Eclampsia

1. Definitions
   1. Eclampsia ("sudden flash" or "shining forth")
      1. Most severe form of PIH characterized by Seizures
   2. Also referred to as Toxemia or "toxin present"
2. Pathophysiology
   1. Results from focal cerebral edema
   2. Associated with transient Vasoconstriction and ischemia
   3. Usually results from progressive Severe Preeclampsia
   4. May also occur with little warning
      1. Mild Preeclampsia may precede Eclamptic Seizure
   5. Blood Pressure is only mildly increased in 30-60% of patients
      1. Up to 20% of cases have diastolic BP <90 mmHg
   6. Usually occurs prior to delivery
      1. Antepartum Seizure: 53% of cases
      2. Intrapartum Seizure: 19%
      3. Postpartum Seizure: 28%
         1. Majority (79%) of postpartum Seizures are late postpartum (>48 hours after delivery)
3. Epidemiology
   1. Rare <20 weeks gestation (except in hydatiform mole)
4. Signs
   1. See Preeclampsia
   2. Phase 1: Prodrome (brief)
      1. Twitching
      2. Facial congestion
      3. Mouth foaming
      4. Altered Level of Consciousness
   3. Phase 2: Tonic
      1. Muscle rigidity
   4. Phase 3: GTCS activity for 1 to 1.5 minutes
      1. Rhythmic muscle contractions and relaxation
      2. Generalized Tonic Clonic Seizure
      3. Loss of respiratory activity
   5. Phase 4: Comatose
      1. Respiratory effort, but otherwise comatose
   6. Phase 5: Post-ictal
      1. Confused and agitated
5. Management
   1. See Eclamptic Seizure Management
6. References
   1. Fontaine (2000) in ALSO, B:1-36
   2. Sibai in Gabbe (2002) Obstetrics, p. 945-74
   3. (2000) Am J Obstet Gynecol 183(1):S1-22
   4. Zamorski (2001) Clin Fam Pract 3:329-47