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Eclampsia: Understanding Symptoms, Risks, and Treatment

Definition

Eclampsia = new-onset generalized tonic-clonic seizures in a pregnant/postpartum woman with preeclampsia (hypertension + proteinuria/end-organ dysfunction), not attributable to other causes.

Diagnostic Criteria (ACOG)

  • Systolic BP ≥160 or diastolic ≥110 mmHg (severe features) OR ≥140/90 with proteinuria.
  • Seizure activity.
  • May occur antepartum (20–38 wks), intrapartum, or postpartum (up to 6 wks; peak 48 hrs).

Warning Signs (Pre-Eclamptic)

  • Severe headache unresponsive to analgesics.
  • Visual disturbances (scotomata, blurred vision, photopsia).
  • Epigastric/RUQ pain (liver capsule stretch).
  • Nausea/vomiting (new onset).
  • Hyperreflexia, clonus.

Emergency Management

  1. ABCs: Protect airway, left lateral position, O2, IV access.
  2. Magnesium Sulfate: 4–6 g IV load + 1–2 g/hr infusion (seizure prophylaxis/control).
  3. Antihypertensives: Labetalol, hydralazine, nifedipine for severe-range BP.
  4. Delivery: Definitive treatment. Timing based on gestational age, maternal/fetal stability. Often expedited after stabilization.
  5. Monitoring: Continuous cardiac, fetal, neurologic; urine output, labs (CBC, LFTs, creatinine, coagulation).

Prognosis

Maternal mortality 0.5–2% (higher in low-resource settings). Fetal risks: prematurity, growth restriction, abruption. Recurrence risk in future pregnancies ~1–2%.

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