Sudden seizures can occur before, during, or rarely up to 6 weeks after delivery postpartum. Postpartum seizures are most common during the first 48 hours after delivery. If you have eclampsia, your doctor will give you medicine such as magnesium sulfate to prevent a seizure from happening again and to control your blood pressure. The doctor will wait until your health is stable before delivering your baby.
A woman with eclampsia has a type of seizure called a grand mal seizure, which begins with a sudden loss of consciousness.
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In poor countries, the incidence of eclampsia is high. In Dar es Salaam, Tanzania, hospital- and population-based incidences of eclampsia are per 10, and 67 per 10,, respectively Human immunodeficiency virus infection treated with highly active antiretroviral therapy prior to pregnancy is associated with a significantly higher risk for preeclampsia and fetal death Nigerian authors conducted a retrospective study of the management and outcome of eclampsia patients in the intensive care unit between November and April During the study period, there were a total of deliveries with total births including multiple births and live births.
Forty eclamptic patients were admitted to the intensive care unit, giving an intensive care unit admission rate of 8.
Twenty patients The risk of eclampsia was greater in nulliparous compared to parous women. A young age younger than 20 years or an older mother older than 35 years , longer birth interval, low socioeconomic status, gestational diabetes, prepregnancy obesity, and weight gain during pregnancy were positively associated with eclampsia Tantillo and colleagues retrospectively analyzed factors associated with seizure- and epilepsy-related readmissions in women who were initially admitted for delivery The authors analyzed data for , index admissions.
A day readmission rate for seizures and epilepsy was Of these, were leveled as eclampsia; in 59 cases, seizures were due to other causes. The mean number of days to readmission after delivery was 6. Lower income quartile, preexisting epilepsy, preeclampsia, and eclampsia predicted the risk of readmission. A significant percentage of eclampsia cases are potentially preventable by patient education or health care response. In fact, the marked reduction in the incidence of eclampsia in developed countries over the years can be attributed to good prenatal care, early detection of signs and symptoms of preeclampsia, and prophylactic use of magnesium sulfate during labor and after delivery in women with preeclampsia.
An adequate diet and iron and folic acid supplementation in pregnancy was associated with a reduced occurrence of symptoms of preeclampsia or eclampsia in Indian women Antiplatelet agents, largely low-dose aspirin, have moderate benefits when used for prevention of preeclampsia.
In a study, early treatment with intravenous blood pressure medication and magnesium sulfate for sustained critical maternal blood pressures resulted in a significant reduction in the rate of eclampsia and severe maternal morbidity The authors thought that an additive or synergistic effect of the combined treatment of an antihypertensive medication and magnesium sulfate had a significant impact on the rate of eclampsia and severe maternal morbidity.
However, concomitant supplementation with vitamin C and vitamin E does not prevent preeclampsia in women at risk but does increase the rate of babies born with a low birth weight Evidence from the latest Cochrane review does not support routine antioxidant administration during pregnancy to reduce the risk of preeclampsia and other serious complications in pregnancy Several clinical symptoms are potentially helpful in establishing the diagnosis of eclampsia.
These symptoms may occur before or after the onset of convulsions, and they include persistent occipital or frontal headaches, vision loss, photophobia, epigastric or right upper-quadrant pain, and altered sensorium. A systemic review tried to analyze all predictive signs and symptoms that can occur before onset of eclampsia in a preeclamptic lady and noted that visual disturbances, epigastric pain, headache, and edema are 4 of the most frequent heralding symptoms Eclampsia is rare after 48 days after delivery, and in such a situation a diagnosis is needed to rule out presence of other brain disorders.
In late postpartum eclampsia, manifestations are often nonspecific. Headache is usually a dominant clinical feature and often is without significant rise in blood pressure The common differential diagnosis of seizures late in postpartum period includes cerebral venous thrombosis, intracerebral hemorrhage, hypertensive encephalopathy, space-occupying lesions of the brain, and metabolic disorders such as hypoglycemia and hyponatremia.
In developing countries, infective diseases like bacterial meningitis, acute viral hepatitis with fulminant hepatic failure, and cerebral malaria are important causes of late puerperal seizures. Acute intermittent porphyria produces seizures and hypertension closely mimicking eclampsia.
Lumbar puncture should always be performed if meningitis is suspected. Imaging studies of the brain are recommended when persistent coma or focal neurologic deficit is present.
Neurocysticercosis should be considered in the differential diagnosis of pregnant patients with coma and seizures, especially if the patient is a resident of an endemic area or has emigrated from or traveled to an endemic area Cerebral infarcts and hemorrhages are uncommon but serious complications of pregnancy.
The majority of strokes are seen in the third trimester and postpartum period. Increased levels of fms-like tyrosine kinase-1 and reduced levels of placental growth factor predict the subsequent development of preeclampsia Decreased urinary placental growth factor at midgestation is strongly associated with subsequent early development of preeclampsia. Abnormal electroencephalographic findings are frequent in preeclamptic-eclamptic patients. Electroencephalographic findings in such patients are not altered by serum magnesium levels achieved in the clinical management of these patients.
In a series, electroencephalograms were recorded in 36 eclamptic, 14 preeclamptic, and 13 normotensive control patients. Twenty-seven eclamptic patients had abnormal electroencephalographic studies, 4 patients showed paroxysmal spike activity, and the others showed focal or diffuse slowing delta waves.
Seven preeclamptic women had abnormal electroencephalographic studies all had generalized slowing. In preeclamptic-eclamptic patients who had serial electroencephalographic recordings, the gross electroencephalographic findings obtained during magnesium sulphate infusion and in the absence of magnesium sulphate were similar Early computed tomography reveals bilateral, often symmetrical, reversible hypodense lesions in the white matter of parieto-occipital regions of brain.
It is not uncommon to find a normal computed tomography. The neuroimaging hallmark of eclampsia is reversible parieto-occipital white matter signal abnormalities as seen on magnetic resonance imaging. Specific magnetic resonance techniques, such as FLAIR and diffusion weighted image sequences, have improved the ability to identify subcortical or cortical lesions and help to clarify the underlying pathophysiological mechanisms.
Diffusion-weighted magnetic resonance imaging differentiates between cytotoxic and vasogenic cerebral edema in a patient with eclampsia. Typical brain lesions predominate in the posterior white matter with some involvement of the overlying cortex. Lesions are hyperintense on T2-weighted images and are usually hypointense or isointense on diffusion-weighted images, with an increase of the apparent diffusion coefficient, indicating vasogenic edema.
Cytotoxic or ischemic edema is characterized by restricted water diffusion and appears markedly hyperintense on diffusion-weighted images and hypointense on apparent diffusion coefficient maps In a study, 27 nulliparous women with eclampsia were evaluated with diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient mapping Those with findings of restricted diffusion suggestive of cytotoxic edema underwent neuroimaging again 6 weeks postpartum.
All but 2 of these 27 women had reversible vasogenic edema. Six were also found to have areas of cytotoxic edema consistent with cerebral infarction. Five of these 6 women had persistent imaging findings of infarction when studied postpartum, however, without clinical neurologic deficits.
Neuroimaging should always be performed in pregnant women with recent onset of neurologic manifestations irrespective of the development of eclampsia A variety of other neuroimaging abnormalities can also be encountered. Twenty patients had cerebral edema, and 1 case had cerebral hemorrhage. Magnesium sulphate is considered to be the agent of choice for the control of recurrent eclamptic seizures in pregnant women.
Magnesium sulphate is also the first line agent for prophylaxis of seizures in eclampsia and preeclampsia. Severe preeclampsia should be treated with magnesium to prevent progression to eclampsia. The mechanisms of action of magnesium sulphate are still not clear. Magnesium sulphate is considered to act as a peripheral and central vasodilator to decrease peripheral vascular resistance or relieve vasoconstriction.
Additionally, magnesium sulfate may also protect the blood-brain barrier and limit cerebral edema formation. Magnesium sulfate has a potent central anticonvulsant action as well In , the efficacy of magnesium sulfate in eclampsia was established in a landmark trial.
The Eclamptic Trial Collaborative Group randomized women at 23 centers in 8 countries to receive magnesium sulfate or diazepam. This study unequivocally showed that magnesium sulphate given intramuscularly or intravenously is superior to phenytoin or diazepam in reducing recurrent eclamptic seizures. Seizures were a half or a third less likely to recur after treatment with magnesium.
In women assigned to the magnesium group, 5. Another study comparing magnesium sulfate with phenytoin for the prevention of eclamptic seizures in women with the diagnosis of severe preeclampsia revealed that magnesium was superior to phenytoin for prophylaxis against eclamptic seizures In this study, a total of women were randomized to receive magnesium or phenytoin after preeclampsia was diagnosed on admission in labor.
Magnesium sulfate was administered at an initial dose of 5 g in each hip, and then 5 g every 4 hours. Reflexes and respirations were checked before each dose. Magnesium was continued until 24 hours after delivery. Phenytoin was given by intravenous infusion of mg over 1 hour, followed by a mg extended-release capsule 10 hours later. Ten of the women assigned to receive phenytoin experienced eclamptic seizures compared with no patients in the magnesium group. In a Cochrane review, authors assessed the effects of magnesium sulphate compared with phenytoin.
Seven randomized controlled trials involving women are included. Magnesium sulphate, rather than phenytoin, for women with eclampsia reduces the risk ratio of recurrence of seizures, probably reduces the risk of maternal death, and improves outcome for the baby The authors concluded that magnesium sulphate should be considered the drug of choice for women with eclampsia.
The use of phenytoin should be abandoned. In another Cochrane review, magnesium sulphate was demonstrated to be substantially more effective than diazepam for treatment of eclampsia In a later review, the same group of authors assessed the effects of magnesium sulphate compared with lytic cocktail comprised of chlorpromazine, promethazine and pethidine These authors suggested that magnesium sulphate, rather than lytic cocktail, for women with eclampsia reduces the risk ratio of maternal death, of further seizures, and of serious maternal morbidity respiratory depression, coma, pneumonia.
It was concluded that the use of lytic cocktail should be abandoned. Severe preeclampsia should also be treated with magnesium sulfate to prevent progression to eclampsia. In another landmark magnesium sulfate for Prevention of Eclampsia Magpie trial, 10, women with preeclampsia were randomized to receive magnesium sulphate before or during labor or after giving birth, in 33 countries. About two thirds of the women in this study were from developing countries with high or moderate perinatal mortality.
Follow-up data were available for 10, Maternal mortality was also lower among women allocated magnesium sulphate. A Cochrane analysis reviewed effects of magnesium sulphate and other anticonvulsants for prevention of eclampsia The authors noted that the magnesium sulphate reduces the risk of eclampsia by more than one half and probably reduces maternal death.
The main side effect was flushing. Nimodipine is a calcium channel blocker with specific cerebral vasodilator activity. Magnesium sulfate is more effective than nimodipine for prophylaxis against seizures in women with severe preeclampsia There is no definite place of magnesium sulfate in the management of mild preeclampsia because the rate of seizures in women with mild preeclampsia not receiving magnesium sulfate is low.
Fourteen women None in either group developed eclampsia or thrombocytopenia The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommends only short-term usually less than 48 hours use of magnesium sulfate in obstetric care, which includes the prevention and treatment of seizures in women with preeclampsia or eclampsia, fetal neuroprotection before anticipated early preterm less than 32 weeks of gestation delivery, and short-term prolongation of pregnancy up to 48 hours to allow for the administration of antenatal corticosteroids in pregnant women between 24 weeks of gestation and 34 weeks of gestation who are at risk of preterm delivery within 7 days Magnesium sulfate is administered most commonly as a continuous intravenous infusion at rates of 2 to 3 grams per hour after an intravenous loading bolus of 4 to 6 grams.
Alternatively, intramuscular regimen can be used with a loading dose of 5 g intramuscular into each buttock, followed by 5 g every 4 hours after assessment of respirations, urine output, and deep tendon reflexes. Magnesium sulfate treatment is frequently started before delivery and continued for varying periods, usually 12 or 24 hours after delivery The onset of diuresis in the postpartum period may be used as a clinical determinant for the discontinuation of magnesium sulfate therapy in patients with severe preeclampsia 44 ; Thirty-nine patients randomized into the low-dose regimen group received a loading dose of 9 g 4 g intravenous and 5 g intramuscular and an intramuscular maintenance of 2.
Postdelivery diuresis heralds reversal of the pathophysiologic abnormalities in this disorder. Polypharmacy should be avoided in patients with eclampsia because medically induced alterations in mental status may make it more difficult to evaluate changes in patient status. In patients with eclampsia, mannitol was not found superior to magnesium sulfate in achieving neurologic recovery. Magnesium sulfate remains the agent of choice for treatment of posterior reversible encephalopathy syndrome No single antihypertensive has been proven to be better than another, although hydralazine is probably the initial intravenous agent of choice.
Sodium nitroprusside should be avoided in most neurologic emergencies because of its tendency to raise intracranial pressure. The starting dose is usually 5 mg given intravenously followed by a subsequent dose of 5 to 10 mg every 20 to 30 minutes as needed.
Another agent commonly used in severe hypertension is the intravenous form of labetalol. Nifedipine can also be used in the treatment of acute hypertension. Delivery remains the definitive treatment for preeclampsia, but there may be initial deterioration after birth, especially in the HELLP syndrome. In the eclamptic patient, delivery should be undertaken after stabilization of the patient.
Route of delivery is dictated by other obstetric indications. Cervical ripening agents and induction of labor are not contraindicated. Evaluation of maternal and fetal status must be done before proceeding with induction.
A report described 2 patients with refractory late postpartum eclampsia; these patients had rapid recovery following uterine curettage Although general anesthesia can be safely used in preeclamptic women, it is fraught with greater maternal morbidity and mortality. Currently, the safety of regional anesthesia techniques is well established, and they can provide better obstetrical outcome when chosen properly.
Thus, regional anesthesia is extensively used for the management of pain and labor in women with preeclampsia. This article highlights the advantages and disadvantages of regional anesthetic techniques, including epidural, spinal, and combined spinal-epidural analgesia used as a part of the management of preeclampsia Every article is reviewed by our esteemed Editorial Board for accuracy and currency.
Seizure first aid. Action on Pre-eclampsia. American Pregnancy Association: Preeclampsia. Preeclampsia Foundation. NIH: Eclampsia. Peripheral Neuropathies. Neuroacanthocytosis is a neurologic syndrome characterized by a broad spectrum of movement disorders that often share acanthocytes on the blood smear.
A variety of other neurologic symptoms may accompany neuroacanthocytosis, including seizures, motor neuron disease, and dementia.
Chorea-acanthocytosis is an autosomal recessive disorder due to mutations in the VPS13A gene chromosome 9q21 , and is among the disorders known to cause neuroacanthocytosis. Valproic acid is used as an anticonvulsant drug to treat multiple seizure types, as well as for prevention of migraine and treatment of bipolar disorder.
It is structurally unrelated to other antiepileptic drugs. The aim of therapy is to control seizures, continued for as long as seizure control is required.
Lacosamide trade name Vimpat is used as an antiepileptic drug for the adjunctive treatment of partial-onset seizures, and is also being developed for the treatment of diabetic neuropathic pain. Gabapentin, a GABA receptor agonist, is indicated as an add-on therapy for the treatment of partial seizures with or without secondary generalization. It is also approved for the treatment of postherpetic neuralgia and restless legs syndrome.
Most publications deal with use of gabapentin in all types of pain problems. Carbamazepine is classified as an antiepileptic drug, although it is used for other indications as well. It is indicated for use in epilepsy, trigeminal and glossopharyngeal neuralgias, acute manic or mixed episodes associated with bipolar I disorder in adults, and intravenously as a short-term replacement therapy for oral carbamazepine formulations. Drug-induced seizures can occur as an adverse effect of drugs from different pharmacological categories, and have no clinical features to differentiate them from idiopathic epileptic seizures.
Most resolve after discontinuation of the offending drug. Use of drugs known to cause seizures should be avoided in patients with predisposition to seizures.
Sign Up for a Free Account. Go to Pubmed. Updated Seizures associated with eclampsia. Overview Preeclampsia or eclampsia is a multisystem disorder of pregnancy and the puerperium. Historical note and terminology Ancient accounts of eclampsia and childbirth are available in medical writings of Egyptian, Indian, Chinese, and Greek civilizations. Presentation and course Eclampsia is a serious complication of preeclampsia with a high maternal and perinatal mortality and morbidity. Table 1.
Posterior leukoencephalopathy brain CT. Computed tomography of brain showing bilateral hypodensity in visual cortex. Patient presented with 1-year history of acute vision loss. Vision loss had occurred 24 hours after 3 episodes of puerperal generalized convulsions. Eclampsia features brain CT. Computed tomography of brain showing multiple white matter hypodensities in a patient with eclampsia.
Contributed by Dr. Ravindra Kumar Garg. Posterior leukoencephalopathy brain MRI. Magnetic resonance imaging T2-weighted image of brain showing bilateral symmetrical hyperintense signals in occipital lobes.
Magnetic resonance imaging FLAIR image of brain showing multiple hyperintense signals dominantly in parieto-occipital regions. Posterior leukoencephalopathy syndrome. Computed tomography of brain showing symmetrical hypodensities in bilateral parieto-occipital regions in a patient with eclampsia who presented with recurrent seizures.
Postpartum cerebral angiopathy MR angiography. Magnetic resonance angiography of brain showing diffuse vasospasm of posterior cerebral arteries, basilar artery, and their branches. Prognosis and complications The overall maternal death rate varies from 0. Pathophysiology Genetic susceptibility may play an important role in the pathogenesis of eclampsia. Confusing conditions Several clinical symptoms are potentially helpful in establishing the diagnosis of eclampsia. Cerebral venous thrombosis features brain CT.
Computed tomography of brain showing features of cerebral venous thrombosis in a pregnant woman. The lady presented in 30th week of pregnancy with deep coma and recurrent seizures. Venous infarcts are present in both lobes. Solitary cysticercus granuloma brain CT. Computed tomography of brain showing a solitary cysticercus granuloma a common cause of seizures in developing countries.
This pregnant woman was misdiagnosed as postpartum eclampsia. Intracerebral hemorrhage in patient with eclampsia CT. Computed tomography of brain showing intracerebral hemorrhage in a patient with eclampsia. Table 2. Anesthesia Although general anesthesia can be safely used in preeclamptic women, it is fraught with greater maternal morbidity and mortality. Eclampsia: morbidity, mortality, and management. Clin Obstet Gynecol ;48 1 PMID Low-dose magnesium sulphate in the control of eclamptic fits: a randomized controlled trial.
In order to cure this disorder, your doctor may need to induce labor and deliver your baby. Depending on…. A creatinine blood test measures the level of creatinine, a waste product, in the blood. Learn how to prepare for it, what to expect, and what the…. Low dose aspirin has been a common treatment for pregnant women with a risk of preeclampsia.
Now, doctors at the University of Texas are prescribing…. Researchers say a timely diagnosis can help pregnant women get quicker treatment for the potentially deadly ailment. Health Conditions Discover Plan Connect. What are the symptoms of eclampsia?
The following are common symptoms of preeclampsia: elevated blood pressure swelling in your face or hands headaches excessive weight gain nausea and vomiting vision problems, including episodes with loss of vision or blurry vision difficulty urinating abdominal pain, especially in the right upper abdomen Patients with eclampsia can have the same symptoms as those noted above, or may even present with no symptoms prior to the onset of eclampsia. The following are common symptoms of eclampsia: seizures loss of consciousness agitation.
What causes eclampsia? High blood pressure Preeclampsia is when your blood pressure, or the force of blood against the walls of your arteries, becomes high enough to damage your arteries and other blood vessels. Proteinuria Preeclampsia commonly affects kidney function. Who is at risk for eclampsia? If you have or have had preeclampsia, you may be at risk for eclampsia. How is eclampsia diagnosed? These tests can include: Blood tests Your doctor may order several types of blood tests to assess your condition.
Creatinine test Creatinine is a waste product created by the muscles. Urine tests Your doctor may order urine tests to check for the presence of protein and its excretion rate. What are the treatments for eclampsia? Medications Medications to prevent seizures, called anticonvulsants drugs , may be necessary.
What is the long-term outlook? Parenthood Pregnancy. Read this next. Treatment of Preeclampsia: Magnesium Sulfate Therapy. Creatinine Blood Test. Medically reviewed by Carissa Stephens, R.
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