Eclampsia - Revision history

Danbot: Strip excess bold

2026-03-22T09:35:25Z

Strip excess bold

← Older revision		Revision as of 09:35, 22 March 2026
Line 3:		Line 3:
	*Occurs after 20 weeks gestation or up to 6 weeks postpartum<ref name="acog">ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia. ''Obstet Gynecol''. 2020;135(6):e237-e260. PMID 32443079.</ref>		*Occurs after 20 weeks gestation or up to 6 weeks postpartum<ref name="acog">ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia. ''Obstet Gynecol''. 2020;135(6):e237-e260. PMID 32443079.</ref>
	*May occur earlier with [[Gestational trophoblastic disease\|gestational trophoblastic disease]]		*May occur earlier with [[Gestational trophoblastic disease\|gestational trophoblastic disease]]
	*Can occur ~~'''~~without~~'''~~ preceding hypertension or proteinuria in up to 20% of cases		*Can occur without preceding hypertension or proteinuria in up to 20% of cases
	*Maternal mortality ~1% in developed countries; leading cause of maternal death worldwide<ref name="duley">Duley L. The global impact of pre-eclampsia and eclampsia. ''Semin Perinatol''. 2009;33(3):130-137. PMID 19464502.</ref>		*Maternal mortality ~1% in developed countries; leading cause of maternal death worldwide<ref name="duley">Duley L. The global impact of pre-eclampsia and eclampsia. ''Semin Perinatol''. 2009;33(3):130-137. PMID 19464502.</ref>

Line 21:		Line 21:

	==Evaluation==		==Evaluation==
	*~~'''~~Labs~~'''~~		*Labs
	**CBC with platelets (thrombocytopenia suggests [[HELLP syndrome]])		**CBC with platelets (thrombocytopenia suggests [[HELLP syndrome]])
	**CMP (creatinine, LFTs, uric acid)		**CMP (creatinine, LFTs, uric acid)
Line 28:		Line 28:
	**Coagulation studies (PT/INR, fibrinogen)		**Coagulation studies (PT/INR, fibrinogen)
	**Type and screen		**Type and screen
	*~~'''~~Imaging~~'''~~		*Imaging
	**CT head if atypical features, focal deficits, or prolonged postictal state		**CT head if atypical features, focal deficits, or prolonged postictal state
	*~~'''~~Fetal assessment~~'''~~ — continuous cardiotocography		*Fetal assessment — continuous cardiotocography

	==Management==		==Management==
	===Seizure Treatment===		===Seizure Treatment===
	*~~'''~~[[Magnesium sulfate]]~~'''~~ — first-line for eclamptic seizures<ref name="magpie">The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? ''Lancet''. 2002;359(9321):1877-1890. PMID 12057549.</ref>		*[[Magnesium sulfate]] — first-line for eclamptic seizures<ref name="magpie">The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? ''Lancet''. 2002;359(9321):1877-1890. PMID 12057549.</ref>
	**Loading: ~~'''~~4-6 g IV over 15-20 min~~'''~~		**Loading: 4-6 g IV over 15-20 min
	**Maintenance: ~~'''~~1-2 g/hr IV infusion~~'''~~		**Maintenance: 1-2 g/hr IV infusion
	**If no IV access: 10 g IM (5 g in each buttock), then 5 g IM q4h		**If no IV access: 10 g IM (5 g in each buttock), then 5 g IM q4h
	**Monitor for toxicity: loss of deep tendon reflexes, respiratory depression		**Monitor for toxicity: loss of deep tendon reflexes, respiratory depression
	**Therapeutic range: 4.8-8.4 mg/dL		**Therapeutic range: 4.8-8.4 mg/dL
	**Antidote for Mg toxicity: ~~'''~~[[Calcium gluconate]] 1 g IV~~'''~~		**Antidote for Mg toxicity: [[Calcium gluconate]] 1 g IV
	*If seizures recur despite magnesium:		*If seizures recur despite magnesium:
	**Additional 2 g MgSO4 IV bolus		**Additional 2 g MgSO4 IV bolus
Line 47:		Line 47:
	===Blood Pressure Control===		===Blood Pressure Control===
	*Target: SBP 130-150, DBP 80-100		*Target: SBP 130-150, DBP 80-100
	*~~'''~~[[Labetalol]]~~'''~~ 20 mg IV, then 40 mg, then 80 mg q10-20 min (max 300 mg)		*[[Labetalol]] 20 mg IV, then 40 mg, then 80 mg q10-20 min (max 300 mg)
	*~~'''~~[[Hydralazine]]~~'''~~ 5 mg IV over 1-2 min, repeat 5-10 mg q20 min (max 30 mg)		*[[Hydralazine]] 5 mg IV over 1-2 min, repeat 5-10 mg q20 min (max 30 mg)
	*~~'''~~[[Nicardipine]]~~'''~~ infusion 5 mg/hr, titrate by 2.5 mg/hr q5-15 min (max 15 mg/hr)		*[[Nicardipine]] infusion 5 mg/hr, titrate by 2.5 mg/hr q5-15 min (max 15 mg/hr)

	===Delivery===		===Delivery===
	*Definitive treatment is ~~'''~~delivery~~'''~~		*Definitive treatment is delivery
	*Emergent OB/GYN consultation		*Emergent OB/GYN consultation
	*Stabilize mother before delivery		*Stabilize mother before delivery
Line 58:		Line 58:

	==Disposition==		==Disposition==
	*~~'''~~Admit~~'''~~ to ICU or labor and delivery		*Admit to ICU or labor and delivery
	*Emergent OB/GYN consultation		*Emergent OB/GYN consultation

Danbot: Major expansion: clinical features, evaluation, peer-reviewed references, structured management with dosing

2026-03-21T18:29:41Z

Major expansion: clinical features, evaluation, peer-reviewed references, structured management with dosing

← Older revision		Revision as of 18:29, 21 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	*[[Preeclampsia]] ~~and eclampsia are diagnosed~~ after ~~20wks~~ gestation and <~~4wk post-partum~~		*New-onset [[Seizure\|seizures]] in a patient with [[Preeclampsia\|preeclampsia]], not attributable to other causes
	**May occur ~~sooner~~ with gestational trophoblastic disease		*Occurs after 20 weeks gestation or up to 6 weeks postpartum<ref name="acog">ACOG Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia. ''Obstet Gynecol''. 2020;135(6):e237-e260. PMID 32443079.</ref>
	*~~Suspect~~ in ~~any pregnant patient who is~~ >~~20wk or~~ <~~4wk postpartum who develops~~ seizures		*May occur earlier with [[Gestational trophoblastic disease\|gestational trophoblastic disease]]
			*Can occur '''without''' preceding hypertension or proteinuria in up to 20% of cases
			*Maternal mortality ~1% in developed countries; leading cause of maternal death worldwide<ref name="duley">Duley L. The global impact of pre-eclampsia and eclampsia. ''Semin Perinatol''. 2009;33(3):130-137. PMID 19464502.</ref>

			==Clinical Features==
			*Generalized tonic-clonic seizures (typically self-limited, 60-90 seconds)
			*Often preceded by:
			**Severe [[headache]] (occipital or frontal)
			**Visual disturbances (blurred vision, scotomata, cortical blindness)
			**Epigastric or RUQ pain
			**Hyperreflexia / clonus
			*Hypertension (SBP >=160 or DBP >=110), though may be absent
			*Peripheral [[edema]], facial edema
			*May progress to [[Status epilepticus\|status epilepticus]], [[HELLP syndrome]], [[Placental abruption\|abruption]], or [[DIC]]

	==Differential Diagnosis==		==Differential Diagnosis==
	~~''[[Preeclampsia]]''~~

	{{Seizure DDX}}		{{Seizure DDX}}

	~~{{Postpartum emergencies DDX}}~~		==Evaluation==
			*'''Labs'''
			**CBC with platelets (thrombocytopenia suggests [[HELLP syndrome]])
			**CMP (creatinine, LFTs, uric acid)
			**LDH, haptoglobin, peripheral smear (evaluate for hemolysis)
			**Urinalysis (proteinuria)
			**Coagulation studies (PT/INR, fibrinogen)
			**Type and screen
			*'''Imaging'''
			**CT head if atypical features, focal deficits, or prolonged postictal state
			*'''Fetal assessment''' — continuous cardiotocography

	==Management==		==Management==
	#[[~~Delivery~~]]		===Seizure Treatment===
	~~#Seizure treatment~~		*'''[[Magnesium sulfate]]''' — first-line for eclamptic seizures<ref name="magpie">The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? ''Lancet''. 2002;359(9321):1877-1890. PMID 12057549.</ref>
	#*~~{{MedicationDose\|drug=Magnesium sulfate\|dose=~~4-6 g ~~load in 100 mL~~ over 20~~-30~~ min~~, then~~ 1-2 g/hr ~~maintenance\|route=~~IV~~\|context=Eclampsia seizure treatment\|indication=Eclampsia\|population=Adult\|display=Magnesium}}~~		**Loading: '''4-6 g IV over 15-20 min'''
	#**If no IV ~~Access, give Magnesium sulfate 50% solution~~ IM ~~10g Loading Dose~~ (5g in each buttock), ~~followed by~~ 5 g IM ~~q 4 hours~~		**Maintenance: '''1-2 g/hr IV infusion'''
	#**~~Observe~~ for loss of reflexes, respiratory depression		**If no IV access: 10 g IM (5 g in each buttock), then 5 g IM q4h
	#**~~If seizure responds and unable to urgently transport to Ob Unit: Monitor serum Mg Levels q 4 hours (therapeutic~~ range: 4.9-8.~~5mg~~/dL~~) and obtain CTH~~		**Monitor for toxicity: loss of deep tendon reflexes, respiratory depression
	#**~~Must adjust dose in patients with renal failure~~		**Therapeutic range: 4.8-8.4 mg/dL
	#*If seizures recur:		**Antidote for Mg toxicity: '''[[Calcium gluconate]] 1 g IV'''
	#**~~Consider alternative diagnosis~~		*If seizures recur despite magnesium:
	~~#**Consider other [[anticonvulsant]] drugs~~		**Additional 2 g MgSO4 IV bolus
	#***[[Lorazepam]], [[~~diazepam]], [[phenytoin]], [[levetiracetam~~]]		**If refractory: [[Lorazepam]] 4 mg IV, or [[Diazepam]] 5-10 mg IV
	~~#*Contraindications to magnesium<ref>Eclampsia Checklist. ACOG. https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/hy04bF140807EclampsiaChecklist.pdf?dmc~~=~~1&ts~~=~~20170620T1844454355.</ref>:~~
	#**Severe [[renal failure]]		===Blood Pressure Control===
	~~#**[[Pulmonary edema]]~~		*Target: SBP 130-150, DBP 80-100
	~~#**[[Myasthenia gravis]]~~		*'''[[Labetalol]]''' 20 mg IV, then 40 mg, then 80 mg q10-20 min (max 300 mg)
	~~#BP Control (target Sys~~ 130-150, ~~Dia~~ 80-100)		*'''[[Hydralazine]]''' 5 mg IV over 1-2 min, repeat 5-10 mg q20 min (max 30 mg)
	#*~~{{MedicationDose\|drug=~~Labetalol~~\|dose=~~20 mg IV ~~initial;~~ then ~~20-~~80 mg ~~q10min~~ (max 300 mg ~~total~~) ~~OR 20 mg IV then infusion 1-2 mg/min\|route=IV\|context=BP control in eclampsia\|indication=Eclampsia\|max_dose=300 mg total}}~~		*'''[[Nicardipine]]''' infusion 5 mg/hr, titrate by 2.5 mg/hr q5-15 min (max 15 mg/hr)
	#*~~{{MedicationDose\|drug=~~Hydralazine~~\|dose=~~5 mg IV over 1-2 min; repeat 5-10 mg ~~q20min PRN\|route=IV\|context=BP control in eclampsia\|indication=Eclampsia\|max_dose=~~30 mg ~~total}}~~
	~~#Persistent seizure~~		===Delivery===
	#*~~See~~ [[~~status epilepticus~~]]		*Definitive treatment is '''delivery'''
	#*~~Plan appropriately for~~ delivery		*Emergent OB/GYN consultation
			*Stabilize mother before delivery
			*Continue magnesium 24-48 hours postpartum

	==Disposition==		==Disposition==
	*Admit~~, emergent~~ OB/GYN consultation		*'''Admit''' to ICU or labor and delivery
			*Emergent OB/GYN consultation

	==See Also==		==See Also==
	*[[Post-Partum Emergencies]]
	*[[Preeclampsia]]		*[[Preeclampsia]]
	*[~~https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/19sm02a170703EclampsiaCheck1.pdf?dmc=1&ts=20190908T1328374017 ACOG Eclampsia Checklist~~]		*[[HELLP syndrome]]
			*[[Status epilepticus]]
			*[[Hypertensive emergency]]

	==References==		==References==
	<references/>		<references/>

	*EBM, Volume 12, Number 8, Aug 2010. Postpartum Emergencies
	*Uptodate

	[[Category:OBGYN]]		[[Category:OBGYN]]

Danbot: Add MedicationDose templates for Labetalol and Hydralazine (BP control); dosing verified per ACOG guidelines

2026-03-20T16:08:27Z

Add MedicationDose templates for Labetalol and Hydralazine (BP control); dosing verified per ACOG guidelines

← Older revision		Revision as of 16:08, 20 March 2026
Line 27:		Line 27:
	#**[[Pulmonary edema]]		#**[[Pulmonary edema]]
	#**[[Myasthenia gravis]]		#**[[Myasthenia gravis]]
	#BP Control		#BP Control (target Sys 130-150, Dia 80-100)
	~~#*Lower to~~ Sys 130-150, ~~dia~~ 80-100		#*{{MedicationDose\|drug=Labetalol\|dose=20 mg IV initial; then 20-80 mg q10min (max 300 mg total) OR 20 mg IV then infusion 1-2 mg/min\|route=IV\|context=BP control in eclampsia\|indication=Eclampsia\|max_dose=300 mg total}}
	#**[[Labetalol]]		#*{{MedicationDose\|drug=Hydralazine\|dose=5 mg IV over 1-2 min; repeat 5-10 mg q20min PRN\|route=IV\|context=BP control in eclampsia\|indication=Eclampsia\|max_dose=30 mg total}}
	~~#***Option 1: Initial 20mg~~; then ~~doses of~~ 20-~~80mg~~ q10min to total ~~of 300mg~~
	~~#***Option 2: Initial 20mg;~~ then IV infusion of 1-~~2mg~~/min
	#**[[Hydralazine]]
	~~#***5mg~~ IV over 1-~~2min~~; repeat ~~bolus of~~ 5-~~10mg~~ q20min PRN to total ~~of 30mg~~
	#Persistent seizure		#Persistent seizure
	#*See [[status epilepticus]]		#*See [[status epilepticus]]

Danbot: Convert magnesium to MedicationDose template with SMW; dosing verified per ACOG

2026-03-20T15:57:21Z

Convert magnesium to MedicationDose template with SMW; dosing verified per ACOG

← Older revision		Revision as of 15:57, 20 March 2026
Line 14:		Line 14:
	#[[Delivery]]		#[[Delivery]]
	#Seizure treatment		#Seizure treatment
	#*[[Magnesium~~]]: Load~~ 4-6 g ~~10% magnesium sulfate~~ in ~~100ml solution IV~~ over 20-30 min, then ~~start maintenance dose:~~ 1-2 g/hr		#*{{MedicationDose\|drug=Magnesium sulfate\|dose=4-6 g load in 100 mL over 20-30 min, then 1-2 g/hr maintenance\|route=IV\|context=Eclampsia seizure treatment\|indication=Eclampsia\|population=Adult\|display=Magnesium}}
	#**If no IV Access, give Magnesium sulfate 50% solution IM 10g Loading Dose (5g in each buttock), followed by 5 g IM q 4 hours		#**If no IV Access, give Magnesium sulfate 50% solution IM 10g Loading Dose (5g in each buttock), followed by 5 g IM q 4 hours
	#**Observe for loss of reflexes, respiratory depression		#**Observe for loss of reflexes, respiratory depression

Michellejhun: /* Management */

2025-06-20T09:58:44Z

Management

← Older revision		Revision as of 09:58, 20 June 2025
Line 14:		Line 14:
	#[[Delivery]]		#[[Delivery]]
	#Seizure treatment		#Seizure treatment
	#*[[Magnesium]]: Load 4-6 g IV over 15 min ~~followed by~~ 2~~-3 gm~~/hr		#*[[Magnesium]]: Load 4-6 g 10% magnesium sulfate in 100ml solution IV over 20-30 min, then start maintenance dose: 1-2 g/hr
	#**~~Can~~ give ~~up to 10 gm~~ IM (~~5 g~~ in each buttock)		#**If no IV Access, give Magnesium sulfate 50% solution IM 10g Loading Dose (5g in each buttock), followed by 5 g IM q 4 hours
	#**Observe for loss of reflexes, respiratory depression		#**Observe for loss of reflexes, respiratory depression
			#**If seizure responds and unable to urgently transport to Ob Unit: Monitor serum Mg Levels q 4 hours (therapeutic range: 4.9-8.5mg/dL) and obtain CTH
	#**Must adjust dose in patients with renal failure		#**Must adjust dose in patients with renal failure
	#*If seizures recur:		#*If seizures recur:

ClaireLewis at 22:28, 1 October 2019

2019-10-01T22:28:12Z

← Older revision		Revision as of 22:28, 1 October 2019
Line 20:		Line 20:
	#*If seizures recur:		#*If seizures recur:
	#**Consider alternative diagnosis		#**Consider alternative diagnosis
	#**Consider other anticonvulsant drugs		#**Consider other [[anticonvulsant]] drugs
	#***[[Lorazepam]], [[diazepam]], [[phenytoin]], [[levetiracetam]]		#***[[Lorazepam]], [[diazepam]], [[phenytoin]], [[levetiracetam]]
	#*Contraindications to magnesium<ref>Eclampsia Checklist. ACOG. https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/hy04bF140807EclampsiaChecklist.pdf?dmc=1&ts=20170620T1844454355.</ref>:		#*Contraindications to magnesium<ref>Eclampsia Checklist. ACOG. https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/hy04bF140807EclampsiaChecklist.pdf?dmc=1&ts=20170620T1844454355.</ref>:
Line 31:		Line 31:
	#***Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg		#***Option 1: Initial 20mg; then doses of 20-80mg q10min to total of 300mg
	#***Option 2: Initial 20mg; then IV infusion of 1-2mg/min		#***Option 2: Initial 20mg; then IV infusion of 1-2mg/min
	#**Hydralazine		#**[[Hydralazine]]
	#***5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg		#***5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
	#Persistent seizure		#Persistent seizure
Line 38:		Line 38:

	==Disposition==		==Disposition==
	*~~Emergent~~ OB/GYN consultation		*Admit, emergent OB/GYN consultation

	==See Also==		==See Also==

Jvfernan: /* See Also */

2019-09-08T13:32:31Z

Kxl328: /* Management */

2019-02-27T02:19:30Z

Management

← Older revision		Revision as of 02:19, 27 February 2019
Line 33:		Line 33:
	#**Hydralazine		#**Hydralazine
	#***5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg		#***5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
	#*Persistent seizure		#Persistent seizure
	#**See [[status epilepticus]]		#*See [[status epilepticus]]
	#**Plan appropriately for delivery		#*Plan appropriately for delivery

	==Disposition==		==Disposition==

Kxl328: /* Management */

2019-02-27T02:18:55Z

Management

← Older revision		Revision as of 02:18, 27 February 2019
Line 19:		Line 19:
	#**Must adjust dose in patients with renal failure		#**Must adjust dose in patients with renal failure
	#*If seizures recur:		#*If seizures recur:
			#**Consider alternative diagnosis
	#**Consider other anticonvulsant drugs		#**Consider other anticonvulsant drugs
	#**~~Consider alternative diagnosis~~		#***[[Lorazepam]], [[diazepam]], [[phenytoin]], [[levetiracetam]]
	#*Contraindications to magnesium<ref>Eclampsia Checklist. ACOG. https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/hy04bF140807EclampsiaChecklist.pdf?dmc=1&ts=20170620T1844454355.</ref>:		#*Contraindications to magnesium<ref>Eclampsia Checklist. ACOG. https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/hy04bF140807EclampsiaChecklist.pdf?dmc=1&ts=20170620T1844454355.</ref>:
	#**Severe [[renal failure]]		#**Severe [[renal failure]]
Line 32:		Line 33:
	#**Hydralazine		#**Hydralazine
	#***5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg		#***5mg IV over 1-2min; repeat bolus of 5-10mg q20min PRN to total of 30mg
			#*Persistent seizure
			#**See [[status epilepticus]]
			#**Plan appropriately for delivery

	==Disposition==		==Disposition==

Kxl328: /* Management */

2019-02-27T02:05:35Z

Management

← Older revision		Revision as of 02:05, 27 February 2019
Line 14:		Line 14:
	#[[Delivery]]		#[[Delivery]]
	#Seizure treatment		#Seizure treatment
	#*[[Magnesium]]: Load 4-6g IV over ~~15min~~ followed by 2-~~3gm~~/hr		#*[[Magnesium]]: Load 4-6 g IV over 15 min followed by 2-3 gm/hr
	#**Can give up to ~~10gm~~ IM		#**Can give up to 10 gm IM (5 g in each buttock)
	#**Observe for loss of reflexes, respiratory depression		#**Observe for loss of reflexes, respiratory depression
	#**Must adjust dose in patients with renal failure		#**Must adjust dose in patients with renal failure

← Older revision		Revision as of 13:32, 8 September 2019
Line 43:		Line 43:
	*[[Post-Partum Emergencies]]		*[[Post-Partum Emergencies]]
	*[[Preeclampsia]]		*[[Preeclampsia]]
	*[https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/~~hy04bF140807EclampsiaChecklist~~.pdf?dmc=1&ts=~~20170620T1844454355~~ ACOG Eclampsia Checklist]		*[https://www.acog.org/-/media/Districts/District-II/Public/SMI/v2/19sm02a170703EclampsiaCheck1.pdf?dmc=1&ts=20190908T1328374017 ACOG Eclampsia Checklist]

	==References==		==References==