Eclampsia

O11/O14.0-2/O14.9/O15.0-2/O15.9

DESCRIPTION

Generalised tonic-clonic seizures after 20 weeks of pregnancy and within 7 days after delivery associated with hypertension and proteinuria. Exclude any other obvious cause of the seizure before making the diagnosis. Management will include preventing further seizures, controlling the blood pressure, referral to a high-care unit and delivery of the baby if not already post-delivery .

GENERAL MEASURES

Place patient in left-lateral position.
Clear airway. If necessary, insert oropharyngeal airway.
Abort seizures with magnesium sulfate.

MEDICINE TREATMENT

If necessary:

  • Oxygen via nasal prongs or face mask to maintain a saturation of >90%.

Treatment

Where infusion pumps are not available:

  • Magnesium sulfate, IV, 4 g in 200 mL sodium chloride 0.9% over 20 minutes.

Follow with:

  • Magnesium sulfate, IM, 5 g every 4 hours administered at different sites, until 24 hours after delivery or following the last convulsion

In high-care setting:

  • Magnesium sulphate, IV, 4 g in 200 mL sodium chloride 0.9% over 20 minutes (loading dose).

Follow with:

  • Magnesium sulfate, IV infusion, 1 g every hour, until 24 hours after delivery, or after the last convulsion (maintenance dose).

STOP MAGNESIUM SULFATE IF KNEE REFLEXES BECOME ABSENT OR IF URINE OUTPUT <100 ML/ 4 HOURS OR RESPIRATORY RATE <16 BREATHS/MINUTE.


If respiratory depression occurs:

  • Calcium gluconate 10%, IV, 10 mL given slowly at a rate not exceeding 5 mL/minute.

Recurrent eclamptic seizure despite magnesium sulphate loading dose administration:

  • Magnesium sulphate, IV, 2 g over 10 minutes.

For agitated and restless women with eclampsia:

  • Lorazepam, IV/IM, 4 mg.
    • Maximum dose: 8 mg.

OR

  • Clonazepam, IV, 2 mg.
    • May be repeated after 5 minutes.
    • Maximum dose: 4 mg.

OR

If above not available :

  • Diazepam, IV, 10–20 mg, not faster than 2 mg/minute.

Notify the person who will resuscitate the newborn that a benzodiazepine and/or magnesium has been given to the mother.

REFERRAL

Refer all eclampsia cases to a high or intensive care facility.