Eclampsia

Alternative names:

toxemia with seizures

Treatment:

Because the risk of eclampsia is unpredictable and often not easily correlated to physical signs such as the degree of hypertension or proteinuria, an anticonvulsant (seizure prevention medication) is usually given to women in labor with hypertension. Magnesium sulfate is a safe drug for both the mother and the fetus when used to prevent seizures.

The treatment of women with preeclampsia is bedrest and delivery as soon as viable for the fetus. Patients are usually hospitalized but occasionally may be managed on an outpatient basis with careful monitoring of blood pressure, urine checks for protein, and weight. Optimally, the condition is managed until delivery after 36 weeks can occur.

Delivery may be induced if any of the following occur:

• diastolic blood pressure of greater than 100 mmHg consistently for a 24-hour period or is greater than 110 mmHg for any confirmed reading
• persistent and/or severe headache
• epigastric (stomach region) pain
• abnormal liver function tests
• rising serum creatinine
• HELLP syndrome
• pulmonary edema (fluid in lungs)
• eclampsia
• thrombocytopenia
• abnormal fetal heart tone
• failure of fetal growth noted by ultrasound

Delivery is the treatment of choice for eclampsia in a pregnancy over 28 weeks. For pregnancies less than 24 weeks, the induction of labor is recommended, although the likelihood of a viable fetus is minimal. Prolonging such pregnancies results in maternal complications as well as infant death in approximately 87% of the cases. Pregnancies between 24 and 28 weeks gestation present a "gray zone," and conservative management may be attempted, with monitoring for the presentation of maternal and fetal complications.

Expectations (prognosis):

Maternal deaths caused by preeclampsia or eclampsia are rare in the U.S. Fetal or perinatal deaths are high and generally decrease as the maturity of the fetus increases. The risk of recurrent pre-eclampsia in subsequent pregnancies is approximately 33%. Preeclampsia does not appear to lead to chronic high blood pressure in women.

Complications:

Preeclampsia may develop into eclampsia, the occurrence of seizures. Eclampsia may lead to complications from trauma or even death. The risk for placenta abruptio is increased with preeclampsia and/or eclampsia. Fetal complications caused by prematurity at the time of delivery may occur.

Calling your health care provider:

Call your health care provider or go to the emergency room if any symptoms of eclampsia or preeclampsia occur during pregnancy. Emergency symptoms include seizures or decreased consciousness.