top of page

Eclampsia

 

Introduction

​

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. It is common in nonwhite nulliparous women from low socioeconomic status. 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 cross-match

  • Ultrasound

  • Urea and creatinine + electrolytes 

  • Liver enzymes tests 

  • 24h urine collection for proteinuria

  • Clotting profile

  • Blood smear to exclude malaria

  • Blood sugar estimation to exclude hypoglycemia.

 

Pharmacological Treatment

 

Magnesium Sulfate (MgSO4)

  • Loading dose 4g IV slowly using one 20mls syringe 

  • Draw 8mls of 50% MgSO4 

  • Add 12mls water for injection to make it 20mls of 20% of MgSO4 and 

  • Give IV slowly over 5 minutes OR use two 10mls syringes

  • Draw 10mls (5gms) of 50% MgSO4 into each syringe 

  • Add 1ml of: 2% lignocaine in each syringe then give deep IM into each buttock  

 

Maintenance dose for 24hours:

 

Infusion of MgSO4 1g per hour (in 200–300 ml of Ringer’s Lactate), or 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 hrs after delivery or the last seizure whichever come last.16

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

  • Seizure prophylaxis should be continued for 24–48 hours post delivery 

 

If convulsions recur within 15 minutes give;

  • 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 minutes16. 

​

Antidote for magnesium sulfate toxicity

  • Calcium gluconate 1g slow IV bolus in 2 to 3 minutes  

 

Note: Contra–indications of magnesium sulfate are; myasthenia, respiratory insufficiency, cardiomyopathy, oligo– anuria. Monitor respiratory rate (> 16 breaths/min), urine output, consciousness, deep tendon reflexes and magnesium sulfate serum levels (where possible)  

 

Obstetrical management 

 

Patients with eclampsia should be delivered within 12 hours after the onset of seizures, even if the foetus is premature. Expectant management is contraindicated. If not in labour, induce labour with misoprostol 50µg PO or 25µg vaginally and repeat every 4 hours up to a total of four doses maximum

​

If failure of induction, immediate Caesarean section is indicated

​

If the pregnancy is 32–34 weeks and no labor - stabilize and administer IM steroids for lung maturity and vaginal delivery is preferred after 24–48 hours of treatment, give:

​

  • Dexamethasone 6 mg IM 12 hourly in 48 hours 

 

If the pregnancy is less than 32 weeks Caesarean section is preferred as the success of induction

 

Updated 3.11.2020

​

References

​

1. STG

bottom of page