Eclampsia

Question 1

What is eclampsia?

Answer 1

• Convulsive manifestation of hypertensive disorder
• Tonic clonic
• Focal or multifocal
• Absence of other causative conditions (such as epilepsy, tumor, ischemia, substance use, hemorrhage)

Question 2

What percentage of patients will seize while on therapeutic magnesium dosing?

Answer 2

1 in 200. (5%)

This is less than 4 in 200 that would seize without magnesium.

Magnesium halved the risk of eclampsia and reduced the risk of placental abruption

Side effect: flushing, increased risk for c-section

Question 3

What are the indication for brain imaging in a patient who has had a seizure?

Answer 3

• Seizure while on magnesium
• Worse headache (thunderclap)
• Altered mental status/confusion, vision loss
• Focal or multifocal symptoms

Question 4

How will you proceed with delivery following an eclamptic seizure?

Answer 4

-Delivery once patient is stable

• C-section if less than 28 weeks and viable due to increased risk for c-section anyway (97%)
• C-section risk falls to 65% between 28-32 weeks

Question 5

Are there symptoms before eclamptic seizures?

Answer 5

Yes. 78-83% are preceded by signs of:

• cerebral irritation such as persistent/severe headaches, frontal headaches, blurred vision , photophobia
• altered mental status

Question 6

How do you manage the patient with an intractable seizure?

Answer 6

• Sodium amobarbital 250mg IV over 3 minutes
• Thopental or phenytoin 1250mg IV at 50mg/min
• Diazepan 10mg
• ** caution should be used due to decreased laryngeal reflexes which increases risk of aspiration

Question 7

What are the fetal risks during a seizure?

Answer 7

Hypoxemia
Abruption
Premature delivery
Fetal demise

Question 8

What is the alternative to IV magnesium if the patient does not have an IV?

Answer 8

IM magnesium 10grams total with 5 grams in each buttock

Question 9

Magnesium is contraindicated in patients with:

Answer 9

• Myasthesnia gravis
• Severe renal failure
• Hypocalcemia
• Myocardial infarction
• Myocarditis
• Heart block

Question 10

Differential diagnosis for eclampsia seizures:

Answer 10

• Epilepsy
• Cerebral arterial ischemia
• Cerebral infarction
• Intracranial hemorrhage
• Drug use

*** consider these alternative diagnosis if seizures continue on magnesium and if onset is 48 hours postpartum

Question 11

What percentage of mild preeclampsia patients develop eclampsia?

Answer 11

1.9%

Question 12

What percentage of severe preeclampsia patients develop eclampsia?

Answer 12

3.2%

Question 13

What causes headaches in hypertensive disorders?

Answer 13

Headaches are due to cerebral edema, hypertensive encephalopathy, elevated cerebral perfusion pressure

Question 14

When do you recommend brain imaging?

Answer 14

• Vision loss
• Refractory seizures
• Altered mental status/confusion
• Thunderclap headache
• Focal symptoms

Question 15

What is PRES?

Answer 15

Posterior reversible encephalopathy syndrome. best seen on MRI. Can lead to vision loss, confusion, altered mental status. Treatment include - antihypertensive to decrease BP and anti epileptic has been used

Question 16

What is the recurrence risk of eclampsia in subsequent pregnancies?

Answer 16

2%

Question 17

What is the percentage of eclampsia postpartum?

Answer 17

29% and it is rare 48 hours postpartum

Question 18

Stepwise approach to management of seizing patient:

Answer 18

• Maternal position to prevent aspiration pneumonia and optimize oxygenation
• Administer magnesium to prevent other seizures
• Assess safety of patient in the event of another seizure
• Anesthesia consultation