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Eclampsia

Background

Overview

Definition
Eclampsia is the presence of new-onset grand mal seizures in women with preeclampsia.
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Pathophysiology
Eclampsia is caused by preeclampsia.
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Disease course
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.
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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.
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Guidelines

Key sources

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 ...
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Screening and diagnosis

Indications for screening: as per AASLD 2021 guidelines, obtain close monitoring for the development of eclampsia in patients with preeclampsia.
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Medical management

Magnesium sulfate: as per SOGC 2022 guidelines, administer magnesium sulfate as first-line therapy in patients with eclampsia.
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Therapeutic procedures

Timing for delivery: as per AASLD 2021 guidelines, perform expeditious deliver after maternal stabilization in patients with suspected eclampsia.
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Specific circumstances

Patients with myasthenia gravis: as per MGFA 2016 guidelines, 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.
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Preventative measures

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.
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