Eclampsia

Aka: Eclampsia, Toxemia of Pregnancy, Eclamptic Seizure

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II. 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"

III. Epidemiology

  1. Rare <20 weeks gestation (except in hydatiform mole)
  2. Most episodes occur prior to delivery
    1. Antepartum Seizure: 53% of cases
    2. Intrapartum Seizure: 19% of cases
    3. Postpartum Seizure: 28% of cases
      1. Majority (79%) of postpartum Seizures are late postpartum (>48 hours after delivery)

IV. 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 15% of cases have diastolic BP <90 mmHg

V. Signs

  1. See Preeclampsia
  2. Phase 0: Preceding symptoms
    1. Headache (80%)
    2. Visual changes (45%)
  3. Phase 1: Prodrome (brief)
    1. Twitching
    2. Facial congestion
    3. Mouth foaming
    4. Altered Level of Consciousness
  4. Phase 2: Tonic
    1. Muscle rigidity
  5. Phase 3: Seizure activity for 1 to 1.5 minutes
    1. May occur without preceding neurologic symptoms (e.g. Headache) in up to 20% of patients
    2. Rhythmic Muscle Contractions and relaxation
    3. Generalized Tonic Clonic Seizure (or multifocal or Focal Seizure)
    4. Loss of respiratory activity
    5. Fetal Bradycardia
  6. Phase 4: Comatose
    1. Respiratory effort, but otherwise comatose
  7. Phase 5: Post-ictal
    1. Confused and agitated, combative

VI. Diagnosis: Eclampsia

  1. New onset Generalized Tonic Clonic Seizure, multifocal or Focal Seizure AND
  2. Pregnant or postpartum (within 6 weeks) AND
  3. Hypertensive Disorder in Pregnancy AND
  4. No alternative diagnosis for Seizure

VII. Differential Diagnosis

  1. See Seizure Causes

VIII. Management

  1. See Eclamptic Seizure Management
  2. See Severe PIH Management

IX. 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 [PubMed]
  4. Farahi (2024) Am Fam Physician 109(3): 251-60 [PubMed]
  5. Leeman (2016) Am Fam Physician 93(2):121-7 [PubMed]
  6. Zamorski (2001) Clin Fam Pract 3:329-47 [PubMed]

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