Related links: Labor and delivery of the eclamptic patient

Eclampsia is the occurrence of seizure in a gravida with known or suspected preeclampsia.

A seizure in a pregnant woman without a history of seizure disorder should be assumed to be eclampsia until proven otherwise.

Initial evaluation

• During the seizure, which will last about one minute, steady the patient to prevent injury. Call for magnesium sulfate.

• When the seizure activity stops, check respirations and perform a brief neurological exam to detect lateralizing signs which may suggest a cause other than eclampsia. If lateralizing signs are present, neurology consult and brain imaging are indicated.

• If not already present, apply fetal monitor to confirm normal fetal heart rate. The fetal heart rate will drop during the seizure and return to normal as the patient begins to take deep breaths in the immediate post-ictal state.

• Do NOT administer Valium or other benzodiazepines as seizure treatment. These drugs are poorly metabolized by the fetus, and also may obscure the maternal sensorium.

Treatment

• Obtain large-bore intravenous access

• Administer magnesium sulfate as described in detail here.

• If blood pressure is greater than 160/110, administer either hydralazine 5 mg every 20 minutes, or labetolol 20 mg every 10 minutes to achieve blood pressure of approximately 150/105.

• If a second seizure occurs, administer an additional 2 grams of 10% or 20% magnesium sulfate by direct IV push.

• If further seizures occur, administer an intermediate-acting barbiturate such as amytal or pentobarbital

• Continuous seizures after adequate treatment suggest an intracerebral lesion such as hemorrhage or infarction, or a metabolic derangement.