eclampsia

File:Abdominal Quadrant Regions.jpg

Eclampsia is a disorder of pregnancy characterized by seizures in the setting of pre-eclampsia.{{Cite book|title=Current diagnosis & treatment. Emergency medicine|last1=Stone|first1=C. Keith|last2=Humphries|first2=Roger L.|publisher=McGraw-Hill|year=2017|isbn=9780071840613|edition=8th|location=New York|chapter=Chapter 19: Seizures|oclc=959876721}} Most people have premonitory signs/symptoms in the hours before the initial seizure. Typically the person develops hypertension before the onset of a convulsion (seizure).{{cite journal|year=2013|title=Contemporary Clinical Management of the Cerebral Complications of Preeclampsia|journal=Obstetrics and Gynecology International|volume=2013|pages=1–10|doi=10.1155/2013/985606|pmc=3893864|pmid=24489551|vauthors=Kane SC, Dennis A, da Silva Costa F, Kornman L, Brennecke S|doi-access=free}} Other signs and symptoms include:{{Cite journal |last1=Berhan |first1=Yifru |last2=Berhan |first2=Asres |date=June 2015 |title=Should magnesium sulfate be administered to women with mild pre-eclampsia? A systematic review of published reports on eclampsia: Systematic review of reports on eclampsia |url=https://onlinelibrary.wiley.com/doi/10.1111/jog.12697 |journal=Journal of Obstetrics and Gynaecology Research |language=en |volume=41 |issue=6 |pages=831–842 |doi=10.1111/jog.12697|pmid=25833188 |s2cid=41573228 }}

• Long-lasting (persistent) frontal, occipital, or thunderclap headaches{{Cite journal |last=Zeeman |first=Gerda G. |date=June 2009 |title=Neurologic Complications of Pre-eclampsia |url=http://dx.doi.org/10.1053/j.semperi.2009.02.003 |journal=Seminars in Perinatology |volume=33 |issue=3 |pages=166–172 |doi=10.1053/j.semperi.2009.02.003 |pmid=19464507 |issn=0146-0005}}
• Visual disturbance (blurred vision, photophobia, diplopopia)
• Photophobia (discomfort from bright light)
• Abdominal pain, often in the epigastric region (the center of the abdomen above the navel) or in the right upper quadrant of the abdomen (below the right side of the rib cage)
• Altered mental status (confusion)

Any of these symptoms may be present before or after the seizure. It is also possible for the person to be asymptomatic prior to the onset of the seizure.{{Citation needed|date=April 2025}}

Other cerebral signs that may precede the convulsion include nausea, vomiting, headaches, and cortical blindness. If the complication of multi-organ failure ensues, signs and symptoms of those failing organs will appear, such as abdominal pain, jaundice, shortness of breath, and diminished urine output.

The seizures of eclampsia typically present during pregnancy and prior to delivery (the antepartum period), but may also occur during labor and delivery (the intrapartum period) or after the baby has been delivered (the postpartum period).{{Cite book|title=Obstetrics : Normal and Problem Pregnancies|last=Gabbe MD|first=Steven G.|publisher=Elsevier, Inc.|others=Jennifer R. Niebyl MD, Joe Leigh Simpson MD, Mark B. Landon MD, Henry L. Galan MD, Eric R.M. Jauniaux MD, PhD, Deborah A. Driscoll MD, Vincenzo Berghella MD and William A. Grobman MD, MBA|year=2017|isbn=9780323321082|edition=7th|location=Philadelphia|pages=661–705|chapter=Chapter 31: Preeclampsia and Hypertensive Disorders|oclc=951627252}}{{Cite book|title=Williams Obstetrics|last=Cunningham|first=F. Gary|publisher=McGraw-Hill Education|others=Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS.|year=2014|isbn=9780071798938|edition=24th|location=New York|chapter=Chapter 40: Hypertensive Disorders|oclc=871619675}} If postpartum seizures develop, it is most likely to occur within the first 48 hours after delivery. However, late postpartum seizures of eclampsia may occur as late as 4 weeks after delivery.

Eclamptic seizure is typically described as a tonic–clonic seizure which may cause an abrupt loss of consciousness at onset.{{Cite journal |last1=Sanders |first1=T G |last2=Clayman |first2=D A |last3=Sanchez-Ramos |first3=L |last4=Vines |first4=F S |last5=Russo |first5=L |date=August 1991 |title=Brain in eclampsia: MR imaging with clinical correlation. |url=http://dx.doi.org/10.1148/radiology.180.2.2068315 |journal=Radiology |volume=180 |issue=2 |pages=475–478 |doi=10.1148/radiology.180.2.2068315 |pmid=2068315 |issn=0033-8419}} This is often associated with a shriek or scream followed by stiffness of the muscles of the arms, legs, back and chest. During the tonic phase, the mother may begin to appear cyanotic. This presentation lasts for about a minute, after which the muscles begin in jerk and twitch for an additional one to two minutes.{{Cite journal |last=Spurr |first=Frederick |title=Three Cases of Puerperal Eclampsia |date=June 1900 |url=http://dx.doi.org/10.1016/s0140-6736(01)78186-x |journal=The Lancet |volume=155 |issue=4007 |pages=1717–1719 |doi=10.1016/s0140-6736(01)78186-x |issn=0140-6736}} Other signs include tongue biting, frothy and bloody sputum coming out of the mouth.{{Cite journal |last1=Wichert-Ana |first1=Lauro |last2=Ferruzzi |first2=Emerson Henklain |last3=Alexandre Jr |first3=Veriano |last4=Velasco |first4=Tonicarlo Rodrigues |last5=Bianchin |first5=Marino Muxfeldt |last6=Terra-Bustamante |first6=Vera Cristina |last7=Kato |first7=Mery |last8=Santos |first8=Antonio Carlos |last9=Azevedo-Marques |first9=Paulo Mazzoncini de |last10=Oliveira |first10=Lucas Ferrari de |last11=Sakamoto |first11=Américo Ceiki |date=December 2006 |title=Epistaxis during a generalized seizure leading to an atypical ictal SPECT finding at the skull base |journal=Journal of Epilepsy and Clinical Neurophysiology |volume=12 |issue=4 |pages=225–227 |doi=10.1590/s1676-26492006000700007 |issn=1676-2649|doi-access=free }}

There are risks to both the parent and the fetus when eclampsia occurs. The fetus may grow more slowly than normal within the womb (uterus) of a person with eclampsia, which is termed intrauterine growth restriction and may result in the child appearing small for gestational age or being born with low birth weight.{{Cite book|title=Essence of Anesthesia Practice|last=Fleisher MD|first=Lee A.|publisher=Elsevier Inc|others=Roizen, Michael F., Roizen, Jeffrey D.|year=2018|isbn=9780323394970|edition=4th|location=Philadelphia|pages=153–154|chapter=Chapter: Eclampsia|oclc=989062320}} Eclampsia may also cause problems with the placenta. The placenta may bleed (hemorrhage) or begin to separate early from the wall of the uterus.{{Cite book|title=Oh's Intensive Care Manual|last=Bersten|first=Andrew D.|publisher=Elsevier Ltd|others=Soni, Neil|year=2014|isbn=9780702047626|edition=7th|location=[Oxford]|pages=677–683|chapter=Chapter 63: Preeclampsia and eclampsia|oclc=868019515}} It is normal for the placenta to separate from the uterine wall during delivery, but it is abnormal for it to separate prior to delivery; this condition is called placental abruption and can be dangerous for the fetus.{{Cite book|title=Creasy and Resnik's maternal-fetal medicine : principles and practice|others=Creasy, Robert K., Resnik, Robert, Greene, Michael F., Iams, Jay D., Lockwood, Charles J.|year=2014|isbn=9781455711376|edition=7th|location=Philadelphia|pages=732–742|chapter=Chapter 46: Placenta Previa, Placenta Accreta, Abruptio Placentae, and Vasa Previa|oclc=859526325|last1 = Robert Resnik|first1 = MD|last2=Robert K. Creasy|first2=MD|last3=Jay D. Iams|first3=MD|last4=Charles J. Lockwood|first4=MD|last5=Thomas Moore|first5=MD|last6=Michael f Greene|first6=MD}} Placental insufficiency may also occur, a state in which the placenta fails to support appropriate fetal development because it cannot deliver the necessary amount of oxygen or nutrients to the fetus. During an eclamptic seizure, the beating of the fetal heart may become slower than normal (bradycardia). If any of these complications occurs, fetal distress may develop. Treatment of the parent’s seizures may also manage fetal bradycardia.{{Citation|last1=Gill|first1=Prabhcharan|title=Acute Eclampsia|url=http://www.ncbi.nlm.nih.gov/books/NBK459193/|work=StatPearls|publisher=StatPearls Publishing|pmid=29083632|access-date=2019-08-04|last2=Tamirisa|first2=Anita P.|last3=Van Hook MD|first3=James W.|year=2020}} If the risk to the health of the fetus or the parent is high, the definitive treatment for eclampsia is delivery of the baby. Delivery by cesarean section may be necessary, especially if the instance of fetal bradycardia does not resolve after 10 to 15 minutes of resuscitative interventions.{{Cite journal|last=Sibai|first=Baha M.|date=February 2005|title=Diagnosis, prevention, and management of eclampsia|journal=Obstetrics and Gynecology|volume=105|issue=2|pages=402–410|doi=10.1097/01.AOG.0000152351.13671.99|issn=0029-7844|pmid=15684172}} It may be safer to deliver the infant preterm than to wait for the full 40 weeks of fetal development to finish, and as a result prematurity is also a potential complication of eclampsia.{{Cite book|title=High risk pregnancy : management options|url=https://archive.org/details/highriskpregnanc00jame|url-access=limited|publisher=Saunders/Elsevier|others=James, D. K. (David K.), Steer, Philip J.|year=2011|isbn=9781416059080|edition=4th|location=St. Louis|pages=[https://archive.org/details/highriskpregnanc00jame/page/n618 599]–626|chapter=Chapter 35: Hypertension|oclc=727346377}}

In the parent, changes in vision may occur as a result of eclampsia, and these changes may include blurry vision, one-sided blindness (either temporary due to amaurosis fugax or potentially permanent due to retinal detachment), or cortical blindness, which affects the vision from both eyes.{{cite journal|date=April 1995|title=Blindness associated with preeclampsia and eclampsia|journal=American Journal of Obstetrics and Gynecology|volume=172|issue=4 Pt 1|pages=1291–1298|doi=10.1016/0002-9378(95)91495-1|pmid=7726272|vauthors=Cunningham FG, Fernandez CO, Hernandez C}}{{Cite book|title=High Risk Pregnancy|url=https://archive.org/details/highriskpregnanc00jame|url-access=limited|last=James|first=David K.|publisher=Saunders/Elsevier|others=Steer, Philip J.|year=2011|isbn=9781416059080|edition=4th|location=St. Louis|pages=[https://archive.org/details/highriskpregnanc00jame/page/n880 861]–891|chapter=Chapter 48: Neurologic Complications of Preeclampsia/Eclampsia|oclc=727346377}} There are also potential complications in the lungs. The person may have fluid slowly collecting in the lungs in a process known as pulmonary edema. During an eclamptic seizure, it is possible for a person to vomit the contents of the stomach and to inhale some of this material in a process known as aspiration. If aspiration occurs, the person may experience difficulty breathing immediately or could develop an infection in the lungs later, called aspiration pneumonia.{{Cite book|title=Rutherford's vascular surgery|last=Cronenwett|first=Jack L.|publisher=Saunders, Elsevier|others=Johnston, K. Wayne|year=2014|isbn=9781455753048|edition=8th|location=Philadelphia|pages=626–637|chapter=Chapter 40: Systemic Complications: Respiratory|oclc=877732063}} It is also possible that during a seizure breathing will stop temporarily or become inefficient, and the amount of oxygen reaching the person’s body and brain will be decreased (in a state known as hypoxia).{{Cite book|title=Emergency medicine : clinical essentials|last=Adams|first=James|publisher=Elsevier/ Saunders|year=2013|isbn=9781437735482|edition=2nd|location=Philadelphia|pages=857–869|chapter=Chapter 99: Seizures|oclc=820203833}} If it becomes difficult for the person to breathe, they may need to have their breathing temporarily supported by an assistive device in a process called mechanical ventilation. In some severe eclampsia cases, the parent may become weak and sluggish (lethargy) or even comatose. These may be signs that the brain is swelling (cerebral edema) or bleeding (intracerebral hemorrhage).

Eclampsia, like pre-eclampsia, tends to occur more commonly in first pregnancies than subsequent pregnancies.{{Cite book|title=Creasy and Resnik's Maternal-Fetal Medicine : Principles and Practice|publisher=Saunders, an imprint of Elsevier Inc.|others=Creasy, Robert K.,, Resnik, Robert,, Greene, Michael F.,, Iams, Jay D.,, Lockwood, Charles J.|year=2014|isbn=9781455711376|edition=7th|location=Philadelphia|pages=756–781|chapter=Chapter 48: Pregnancy-Related Hypertension|oclc=859526325}}{{Cite book|title=Obstetrics : Normal and Problem Pregnancies|last=Gabbe MD|first=Steven G.|publisher=Elsevier, Inc|year=2017|isbn=9780323321082|edition=7th|location=Philadelphia|pages=661–705.e3|chapter=Chapter 31: Preeclampsia and Hypertensive Disorders|oclc=951627252|others=Jennifer R. Niebyl MD, Joe Leigh Simpson MD, Mark B. Landon MD, Henry L. Galan MD, Eric R.M. Jauniaux MD, PhD, Deborah A. Driscoll MD, Vincenzo Berghella MD and William A. Grobman MD, MBA}}{{Cite book|title=Greenspan's basic & clinical endocrinology|last=Gardner|first=David G.|publisher=McGraw-Hill Education|others=Shoback, Dolores M.,, Greenspan, Francis Sorrel|year=2018|isbn=9781259589287|edition=10th|location=[New York]|chapter=Chapter 16: The Endocrinology of Pregnancy|oclc=995848612}} People who have long term high blood pressure before becoming pregnant have a greater risk of pre-eclampsia. People who have gestational hypertension and pre-eclampsia have an increased risk of eclampsia.{{Cite journal |last=American College of Obstetricians and Gynecologists |date=June 2020 |title=Gestational Hypertension and Preeclampsia |journal=Obstetrics & Gynecology |volume=135 |issue=6 |pages=e237–e260 |doi=10.1097/AOG.0000000000003891 |pmid=32443079 |s2cid=218856298 |url=https://journals.lww.com/greenjournal/Fulltext/2020/06000/Gestational_Hypertension_and_Preeclampsia__ACOG.46.aspx |access-date=September 12, 2022}} Furthermore, people with other pre-existing vascular diseases (diabetes or nephropathy) or thrombophilia disease such as the antiphospholipid syndrome are at higher risk to develop pre-eclampsia and eclampsia. Having a placenta that is enlarged by multiple gestation or hydatidiform mole also increases risk of eclampsia.{{Cite book|title=Harrison's principles of internal medicine.|last=Kasper|first=Dennis L.|publisher=McGraw-Hill Education|others=Fauci, Anthony S., Hauser, Stephen L.,, Longo, Dan Louis, Jameson, J. Larry,, Loscalzo, Joseph|year=2015|isbn=9780071802154|edition=19th|location=New York|chapter=Chapter 117: Gynecologic Malignancies|oclc=893557976}} In addition, there is a genetic component: a person whose parent or sibling had the condition is at higher risk than otherwise.{{Cite book|title=Clinical genomics : practical applications in adult patient care|last=Murray|first=Michael F.|publisher=McGraw-Hill Education|others=Babyatsky, Mark W.,, Giovanni, Monica A.,, Alkuraya, Fowzan S.,, Stewart, Douglas R.|year=2014|isbn=9780071622448|edition=1st|location=New York|chapter=Chapter 102: Pre-eclampsia|oclc=899740989}} People who have experienced eclampsia are at increased risk for pre-eclampsia/eclampsia in a later pregnancy. The occurrence of pre-eclampsia was 5% in white, 9% in Hispanic, and 11% in African American patients and this may reflect disproportionate risk of developing pre-eclampsia among ethnic groups. Additionally, people who have black skin were also shown to have a disproportionately higher risk of dying from eclampsia.{{Cite book|url=https://www.worldcat.org/oclc/958829269|title=Williams obstetrics|others=Williams, J. Whitridge (John Whitridge), Cunningham, F. Gary,, Leveno, Kenneth J.,, Bloom, Steven L.,, Spong, Catherine Y.,, Dashe, Jodi S.|date=2018|isbn=978-1-259-64432-0|edition=25th|location=New York|oclc=958829269}}

File:Placenta.svg

The mechanisms of eclampsia and preeclampsia are not definitively understood, but following provides some insight. The presence of a placenta is required, and eclampsia resolves if it is removed. Reduced blood flow to the placenta (placental hypoperfusion) may be a key feature of the process. It is typically accompanied by increased sensitivity of the maternal vasculature to agents which cause constriction of the small arteries, leading to reduced blood flow to multiple organs. Vascular dysfunction-associated maternal conditions such as Lupus, hypertension, and renal disease, or obstetric conditions that increase placental volume without an increase in placental blood flow (such as multifetal gestation) may increase risk for pre-eclampsia.{{Cite book|url=https://www.worldcat.org/oclc/1075522289|title=Greenspan's basic & clinical endocrinology|others=Gardner, David G., Shoback, Dolores M., Greenspan, Francis S., (Francis Sorrel)|date=2017|isbn=9781259589287|edition=10th|location=New York|oclc=1075522289}} Also, activation of the coagulation cascade can lead to microthrombi formation, which may further impair blood flow. Thirdly, increased vascular permeability results in the shift of extracellular fluid from the blood to the interstitial space which reduces blood flow and causes edema. These events can lead to hypertension, renal dysfunction, pulmonary dysfunction, hepatic dysfunction, and cerebral edema with cerebral dysfunction and convulsions.{{cite journal |vauthors=Roberts JM, Cooper DW |s2cid=25280817 |title=Pathogenesis and genetics of pre-eclampsia |journal=Lancet |volume=357 |issue=9249 |pages=53–56 |date=January 2001 |pmid=11197372 |doi=10.1016/S0140-6736(00)03577-7}} In clinical context, increased platelet and endothelial activation may be detected before symptoms appear.

Hypoperfusion of the placenta is associated with abnormal modelling of the fetal–maternal placental interface that may be immunologically mediated. The pathogenesis of pre-eclampsia is poorly understood and may be attributed to factors related to the pregnant person and placenta since pre-eclampsia is seen in molar pregnancies absent of a fetus or fetal tissue. The placenta normally produces the potent vasodilator adrenomedullin but it is reduced in pre-eclampsia and eclampsia.{{cite journal |vauthors=Li H, Dakour J, Kaufman S, Guilbert LJ, Winkler-Lowen B, Morrish DW |title=Adrenomedullin is decreased in preeclampsia because of failed response to epidermal growth factor and impaired syncytialization |journal=Hypertension |volume=42 |issue=5 |pages=895–900 |date=November 2003 |pmid=14517225 |doi=10.1161/01.HYP.0000095613.41961.6E |url=http://hyper.ahajournals.org/cgi/pmidlookup?view=long&pmid=14517225|doi-access=free }} Other vasodilators, including prostacyclin, thromboxane A2, nitric oxide, and endothelins, are reduced in eclampsia and may lead to vasoconstriction.

Eclampsia is associated with hypertensive encephalopathy in which cerebral vascular resistance is reduced, leading to increased blood flow to the brain, cerebral edema and resultant convulsions.{{cite journal | author=Cipolla MJ | title=Cerebrovascular function in pregnancy and eclampsia | journal=Hypertension | volume=50 | issue=1 | pages=14–24 | date=July 2007 | pmid=17548723 | doi=10.1161/HYPERTENSIONAHA.106.079442 | doi-access=free }} An eclamptic convulsion usually does not cause chronic brain damage unless intracranial haemorrhage occurs.{{cite journal |vauthors=Richards A, Graham D, Bullock R |title=Clinicopathological study of neurological complications due to hypertensive disorders of pregnancy |journal=J. Neurol. Neurosurg. Psychiatry |volume=51 |issue=3 |pages=416–421 |date=March 1988 |pmid=3361333 |pmc=1032870 |doi=10.1136/jnnp.51.3.416}}

If a pregnant person has already been diagnosed with pre-eclampsia during the current pregnancy and then develops a seizure, they may be assigned a 'clinical diagnosis' of eclampsia without further workup. While seizures are most common in the third trimester, they may occur any time from 20 weeks of pregnancy until 6 weeks after birth.{{Cite book|url=https://www.worldcat.org/oclc/1191849672|title=Current medical diagnosis & treatment 2021|others=Papadakis, Maxine A., McPhee, Stephen J., Rabow, Michael W.|date=2020|isbn=978-1-260-46986-8|edition=60th|location=New York|oclc=1191849672}} Because pre-eclampsia and eclampsia are common conditions in pregnant people, eclampsia can be assumed to be the correct diagnosis until proven otherwise in pregnant or postpartum people who experience seizures.{{Cite journal|last1=Edlow|first1=Jonathan A.|last2=Caplan|first2=Louis R.|last3=O'Brien|first3=Karen|last4=Tibbles|first4=Carrie D.|s2cid=17711531|date=February 2013|title=Diagnosis of acute neurological emergencies in pregnant and post-partum women|journal=The Lancet. Neurology|volume=12|issue=2|pages=175–185|doi=10.1016/S1474-4422(12)70306-X|issn=1474-4465|pmid=23332362}} However, if a person has a seizure and it is unknown whether or not they have pre-eclampsia, testing can help make the diagnosis clear.

Pre-eclampsia is diagnosed when repeated blood pressure measurements are greater or equal to 140/90mmHg, in addition to any signs of organ dysfunction, including: proteinuria, thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, cerebral symptoms, or abdominal pain.{{Cite book |url=https://www.worldcat.org/oclc/1080940730 |title=Current diagnosis & treatment : obstetrics & gynecology |date=2019 |others=DeCherney, Alan H.|publisher=McGraw-Hill |isbn=978-0071833905 |edition=12th |location=[New York] |oclc=1080940730}}

One of the core features of pre-eclampsia is the new onset of high blood pressure. Blood pressure is a measurement of two numbers: systolic blood pressure and diastolic blood pressure. A systolic blood pressure (the top number) of greater than 140 mmHg and/or a diastolic blood pressure (the bottom number) of greater than 90 mmHg is higher than the normal range. If the blood pressure is high on at least two separate occasions after the first 20 weeks of pregnancy and the person has signs of organ dysfunction (e.g. proteinuria), then they meet the criteria for a diagnosis of pre-eclampsia. If the systolic blood pressure is greater than 160 or the diastolic pressure is greater than 110, the hypertension is considered to be severe.

Another common feature of pre-eclampsia is proteinuria, which is the presence of excess protein in the urine. To determine if proteinuria is present, the urine can be collected and tested for protein; if there is 0.3 grams of protein or more in the urine of a pregnant person collected over 24 hours, this is one of the diagnostic criteria for pre-eclampsia and raises the suspicion that a seizure is due to eclampsia.

In cases of severe eclampsia or pre-eclampsia, the person can have low levels of platelets in the blood, a condition termed thrombocytopenia.{{Cite book|title=Tintinalli's Emergency Medicine : A Comprehensive Study Guide|last=Tintinalli|first=Judith E.|publisher=McGraw-Hill Education|others=Stapczynski, J. Stephan, Ma, O. John, Yealy, Donald M., Meckler, Garth D., Cline, David|year=2016|isbn=9780071794763|edition=8th|location=New York|chapter=Chapter 100: Maternal Emergencies After 20 Weeks of Pregnancy and in the Postpartum Period|oclc=915775025}} A complete blood count, or CBC, is a test of the blood that can be performed to check platelet levels.

Other investigations include: kidney function test, liver function tests (LFT), coagulation screen, 24-hour urine creatinine, and fetal/placental ultrasound.

Convulsions during pregnancy that are unrelated to pre-eclampsia need to be distinguished from eclampsia. Such disorders include seizure disorders as well as brain tumor, aneurysm of the brain, and medication- or drug-related seizures. Usually, the presence of the signs of severe pre-eclampsia precede and accompany eclampsia, facilitating the diagnosis.

Detection and management of pre-eclampsia is critical to reduce the risk of eclampsia. The USPSTF recommends regular checking of blood pressure through pregnancy in order to detect preeclampsia.{{cite journal|last1=Sperling|first1=Jeffrey D.|last2=Gossett|first2=Dana R.|date=25 April 2017|title=Screening for Preeclampsia and the USPSTF Recommendations|journal=JAMA|volume=317|issue=16|pages=1629–1630|doi=10.1001/jama.2017.2018|pmid=28444259}} Appropriate management of a woman with pre-eclampsia generally involves the use of magnesium sulfate to prevent eclamptic seizures.{{Cite book|url=https://www.worldcat.org/oclc/1029074059|title=Harrison's principles of internal medicine|others=Jameson, J. Larry,, Kasper, Dennis L., Longo, Dan Louis, Fauci, Anthony S., Hauser, Stephen L., Loscalzo, Joseph|date=2018|isbn=978-1-259-64403-0|edition=20th|location=New York|oclc=1029074059}} In some cases, low-dose aspirin has been shown to decrease the risk of pre-eclampsia in pregnant people, especially when taken in the late first trimester.

The four goals of the treatment of eclampsia are to stop and prevent further convulsions, to control the elevated blood pressure, to deliver the baby as promptly as possible, and to monitor closely for the onset of multi-organ failure.

Convulsions are prevented and treated using magnesium sulfate.{{Cite journal|last1=Patel|first1=Minal K.|last2=Goodson|first2=James L.|last3=Alexander|first3=James P.|last4=Kretsinger|first4=Katrina|last5=Sodha|first5=Samir V.|last6=Steulet|first6=Claudia|last7=Gacic-Dobo|first7=Marta|last8=Rota|first8=Paul A.|last9=McFarland|first9=Jeffrey|last10=Menning|first10=Lisa|last11=Mulders|first11=Mick N.|date=2020-11-13|title=Progress Toward Regional Measles Elimination – Worldwide, 2000–2019|url=http://www.cdc.gov/mmwr/volumes/69/wr/mm6945a6.htm?s_cid=mm6945a6_w|journal=MMWR. Morbidity and Mortality Weekly Report|volume=69|issue=45|pages=1700–1705|doi=10.15585/mmwr.mm6945a6|issn=0149-2195|pmc=7660667|pmid=33180759}} The study demonstrating the effectiveness of magnesium sulfate for the management of eclampsia was first published in 1955.{{cite journal |author=Pritchard JA |title=The use of the magnesium ion in the management of eclamptogenic toxemias |journal=Surg Gynecol Obstet|volume=100 |issue=2 |pages=131–140 |date=February 1955 |pmid=13238166 }} Effective anticonvulsant serum levels range from 2.5 to 7.5 mEq/L,{{Cite web|title=Magnesium Sulfate – FDA prescribing information, side effects and uses|url=https://www.drugs.com/pro/magnesium-sulfate.html|access-date=2020-12-07|website=Drugs.com|language=en}} however the ideal dosing regime (dose, route of administration, timing of dosing) to prevent and treat eclampsia is not clear.{{Cite journal |last1=Diaz |first1=Virginia |last2=Long |first2=Qian |last3=Oladapo |first3=Olufemi T |date=2023-10-10 |editor-last=Cochrane Pregnancy and Childbirth Group |title=Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=10 |pages=CD007388 |doi=10.1002/14651858.CD007388.pub3 |pmc=10563167 |pmid=37815037 }}

With intravenous administration, the onset of anticonvulsant action is fast and lasts about 30 minutes. Following intramuscular administration the onset of action is about one hour and lasts for three to four hours. Magnesium is excreted solely by the kidneys at a rate proportional to the plasma concentration (concentration in the blood) and glomerular filtration (rate at which the blood is filtered through the kidneys). Magnesium sulfate is associated with several minor side effects; serious side effects are uncommon, occurring at elevated magnesium serum concentrations greater than 7.0 mEq/L. Serious toxicity can be counteracted with calcium gluconate.{{Cite journal|last1=Smith|first1=Jeffrey Michael|last2=Lowe|first2=Richard F.|last3=Fullerton|first3=Judith|last4=Currie|first4=Sheena M.|last5=Harris|first5=Laura|last6=Felker-Kantor|first6=Erica|date=2013-02-05|title=An integrative review of the side effects related to the use of magnesium sulfate for pre-eclampsia and eclampsia management|url= |journal=BMC Pregnancy and Childbirth|volume=13|issue=1|pages=34|doi=10.1186/1471-2393-13-34|pmid=23383864|pmc=3570392|issn=1471-2393 |doi-access=free }}

Even with therapeutic serum magnesium concentrations, recurrent convulsions may occur, and additional magnesium may be needed, but with close monitoring for respiratory, cardiac, and neurological depression. If magnesium administration with resultant high serum concentrations fails to control convulsions, the addition of other intravenous anticonvulsants may be used and intubation and mechanical ventilation may be initiated. It is important to avoid magnesium toxicity, including thoracic muscle paralysis, which could cause respiratory failure and death.

Magnesium sulfate results in better outcomes than diazepam, phenytoin or a combination of chlorpromazine, promethazine, and pethidine.{{cite journal|last1=Duley|first1=L|last2=Henderson-Smart|first2=DJ|last3=Walker|first3=GJ|last4=Chou|first4=D|title=Magnesium sulphate versus diazepam for eclampsia.|journal=The Cochrane Database of Systematic Reviews|date=Dec 8, 2010|volume=2010|issue=12|pages=CD000127|pmid=21154341|doi=10.1002/14651858.CD000127.pub2|pmc=7045443}}{{cite journal|last1=Duley|first1=L|last2=Henderson-Smart|first2=DJ|last3=Chou|first3=D|title=Magnesium sulphate versus phenytoin for eclampsia.|journal=The Cochrane Database of Systematic Reviews|date=Oct 6, 2010|issue=10|pages=CD000128|pmid=20927719|doi=10.1002/14651858.CD000128.pub2}}{{cite journal|last1=Duley|first1=L|last2=Gülmezoglu|first2=AM|last3=Chou|first3=D|title=Magnesium sulphate versus lytic cocktail for eclampsia.|journal=The Cochrane Database of Systematic Reviews|date=Sep 8, 2010|volume=2010|issue=9|pages=CD002960|pmid=20824833|doi=10.1002/14651858.CD002960.pub2|pmc=7138041}} The estimated risk of additional seizures following treatment with magnesium sulfate in the setting of eclampsia is 3.7%.{{Cite report |url=https://effectivehealthcare.ahrq.gov/products/hypertensive-disorders-pregnancy/research |title=Management of Postpartum Hypertensive Disorders of Pregnancy |last=Steele |first=Dale W. |last2=Adam |first2=Gaelen P. |last3=Saldanha |first3=Ian J. |last4=Kanaan |first4=Ghid |last5=Zahradnik |first5=Michael L. |last6=Danilack |first6=Valery A. |last7=Stuebe |first7=Alison M. |last8=Peahl |first8=Alex Friedman |last9=Chen |first9=Kenneth K. |date=2023-05-31 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/ahrqepccer263 |language=en}}

Blood pressure is controlled to prevent stroke, which accounts for 15 to 20 percent of deaths in women with eclampsia.{{Cite journal|last1=Townsend|first1=Rosemary|last2=O’Brien|first2=Patrick|last3=Khalil|first3=Asma|date=2016-07-27|title=Current best practice in the management of hypertensive disorders in pregnancy|journal=Integrated Blood Pressure Control|volume=9|pages=79–94|doi=10.2147/IBPC.S77344|issn=1178-7104|pmc=4968992|pmid=27555797 |doi-access=free }} Common drugs used for blood pressure control during eclampsia are hydralazine or labetalol,{{cite journal |title=ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002 |journal=Obstet Gynecol |volume=99 |issue=1 |pages=159–167 |date=January 2002 |pmid=16175681 |doi=10.1016/s0029-7844(01)01747-1|last1=Acog Committee On Obstetric Practice }} due to their effectiveness, lack of negative effects on the fetus, and mechanism of action. Blood pressure management is indicated with a diastolic blood pressure above 105–110 mm Hg. Normal blood pressure levels for pregnant people vary between trimesters and as so blood pressure management will be tailored accordingly.{{cite journal |last1=Medicinewise |first1=NPS |title=Management of Hypertension |url=https://www.nps.org.au/australian-prescriber/articles/management-of-hypertension-in-pregnancy |journal=Australian Prescriber |date=October 2021 |volume=44 |issue=5 |pages=148–152 |publisher=NPS |doi=10.18773/austprescr.2021.039 |pmid=34728879 |pmc=8542489 |access-date=2023-01-30}}

If the baby has not yet been delivered, steps need to be taken to stabilize the parent and deliver speedily. This needs to be done even if the baby is immature, as the eclamptic condition is unsafe for both baby and parent. As eclampsia is a manifestation of a type of non-infectious multiorgan dysfunction or failure, other organs (liver, kidney, lungs, cardiovascular system, and coagulation system) need to be assessed in preparation for a delivery (often a caesarean section), unless the person is already in advanced labor. Regional anesthesia for caesarean section is contraindicated when a coagulopathy has developed.

There is limited to no evidence in favor of a particular delivery method for people with eclampsia. Therefore, the delivery method of choice is an individualized decision.{{Cite journal|last=ACOG Committee on Obstetric Practice|date=April 2002|title=ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American College of Obstetricians and Gynecologists|journal=International Journal of Gynaecology and Obstetrics|volume=77|issue=1|pages=67–75|issn=0020-7292|pmid=12094777}}

Invasive hemodynamic monitoring may be elected in an eclamptic person at risk for or with heart disease, kidney disease, refractory hypertension, pulmonary edema, or poor urine output.

The Greek noun {{lang|el|ἐκλαμψία}}, {{transliteration|el|'eklampsía'}}, denotes a "light burst"; metaphorically, in this context, "sudden occurrence." The Neo-Latin term first appeared in Johannes Varandaeus’ 1620 treatise on gynaecology Tractatus de affectibus Renum et Vesicae.{{cite book |first=S. |last=Ong |chapter=Pre-eclampsia: A historical perspective |editor-last=Baker |editor-first=P.N. |editor2-last=Kingdom |editor2-first=J.C.P. |title=Pr-eclampsia: Current perspectives on management |publisher=Taylor & Francis |year=2003 |isbn=978-1842141809 |pages=15–24 }} The term 'toxemia of pregnancy' is no longer recommended: placental toxins are not the cause of eclampsia occurrences, as previously believed.[http://www.preeclampsia.org/health-information/faqs#preeclampsia-toxemia FAQ: Toxemia] {{webarchive|url=https://web.archive.org/web/20150925213710/http://www.preeclampsia.org/health-information/faqs |date=2015-09-25 }} at the Pre-Eclampsia Foundation website

• Tori Bowie (fetus died too){{cite news|url=https://www.abc.net.au/news/2023-06-13/tori-bowie-died-from-childbirth-complications-autopsy-reveals/102475166|title=Olympic medallist Tori Bowie's cause of death revealed to be childbirth complications|newspaper=ABC News |date=13 June 2023 }}{{cite web|url=https://www.npr.org/2023/06/13/1181971448/tori-bowie-an-elite-olympic-athlete-died-of-complications-from-childbirth|title=Tori Bowie, an elite Olympic athlete, died of complications from childbirth|website=NPR }}

• In Downton Abbey, a historical drama television series, the character Lady Sybil dies (in series 3, episode 5) of eclampsia shortly after child birth.{{cite news|last1=Stone|first1=Rachel Marie|title=Stop With All the Dangerous Childbirth Stories Already|url=http://www.christianitytoday.com/women/2013/january/stop-with-all-dangerous-childbirth-stories-already.html?paging=off|access-date=March 11, 2016|work=Christianity Today|date=January 30, 2013|url-status=live|archive-url=https://web.archive.org/web/20160311081238/http://www.christianitytoday.com/women/2013/january/stop-with-all-dangerous-childbirth-stories-already.html?paging=off|archive-date=March 11, 2016}}
• In Call the Midwife, a medical drama television series set in London in the 1950s and 1960s, the character (in series 1, episode 4) named Margaret Jones is struck with pre-eclampsia, ultimately proceeding from a comatose condition to death. The term "toxemia" was also used for the condition, in the dialogue.{{cite web|url=https://www.imdb.com/title/tt2082580/?ref_=ttep_ep4|title=Episode #1.4|date=5 February 2012|access-date=4 September 2016|via=IMDb|url-status=live|archive-url=https://web.archive.org/web/20170910175833/http://www.imdb.com/title/tt2082580/?ref_=ttep_ep4|archive-date=10 September 2017}}
• In House M.D., a medical drama television series set in the U.S., Dr. Cuddy, the hospital director, adopts a baby whose teenage mother dies from eclampsia and had no other parental figures available.{{Citation|title="House" Joy to the World (TV Episode 2008) - IMDb|url=http://www.imdb.com/title/tt1273714/plotsummary|access-date=2021-10-02}}
• In The Lemon Drop Kid, the main character's wife dies of eclampsia shortly after giving birth to a boy.
• In Fringe, a science fiction series, the character Olivia (in the parallel universe) is diagnosed with a fictionalized version of the disorder, called "viral-propagated eclampsia", which threatens her and her unborn child (series 3, episode 18).{{Citation|title="Fringe" Bloodline (TV Episode 2011) - IMDb|url=https://www.imdb.com/title/tt1635950/plotsummary/|access-date=March 23, 2023}}

{{Reflist}}

{{Pathology of pregnancy, childbirth and the puerperium}}

{{Medical resources

| ICD10 = {{ICD10|O|15||o|10}}

| ICD9 = {{ICD9|642.6}}

| ICDO =

| OMIM =

| OMIM_mult =

| MedlinePlus = 000899

| eMedicineSubj =

| eMedicineTopic = 1738

| eMedicine_mult = {{EMedicine2|med|1905}} {{EMedicine2|emerg|796}}

| DiseasesDB = 4068

| MeshID = D004461

| Scholia = Q552348

}}

{{Authority control}}

{{Women's health|state=collapsed}}

Category:Medical emergencies

Category:Health issues in pregnancy

Category:Disorders causing seizures

Category:Wikipedia medicine articles ready to translate

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