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eclampsia

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This is the association of convulsions with pregnancy induced hypertension. Rarely, eclamptic fits occur early in the third trimester without any clinical indications. More commonly, fitting occurs during labour or the puerperium following a history of pregnancy induced hypertension and proteinuria.

Useful prodromal signs of impending eclampsia include rapidly increasing blood pressure and proteinuria; evidence of cerebral oedema - frontal headaches, visual symptoms with jagged, angular flashes at the periphery of the visual fields and loss of vision in areas; upper abdominal pain from stretching of the peritoneum over an oedematous liver; and occasionally, facial itching. There may be increased and brisk reflex knee jerks and clonus.

The woman should immediately be placed in the recovery position and an airway secured. If the patient is fitting then they are treated with anticonvulsant therapy - a major recent trial has shown that maternal mortality is significantly lower when magnesium sulphate is used as anticonvulsant therapy rather than diazepam or phenytoin. Hydrazaline should be administered to reduce any elevated blood pressure. Ultimately, the condition is resolved by delivery.

Fortunately, eclampsia is less common today. About 2% of sufferers die, and between 1982-4, 14 maternal deaths in England and Wales were attributed to eclampsia.

  • magnesium sulphate for women with pre-eclampsia halves the risk of eclampsia and is the drug of choice for treating eclamptic fits. Phenytoin, lytic cocktail, and diazepam should not be used (1)

Reference:

  1. BMJ. 2006 Feb 25;332(7539):463-8.

Last reviewed 05/2018

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