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Eclampsia is the presence of new-onset grand mal seizures in women with preeclampsia.
Eclampsia is caused by preeclampsia.
Clinical manifestations of eclampsia include hypertension, proteinuria, generalized edema, and convulsions with headache, RUQ epigastric pain, and visual changes either antepartum, intrapartum, or postpartum. Eclampsia is associated with increased maternal complications, including HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, abruptio placentae, disseminated intravascular coagulopathy, pulmonary edema, acute renal failure, aspiration pneumonia, cardiopulmonary arrest, liver hematoma, and respiratory distress syndrome.
Prognosis and risk of recurrence
Eclampsia is associated with a mortality rate ranging from 0-1.8% in developed countries and 14% in developing countries.
The following summarized guidelines for the evaluation and management of eclampsia are prepared by our editorial team based on guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC 2022), the American Association for the Study of Liver Diseases (AASLD 2021), the Italian Association for the Study of the Liver (AISF 2016), and the Myasthenia Gravis Foundation of America (MGFA 2016).
1.Screening and diagnosis
Indications for screening: obtain close monitoring for the development of eclampsia in patients with preeclampsia.
Magnesium sulfate: as per SOGC 2022 guidelines, administer magnesium sulfate as first-line therapy in patients with eclampsia.
Timing for delivery: perform expeditious deliver after maternal stabilization in patients with suspected eclampsia.
Patients with myasthenia gravis: do not use magnesium sulfate for the management of eclampsia in patients with myasthenia gravis because of its neuromuscular blocking effects. Offer barbiturates or phenytoin to provide adequate treatment.
Magnesium sulfate: as per SOGC 2022 guidelines, administer magnesium sulfate as prophylaxis against eclampsia in patients with preeclampsia and severe hypertension or adverse maternal conditions.