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Eclampsia
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Eclampsia
, Toxemia of Pregnancy, Eclamptic Seizure
Definitions
Eclampsia ("sudden flash" or "shining forth")
Most severe form of PIH characterized by
Seizure
s
Also referred to as Toxemia or "toxin present"
Epidemiology
Rare <20 weeks gestation (except in hydatiform mole)
Most episodes occur prior to delivery
Antepartum
Seizure
: 53% of cases
Intrapartum
Seizure
: 19% of cases
Postpartum
Seizure
: 28% of cases
Majority (79%) of postpartum
Seizure
s are late postpartum (>48 hours after delivery)
Pathophysiology
Results from focal cerebral edema
Associated with transient
Vasocon
striction and ischemia
Usually results from progressive
Severe Preeclampsia
May also occur with little warning
Mild Preeclampsia
may precede Eclamptic Seizure
Blood Pressure
is only mildly increased in 30-60% of patients
Up to 15% of cases have diastolic BP <90 mmHg
Signs
See
Preeclampsia
Phase 0: Preceding symptoms
Headache
(80%)
Visual changes (45%)
Phase 1: Prodrome (brief)
Twitching
Facial congestion
Mouth foaming
Altered Level of Consciousness
Phase 2: Tonic
Muscle
rigidity
Phase 3:
GTCS
activity for 1 to 1.5 minutes
Rhythmic
Muscle Contraction
s and relaxation
Generalized Tonic Clonic Seizure
Loss of respiratory activity
Fetal Bradycardia
Phase 4:
Coma
tose
Respiratory effort, but otherwise comatose
Phase 5: Post-ictal
Confused and agitated, combative
Management
See
Eclamptic Seizure Management
References
Fontaine (2000) in ALSO, B:1-36
Sibai in Gabbe (2002) Obstetrics, p. 945-74
(2000) Am J Obstet Gynecol 183(1):S1-22 [PubMed]
Leeman (2016) Am Fam Physician 93(2):121-7 [PubMed]
Zamorski (2001) Clin Fam Pract 3:329-47 [PubMed]
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