Obstetrics & Gynecology
Eclampsia
자간증
New-onset generalized tonic-clonic seizure superimposed on preeclampsia
- How common
- 1–2% of preeclampsia cases
- Typical age
- Late pregnancy or within 48 h postpartum
What is it?
Severe vasospasm and endothelial dysfunction → impaired cerebral autoregulation, cerebral edema → PRES pattern → seizure.
Commonly affected: Brain plus all preeclampsia target organs
How it develops
- Severe preeclampsiaAccelerated vasospasm
- Cerebral autoregulation failureHyperperfusion or hypoperfusion
- Vasogenic cerebral edemaPRES pattern (posterior predominant)
- Generalized tonic-clonic seizureUsually self-limited; can recur
Symptoms
- Tonic-clonic seizure60–90 s, loss of consciousness
- Severe headacheCommon premonitory symptom
- Severe hypertension≥160/110
- Visual disturbancePhotopsia, scotomata
- Confusion/altered MSPostictal
How it is examined
- ABC and airway protectionLateral position, suction, O₂
- Neurologic examPostictal recovery, focal deficits
- Labs + fetal assessmentCBC, LFT, renal, coagulation, NST
Imaging
CXR for aspiration pneumonia/pulmonary edema.
- Aspiration opacity
- Pulmonary edema
Brain MRI: posterior-parietal reversible edema (PRES). CT to rule out hemorrhage.
- Posterior T2 hyperintensity
- PRES pattern
- No hemorrhage
Non-surgical care
- Magnesium sulfate (immediate)Load 4–6 g IV over 15–20 min → 2 g/h × 24 h postpartum
- Recurrent seizureAdditional 2 g IV bolus or lorazepam
- AntihypertensiveLabetalol 20 mg IV → 40–80 mg; hydralazine 5–10 mg
- Airway and O₂Lateral position, prevent aspiration, maintain SpO₂
- Strict fluid management~80 mL/h to limit pulmonary edema risk
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Delivery after maternal stabilization (delivery indicated in all cases)
Procedures that may be discussed
- Induction (amniotomy, oxytocin)
- Emergency cesarean (fetal distress or unstable mother)
- Continue magnesium 24 h postpartum
Outlook
Maternal mortality <1% with prompt magnesium and delivery; recurrence ~2%.