Guideline sources The following summarized guidelines for the evaluation and management of eclampsia are prepared by our editorial team based on guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC 2022), the American Association for the Study of Liver Diseases (AASLD 2021), the Myasthenia Gravis Foundation of America (MGFA 2016), and the Italian Association for the Study of the Liver (AISF 2016). 1 2 3 4 5 5 6 6 Definition Eclampsia is the presence of new-onset grand mal seizures in women with preeclampsia. 5 Epidemiology Eclampsia is caused by preeclampsia. 5 Disease course Clinical manifestations of eclampsia include hypertension, proteinuria, generalized edema, and convulsions with headache, RUQ epigastric pain, and visual changes either antepartum, intrapartum, or postpartum. Eclampsia is associated with increased maternal complications, including HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, abruptio placentae, disseminated intravascular coagulopathy, pulmonary edema, acute renal failure, https://web.pathway.md/diseases/recjnQsCXSa25TDKR 1/4 6/29/23, 4:15 AM Eclampsia Pathway aspiration pneumonia, cardiopulmonary arrest, liver hematoma, and respiratory distress syndrome. 6 Prognosis and risk of recurrence Eclampsia is associated with a mortality rate ranging from 0-1.8% in developed countries and 14% in developing countries. 6 Guidelines 1. Screening and diagnosis Indications for screening: obtain close monitoring for the development of eclampsia in patients with preeclampsia. E 2. Medical management Magnesium sulfate: As per SOGC 2022 guidelines, administer magnesium sulfate as first-line therapy in patients with eclampsia. A As per AISF 2016 guidelines, administer magnesium sulphate for controlling seizures in patients with eclampsia. A 3. Therapeutic procedures Timing for delivery: perform expeditious deliver after maternal stabilization in patients with suspected eclampsia. E 4. Specific circumstances Patients with myasthenia gravis: do not use magnesium sulfate for the management of eclampsia in patients with myasthenia gravis because of its neuromuscular blocking effects. Offer barbiturates or phenytoin to provide adequate treatment. D 5. Preventative measures Magnesium sulfate: As per SOGC 2022 guidelines, administer magnesium sulfate as prophylaxis against eclampsia in patients with preeclampsia and severe hypertension or adverse maternal conditions. A As per AISF 2016 guidelines, administer magnesium sulphate for seizure prophylaxis in patients with severe preeclampsia. A https://web.pathway.md/diseases/recjnQsCXSa25TDKR 2/4 6/29/23, 4:15 AM Eclampsia Pathway Clinical findings Symptoms Past medical history Agitation Diabetes mellitus Blurred vision Hypertension Double vision Vital signs Headache Loss of consciousness Hypertension Photophobia Lab findings Seizure Visual disturbances urine protein Weight gain Past obstetric history Preeclampsia Vascular exam Peripheral edema Studies 2002 MAGPIE In women who had not given birth or were 24 h postpartum with BP 140/90 mmHg and proteinuria 1+, magnesium sulfate was superior to placebo with respect to eclampsia. Altman D et al. Lancet. 2002 Jun 1. References 1. Monika Sarkar, Carla W Brady, Jaquelyn Fleckenstein et al. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Jan;73 1 318 365. Open 2. Sanders DB, Wolfe GI, Benatar M et al. International consensus guidance for management of myasthenia gravis: Executive summary. Neurology. 2016 Jul 26;87 4 419 25. Open 3. Italian Association for the Study of the Liver AISF , Italian Association for the Study of the Liver AISF. AISF position paper on liver disease and pregnancy. Dig Liver Dis. 2016 Feb;48 2 120 37. Open 4. Laura A Magee, Graeme N Smith, Christine Bloch et al. Guideline No. 426 Hypertensive Disorders of Pregnancy: Diagnosis, Prediction, Prevention, and Management. J Obstet Gynaecol Can. 2022 May;44 5 547 571.e1. Open 5. Mauro H Schenone, Dorothy Miller, Jacques E Samson et al. Eclampsia characteristics and outcomes: a comparison of two eras. 2013;2013 826045.2013;2013 826045. Open 6. Baha M Sibai. Diagnosis, prevention, and management of eclampsia. Obstet Gynecol. 2005 Feb;105 2 402 10. Open https://web.pathway.md/diseases/recjnQsCXSa25TDKR 3/4 6/29/23, 4:15 AM Eclampsia Pathway 7. Douglas KA, Redman CW. Eclampsia in the United Kingdom. BMJ. 1994 Nov 26;309 6966 1395 400. Open 8. Sibai BM. Eclampsia. VI. Maternal-perinatal outcome in 254 consecutive cases. Am J Obstet Gynecol. 1990 Sep;163 3 1049 54; discussion 1054 5. Open 9. Magee LA, Pels A, Helewa M et al. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can. 2014 May;36 5 416 41. Open 10. Ahmad Mahran, Hashem Fares, Reham Elkhateeb et al. Risk factors and outcome of patients with eclampsia at a tertiary hospital in Egypt. BMC Pregnancy Childbirth. 2017; 17 435. Open 11. Mauro H. Schenone, Dorothy Miller, Jacques E. Samson et al. Eclampsia Characteristics and Outcomes: A Comparison of Two Eras. J Pregnancy. 2013; 2013 826045. Open 12. Tram T Tran, Joseph Ahn, Nancy S Reau. ACG Clinical Guideline: Liver Disease and Pregnancy. Am J Gastroenterol. 2016 Feb;111 2 176 94; quiz 196. Open https://web.pathway.md/diseases/recjnQsCXSa25TDKR 4/4