Eclampsia

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Eclampsia is a condition peculiar to pregnancy and post-partum periods, characterized by elevated  BP  and  tonic-clonic  convulsions  which  are  not  caused  by  epilepsy,  severe  malaria,  meningitis,  hypoglycemia or other causes of convulsions.  Majority (50%) occur preterm. Eclampsia may occur  without prior elevation of BP. 

Diagnostic Criteria 

  • Signs of severe pre-eclampsia (BP > 160/110mm Hg)
  • Loss of consciousness
  • Tonic-clonic seizures, coma

Investigations 

  • Full blood count and crossmatch
  • Ultrasound for GA and fetal viability
  • Urea and creatinine + electrolytes
  • Liver enzymes tests
  • 24h urine collection for proteinuria
  • Clotting profile

Pharmacological Treatment 

Manage with antihypertensive as in pre-eclampsia with severe features AND 

A:magnesium sulfate (IV) 

Loading dose: magnesium sulfate (IV) 4g of 20% (MgSO4) slowly over 5minutes.  

If having 50% MgSO4 dilute it to make it 20% MgSO4 by Drawing 8mls of 50% MgSO4 and adding  12mls water for injection to make it 20mls of 20% of MgSO4 and  

OR 

Draw 10mls (5gms) of 50% MgSO4 into each syringe 1ml of A: 2% lignocaine in each syringe then give deep IM into each buttock. Continue with maintenance dose until 24hours post-delivery or since  the last episode of convulsion: With MgSO4 infusion 1g per hour (in 200–300 ml of Ringer’s Lactate),  or  MgSO4  5g  undiluted  50%  of  MgSO4  injection  (add  1ml  of  lignocaine  2%)  apply  deep  intra- muscular  (IM)  injection  into  each  buttock  every  4hrs  for  about  24  hours  after  delivery  or  the  last  seizure whichever come last.16 

Note:  The magnesium sulfate infusion should only be given if patellar reflexes are present, respiration rate  is ≥ 12 per minute, and urine output is >100mls in 4 hours.

If convulsions recur within 15 minutes give; 

A:  magnesium  sulfate  2g.  Draw  4mls  of  50%  of  MgSO4  (2gm),  add  6mls  of  water  for injection to make it 10mls of 20% MgSO4 then give IV slowly over 5 minutes 

Features of Magnesium Sulphate toxicity 

  • Respiratory depression (˂16cycles/min
    Reduced urine output(˂30mls/hour)
    Loss of deep tendon reflexes

In case of magnesium sulphate toxicity 

Stop magnesium sulphate administration

A: calcium gluconate (IV) 1g slow bolus in 2 to 3 minutes

Obstetrical management 

Patients with eclampsia should be delivered within 12hours after the onset of seizures, even if the  foetus  is  premature.  Expectant  management  is  contraindicated.  If  not  in  labour,  and  no  contraindications, induce labour with misoprostol 50µg (PO) ,4hourly or 25µg vaginally and repeat  8hourly up to a total of four doses maximum  

  • If failure of induction or contraindication to vaginal delivery, immediate Caesarean section is indicated

Prevention of pre-eclampsia and eclampsia 

  • Ensure effective antenatal care
  • Calcium  supplementation  calcium  supplementation  at  doses  of  1.5–2.0g  elemental calcium/day) for those at high risk of developing pre-eclampsia.
  • Low-dose acetylsalicylic acid (aspirin, 75 mg) is recommended for the prevention of pre-eclampsia in women at high risk of developing pre-eclampsia.