and epigastric or right upper quadrant pain
are symptoms that should excite grave concern.
Apprehension ,excitability, and hyperreflexia often precede the convulsions,
although a convulsion may occur in their absence.
-The convulsive movements usually begin about the mouth in the form of
facial twitching. After a few seconds the whole body becomes rigid in a
generalized muscular contraction.
-During the clonic stage the muscles alternately contract and relax in rapid
succession, irregular respiratory movements resume, and the patient is
usually cyanotic.
During this stage the patient may throw herself out of bed, breaking bones ,
and may bite her tongue.
-After 1 or 2 minutes these seizures stop and the patient gradually regain
consciousness but continues to be disoriented and restless for a varying
period of time- minutes to hours (postictal state).
The goals of therapy are:
-prevention of convulsions
-stabilization of blood pressure
-correction of any fluid, acid-base, or electrolyte imbalances.
-termination of pregnancy
1. Acute management:
The patient should be placed in the left lateral position and the airway secured. Oxygen should be
Eclampsia administered.
2. Treatment and prophylaxis of seizures:
The results of the Collaborative Eclampsia Trial show that women treated with Magnesium Sulphate
have fewer recurrent seizures compared with women treated with diazepam or phenytoin.
A loading dose of 4g should be given over 10 minutes followed by a maintenance infusion of 1-2g/h
continued for at least 24 hours after the last seizure. Recurrent seizures should be treated by a further
🔹causes
bolus of 2g.
Magnesium toxicity:
loss of deep tendon reflexes, followed by respiratory depression and ultimately respiratory arrest.
In most cases therapy can be monitored safely by hourly measurement of the patellar reflex and
respiratory rate (or oxygen saturation).
If deep tendon reflexes are absent, further doses of magnesium sulphate should be withheld until reflexes
return. Significant respiratory depression should be treated with 1g IV calcium gluconate (given over 10
minutes).
-Magnesium is excreted by the kidney and regular monitoring of serum levels should be considered in
Treatment of eclampsia: women with oliguria (urine output < 100ml/4h).
-The therapeutic range is believed to be between 2 and 4mmol/l. If serum levels are not available the
by fatema okoff 🔹
maintenance dose should be reduced to 0.5g/h.
If repeated seizures occur despite magnesium, options include diazepam (10mg IV) or thiopentone
(50mg IV). Intubation may become necessary in such women in order to protect the airway and ensure
adequate oxygenation. Further seizures should be managed by intermittent positive pressure ventilation
and muscle relaxation.
3. Treatment of hypertension:
Reduction of severe hypertension (blood pressure > 160/110 mm Hg is mandatory to reduce the risk of
cerebrovascular accident. Treatment may also reduce the risk of further seizures.
-Hydralazine: 5mg IV repeated every 20 minutes to a maximum cumulative dose of 20mg
or
🔻
-Labetalol: 20mg IV escalating to 40 or 80mg every 10 minutes to a maximum cumulative dose of 300mg
Both may precipitate fetal distress and therefore continuous fetal heart rate monitoring is necessary.
Delivery
🔹
The definitive treatment of eclampsia is delivery.
Attempts to prolong pregnancy in order to improve fetal maturity are unlikely to be of value. However, it
is inappropriate to deliver an unstable mother even if there is fetal distress.
Once seizures are controlled, severe hypertension treated, and hypoxia corrected, delivery can be
🔹
expedited.
Vaginal delivery should be considered but caesarean section is likely to be required in primigravidae
remote from term with an unfavourable cervix. After delivery, high dependency care should be continued
for a minimum of 24 hours
1. MgSO4 is recommended for first-line treatment of
eclampsia.
Magnesium Sulphate (MgSO4) for Eclampsia 2. MgSO4 is recommended as prophylaxis against eclampsia in women with severe preeclampsia.
Prophylaxis or Treatment 3. MgSO4 may be considered for women with non-severe preeclampsia.
4. Phenytoin and benzodiazepines should not be used for eclampsia prophylaxis or treatment, unless there
is a contraindication to MgSO4 or it is ineffective.
is an acute disorder characterized by clonic and tonic convulsions that are
🔹Clinical course:
caused in some way by hypertension induced or aggravated by pregnancy.
Depending on whether convulsions first appears before labor , during labor ,
or in the puerperium, eclampsia is designated as antepartum (25%),
🔹Frequency:
intrapartum (50%), or postpartum (25%).
Approximately 5% of pregnancies are complicated by preeclampsia. Of
these patients, 0.5-2% progress to eclampsia. The incidence is increased in
🔻
women of low socioeconomic status, extremes of age, and primigravid state.
Both preeclampsia and eclampsia account for significant maternal and
fetal morbidity and mortality.
Clinical course:
Almost without exception, preeclampsia precedes the outset of convulsions.
Headache, visual disturbance, and epigastric or right upper quadrant pain
are symptoms that should excite grave concern.
Apprehension ,excitability, and hyperreflexia often precede the convulsions,
although a convulsion may occur in their absence.
-The convulsive movements usually begin about the mouth in the form of
facial twitching. After a few seconds the whole body becomes rigid in a
generalized muscular contraction.
-During the clonic stage the muscles alternately contract and relax in rapid
succession, irregular respiratory movements resume, and the patient is
usually cyanotic.
During this stage the patient may throw herself out of bed, breaking bones ,
and may bite her tongue.
-After 1 or 2 minutes these seizures stop and the patient gradually regain
consciousness but continues to be disoriented and restless for a varying
period of time- minutes to hours (postictal state).
The goals of therapy are:
-prevention of convulsions
-stabilization of blood pressure
-correction of any fluid, acid-base, or electrolyte imbalances.
-termination of pregnancy
1. Acute management:
The patient should be placed in the left lateral position and the airway secured. Oxygen should be
Eclampsia administered.
2. Treatment and prophylaxis of seizures:
The results of the Collaborative Eclampsia Trial show that women treated with Magnesium Sulphate
have fewer recurrent seizures compared with women treated with diazepam or phenytoin.
A loading dose of 4g should be given over 10 minutes followed by a maintenance infusion of 1-2g/h
continued for at least 24 hours after the last seizure. Recurrent seizures should be treated by a further
🔹causes
bolus of 2g.
Magnesium toxicity:
loss of deep tendon reflexes, followed by respiratory depression and ultimately respiratory arrest.
In most cases therapy can be monitored safely by hourly measurement of the patellar reflex and
respiratory rate (or oxygen saturation).
If deep tendon reflexes are absent, further doses of magnesium sulphate should be withheld until reflexes
return. Significant respiratory depression should be treated with 1g IV calcium gluconate (given over 10
minutes).
-Magnesium is excreted by the kidney and regular monitoring of serum levels should be considered in
Treatment of eclampsia: women with oliguria (urine output < 100ml/4h).
-The therapeutic range is believed to be between 2 and 4mmol/l. If serum levels are not available the
by fatema okoff 🔹
maintenance dose should be reduced to 0.5g/h.
If repeated seizures occur despite magnesium, options include diazepam (10mg IV) or thiopentone
(50mg IV). Intubation may become necessary in such women in order to protect the airway and ensure
adequate oxygenation. Further seizures should be managed by intermittent positive pressure ventilation
and muscle relaxation.
3. Treatment of hypertension:
Reduction of severe hypertension (blood pressure > 160/110 mm Hg is mandatory to reduce the risk of
cerebrovascular accident. Treatment may also reduce the risk of further seizures.
-Hydralazine: 5mg IV repeated every 20 minutes to a maximum cumulative dose of 20mg
or
🔻
-Labetalol: 20mg IV escalating to 40 or 80mg every 10 minutes to a maximum cumulative dose of 300mg
Both may precipitate fetal distress and therefore continuous fetal heart rate monitoring is necessary.
Delivery
🔹
The definitive treatment of eclampsia is delivery.
Attempts to prolong pregnancy in order to improve fetal maturity are unlikely to be of value. However, it
is inappropriate to deliver an unstable mother even if there is fetal distress.
Once seizures are controlled, severe hypertension treated, and hypoxia corrected, delivery can be
🔹
expedited.
Vaginal delivery should be considered but caesarean section is likely to be required in primigravidae
remote from term with an unfavourable cervix. After delivery, high dependency care should be continued
for a minimum of 24 hours
1. MgSO4 is recommended for first-line treatment of
eclampsia.
Magnesium Sulphate (MgSO4) for Eclampsia 2. MgSO4 is recommended as prophylaxis against eclampsia in women with severe preeclampsia.
Prophylaxis or Treatment 3. MgSO4 may be considered for women with non-severe preeclampsia.
4. Phenytoin and benzodiazepines should not be used for eclampsia prophylaxis or treatment, unless there
is a contraindication to MgSO4 or it is ineffective.
