ECLAMPSIA

A   21-year-old primigravida    is  brought to  the emergency   department  after

suffering   from    a   generalized tonic-clonic    seizure at  32  weeks’  gestation.

The seizure was preceded    by  a   severe  headache.   She lost    control of  her

bowels  and bladder.    She has gained  10  pounds  since   her last    prenatal    visit

two weeks   ago.    On  examination she is  unresponsive    and in  a   postictal   state.

BP  is  185/115mm   Hg  and spot    urine   dipstick    shows   4+  protein.

Eclampsia is the presence of unexplained generalized seizures in a
hypertensive, proteinuric pregnant woman in the last half of pregnancy.
Pathophysiology is severe diffuse cerebral vasospasm resulting in cerebral
perfusion deficits and cerebral edema.

In addition to those presenting symptoms of mild and severe preeclampsia, the
most significant finding is unexplained tonic-clonic seizures.

Lab abnormalities are the same as those found with mild and severe
preeclampsia.

Diagnosis is made clinically with unexplained generalized seizures occurring in
a hypertensive, proteinuric pregnant woman in the last half of pregnancy.

Risk factors are the same as in preeclampsia. A primary seizure disorder does
not predispose to eclampsia.

Management. The first step is to protect the mother’s airway and tongue.