Obstetric Emergencies
Eclampsia is the occurrence of generalized tonic-clonic seizures and/or coma in a woman with preeclampsia, not attributable to any other neurological cause. It is a medical emergency with high maternal and fetal mortality.
Epidemiology & Risk Factors
1 in 2000 (developed) to 1 in 100 (low-resource). Most in third trimester or postpartum.
- Primigravida
- Teenage/elderly mothers
- Multiple pregnancy
- Chronic HTN, renal disease
- Poor ANC
Pathophysiology
Placental ischemia → endothelial dysfunction → cerebral vasospasm → edema → seizures.
Clinical Features
Prodromal Signs
- Severe headache
- Visual disturbances
- Epigastric pain
- Restlessness
Seizure Stages
- Premonitory: facial twitching
- Tonic: rigidity (~15–20s)
- Clonic: jerking (~60s)
- Coma: variable duration
Timing
- Antepartum: 50%
- Intrapartum: 30%
- Postpartum: 20%
Management: Control, Stabilize, Deliver
MgSO₄ (Pritchard Regimen)
- Loading: 4g IV + 10g IM
- Maintenance: 5g IM q4h × 24h
- Monitor: reflexes, RR ≥16, UO ≥25 mL/h
- Antidote: Calcium gluconate 10 mL IV
| Drug | Dose | Comments |
|---|---|---|
| Labetalol | 20–80 mg IV q10min | First-line |
| Hydralazine | 5–10 mg IV q20min | Emergency |
| Nifedipine | 10 mg PO | Avoid with MgSO₄ |
Definitive: Delivery after stabilization
Prevention
- Early ANC
- Aspirin 75–150 mg from 12w (high-risk)
- Calcium 1–2 g/day
Key Takeaways
- Eclampsia = seizures in preeclampsia
- Prodromal: headache, vision, pain
- MgSO₄ Pritchard regimen
- Monitor reflexes, UO, RR
- Delivery = cure
- Postpartum risk up to 2 weeks
Conclusion
Eclampsia is preventable with early detection of preeclampsia. MgSO₄ and timely delivery save lives.
Eclampsia is a race against time — act before the seizure.