The occurrence of one or more convulsions in a pre-eclamptic woman ****in the absence of any other neurological or metabolic cause

Aetiology

• All patients with pre-eclampsia are at risk of developing eclampsia
• Eclampsia is more common in teenagers

Clinical features

• The hallmark feature of eclampsia is a new onset tonic-clonic type seizure, in the presence of pre-eclampsia
• Other signs and symptoms include:
  • Headache (usually frontal)
  • Hyper-reflexia
  • Nausea and vomiting
  • Generalised oedema
  • Right upper quadrant pain +/- jaundice
  • Visual disturbances e.g. flashing lights, blurred or double vision
  • Change in mental state

Investigations

• Investigations in suspected eclampsia are used to exclude other reversible causes (such as hypoglycaemia), and assess for any complications (such as DIC or HELLP syndrome)
  • FBC, U+Es, LFTs, clotting studies, blood glucose
• It may be necessary to rule out other causes of seizures if there is any doubt regarding the diagnosis of eclampsia
  • e.g. if there is a history of head trauma or seizure onset in the 1st trimester, this is more likely to be associated with CNS pathology and requires a full neurological work-up including CT/ MRI head.

Management

• Control BP - IV labetolol, IV hydralazine
• Stop seizures - IV magnesium sulphate, if persistent seizures consider IV diazepam
• Fluid balance
• Delivery