Eclampsia/Pre-Eclampsia

Table of Contents

Aliases

Pregnant seizures, toxemia of pregnancy

Patient Care Goals

  1. Recognize serious conditions associated with pregnancy and hypertension
  2. Prevention of eclampsia-related seizures
  3. Provide adequate treatment for eclampsia-related seizures

Patient Presentation

Inclusion Criteria

  1. Female patient, more than 20-weeks’ gestation, presenting with hypertension and evidence of end organ dysfunction, including renal insufficiency, liver involvement, neurological, or hematological involvement
  2. May occur up to 4-weeks post-partum but is rare after 48 hours post-delivery.
  3. Severe features of pre-eclampsia include:
    1. Severe hypertension (SBP 160, DBP  110)
    2. Headache
    3. Mental confusion
    4. Vision changes
    5. Right upper quadrant or epigastric pain
    6. Pulmonary edema
  4. Eclampsia
    1. Pre-eclampsia symptoms plus seizures
  5. Eclampsia/pre-eclampsia associated with abruptio placenta and fetal loss

Exclusion Criteria

Chronic hypertension without end organ dysfunction.

Patient Management

Assessment

  1. Obtain history
    1. Gestational age or recent post-partum
    2. Symptoms suggestive of end organ involvement such as headache, confusion, visual disturbances, seizure, epigastric pain, right upper quadrant pain, nausea, and vomiting
    3. Previous history of hypertension or known pre-eclampsia
  2. Monitoring
    1. Vital signs including repeat blood pressures every 10 min
  3. Secondary survey pertinent to obstetric issues:
    1. Constitutional: vital signs, orthostatic vital signs, skin color
    2. Abdomen: distention, tenderness
    3. Genitourinary: visible bleeding
    4. Neurologic: mental status

Treatment and Interventions

  1. Severe hypertension (SBP greater than 160 or DBP greater than 110) lasting more than 15 min with associated preeclampsia symptoms
    1. Magnesium sulfate – 4 g IVPB over 20 min.
    2. Reassess vital signs every 10 min during transport
  2. Seizures associated with pregnancy greater than 20-weeks’ gestation
    1. Magnesium sulfate
      1. 4 g IVPB over 20 min
      2. Contact direct medical oversight for additional orders if persistent seizure despite initial magnesium (may give additional 1-2 g IV over 5 min)
    2. Benzodiazepine, per Seizures guideline, for active seizure not responding to magnesium – Caution: respiratory depression
  3. IV fluids:
    1. Saline lock
  4. Disposition
    1. Transport to closest appropriate receiving facility
    2. Patients in second or third trimester of pregnancy should be transported on left side or with uterus manually displaced to left if hypotensive

Notes – Eclampsia/Pre-Eclampsia