ECLAMPSIA

Al Farizi Adhi Sunjaya Hazrati Dzatil Aziyati Talitha Rahma Ayuningtyas

ECLAMPSIA
Background
Definition

Eclampsia refers to the occurrence of new-onset,

generalized, tonic-clonic seizures or coma in a
woman with preeclampsia.
It typically occurs during or after the 20th week of
gestation or in the postpartum period.
Definition of Eclampsia
Convulsion and or loss of consciousness in
a woman with preeclampsia that cannot be attributed
to another cause.
• Severe headache
• Blurred vision
• Epigastric pain

Physical Examination:
• Level of consiousness: somnolent – coma
• Blood Pressure >140/90 mmHg
 Depending on the time convulsion
appears,
eclampsia is divided into:
• Antepartum eclampsia: before labor
• Intrapartum eclampsia: during labor
• Postpartum eclampsia: after labor. Postpartum eclampsia
can occur immediately (early postpartum, 24 hours until 7
days after labor) or later (late post partum, more than 7 da
ys during the puerperium. Late post partum eclampsia is rar
e.
Risk Factor of Eclampsia

• Poor outcome of previous

pregnancy, including
History of intrauterine growth retardation,
Nulliparity Primigravida Pre/eclampsia
abruptio placentae, or fetal
death.

• Multifetal gestations,
Teen Lower hydatid mole, fetal hydrops,
Pregnancy > 35 years old socioeconomic primigravida
status
Epidemiology

10% About 2% of women

with eclampsia develop
of all pregnancies are eclampsia with future
complicated by hypertension. pregnancies.

5 % of patients with hypertension

develop severe preeclampsia

Most cases of eclampsia present in the 3rd trimester of pregnancy, with about 80% of
eclamptic seizures occurring intrapartum or within the first 48 hours following delivery.
Course of Eclamptic Seizures
Facial
Eclampsia manifests as 1 twitching Distortion
seizure or more, with each
Protrusion
seizure generally lasting 60 Foaming
-75 seconds.
Respiration
Phase 1 lasts 15-20 seconds and begins ceases
with facial twitching. The body becomes
rigid, leading to generalized muscular
contractions.

Phase 2 lasts about 60 seconds. It starts in

Rigid
the jaw, moves to the muscles of the face
and eyelids, and then spreads throughout
the body.
The muscles begin alternating between
contracting and relaxing in rapid sequence.
A coma or period of unconsciousness,
lasting for a variable period, follows
phase 2.
After the coma phase, the patient may
regain some consciousness.
Principles of Therapy
Resucitation
Airway
Breathing
Circulation

Anticonvulsant
MgSO4

Anti Hypertension
Nifedifine
Methyldopha

Termination
How to exclude the differential
diagnosis of the other seizures?
Epilepsy

• At least two unprovoked (or reflex) seizures occurring >24 h apart;

• one unprovoked (or reflex) seizure and a probability of further seizures
similar to the general recurrence risk (at least 60%) after two unprovoked
seizures, occurring over the next 10 years;
• Diagnosis of an epilepsy syndrome.
Meningitis

• Fever
• Severe headache
• Nuchal rigidity
Resusitation

• Call for help

• Don't leave the patient
• Prevent trauma (wide bed, fix enough)
• If the patient has a seizure:
• Prepare seizure equipment (suction, Oxygen mask, tongue spatel, etc.)
• Left tilt position
• Oxygen 4-6 lpm
• Anti convultant: MgSO4
 Control and preventing recurrent convulsions

• Using an intravenously administered loading dose of magnesium

sulfate that is followed by a maintenance dose, usually IV,
of magnesium sulfate
• INITIAL DOSAGE - 4 g of MgSO4 in 100 cc RL (given in 15-20
minutes)
• MAINTENANCE DOSAGE - 10 g in 500 cc RL with rates 1-2 g /
hour (20-30 tpm)
• RECURRENT CONVULTION - 2 g MgSO4 bolus IV
Terms MgSO4 administration:
• Patellar reflex (+)
• Breath Frequency > 16x / minute
• Minimum urine production of 0.5 cc / kg / hour or 25
cc / hour (last 4 hours)
• Available antidote  Ca Gluconas 10%

If there is a sign of intoxication  STOP MgSO4! 

Give antidote
Management of Hypertension

Dangerous hypertension can cause cerebrovascular hemorrhage and

hypertensive encephalopathy, and it can trigger eclamptic convulsions
in women with preeclampsia. Other complications include hypertensive
afterload congestive heart failure and placental abruption. Because of
these sequelae, the National High Blood pressure Education Program
Working Group (2000) and the 2013 Task Force

Antihypertensive recommendations in pregnancy:

• Systolic ≥ 160 mmHg or
• Diastolic ≥ 110 mmHg
Essential Antihypertensive:

• Nifedipine: recommend a 10-mg initial oral dose to be repeated in 30

minutes if necessary
• Methyldopa
• Hidralazin: intravenously with a 5-mg initial dose, and this is followed
by 5- to 10-mg doses at 15- to 20-minute intervals until a satisfactory
response is achieved. limit the total dose to 30 mg per treatment cycle
• Labetalol: we give 10 mg intravenously initially. If the blood pressure
has not decreased to the desirable level in 10 minutes, then 20 mg is
given. The next 10-minute incremental dose is 40 mg and is followed
by another 40 mg if needed. If a salutary response is not achieved,
then an 80-mg dose is given. maximum dose of 220 mg per treatment
cycle.
The target of decreasing BLOOD PRESSURE is 20% from MAP [(1S + 2D) / 3]

If blood pressure is 140-159 / 90-109 mmHg:

Started: calcium channel blocker group (nifedipine)
Continued: methyldopa or other beta blockers (propanolol, acebutolol, etc.)

For cases of postpartum and breastfeeding:

Methyldopa, nifedipine, captopril
Termination of pregnancy

• All cases of eclampsia are terminated without regard to gestational age.

• Termination is carried out after stabilization of the mother's condition.
• Eclampsia is not an indication of SC.
• Principles of labor: 1 and 2 Phase accelerated
• The treatment of eclampsia patients is multidisciplinary with intensive care
• Maintain BP <160/110 mmHg during labor
Pospartum Care

• Anticonvulsants are continued until 24 hours

post-partum / from the last seizure
• Antihypertension is still given
• Monitoring fluid
References
• Cunningham, F. Gary,, et al. Williams Obstetrics. 24th edition.
Chapter 18: 351.New York: McGraw-Hill Education, 2014.
• Medscape. Eclampsia. (Internet: https://emedicine.medscape.com/
article/253960)
• DEP./SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas
Padjadjaran. Obstetri Patologi. Ilmu kesehatan reproduksi. Edisi 3
• DEP./SMF Obstetri & Ginekologi Fakultas Kedokteran Universitas
Padjadjaran. Panduan Praktis Klinis Obstetri dan Ginekologi. Band
ung, 2015.
Thank you