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. 1999 Feb;75(880):78–82. doi: 10.1136/pgmj.75.880.78

Modern management of eclampsia

O Salha 1, J Walker 1
PMCID: PMC1741124  PMID: 10448466

Abstract

Eclampsia, the occurrence of a seizure in association with pre-eclampsia, remains an important cause of maternal mortality and morbidity. Despite being recognised since antiquity, consistent management practices are still lacking. Given that the aim of good care is to prevent seizures, it is disappointing that in the majority of cases the first eclamptic convulsion occurs after admission to hospital. This indicates that either the women who are likely to have a convulsion were not identified accurately, or the treatment given was ineffective. The answer to poor management of eclampsia lies in better education and training of all obstetricians, anaesthetists, midwives, and general practitioners in the diagnosis and treatment of severe pre-eclampsia and eclampsia. Protocols for the management of fluid balance, antihypertensive and anticonvulsant therapies should be available and reviewed regularly. The universal adoption of such guidelines in all obstetric units would substantially reduce elements of substandard care which have repeatedly been identified in the triennial reports of the confidential enquiries into maternal deaths in the UK.


Keywords: pregnancy; hypertension; eclampsia

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Selected References

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  1. Ashe R. G., Moodley J., Richards A. M., Philpott R. H. Comparison of labetalol and dihydralazine in hypertensive emergencies of pregnancy. S Afr Med J. 1987 Mar 21;71(6):354–356. [PubMed] [Google Scholar]
  2. Belfort M. A., Moise K. J., Jr Effect of magnesium sulfate on maternal brain blood flow in preeclampsia: a randomized, placebo-controlled study. Am J Obstet Gynecol. 1992 Sep;167(3):661–666. doi: 10.1016/s0002-9378(11)91567-1. [DOI] [PubMed] [Google Scholar]
  3. Bergström S., Povey G., Songane F., Ching C. Seasonal incidence of eclampsia and its relationship to meteorological data in Mozambique. J Perinat Med. 1992;20(2):153–158. doi: 10.1515/jpme.1992.20.2.153. [DOI] [PubMed] [Google Scholar]
  4. Brown M. A., Zammit V. C., Lowe S. A. Capillary permeability and extracellular fluid volumes in pregnancy-induced hypertension. Clin Sci (Lond) 1989 Dec;77(6):599–604. doi: 10.1042/cs0770599. [DOI] [PubMed] [Google Scholar]
  5. Burrows R. F., Burrows E. A. The feasibility of a control population for a randomized control trial of seizure prophylaxis in the hypertensive disorders of pregnancy. Am J Obstet Gynecol. 1995 Sep;173(3 Pt 1):929–935. doi: 10.1016/0002-9378(95)90368-2. [DOI] [PubMed] [Google Scholar]
  6. Chua S., Redman C. W. Are prophylactic anticonvulsants required in severe pre-eclampsia? Lancet. 1991 Jan 26;337(8735):250–251. doi: 10.1016/0140-6736(91)92227-s. [DOI] [PubMed] [Google Scholar]
  7. Cotton D. B., Janusz C. A., Berman R. F. Anticonvulsant effects of magnesium sulfate on hippocampal seizures: therapeutic implications in preeclampsia-eclampsia. Am J Obstet Gynecol. 1992 Apr;166(4):1127–1136. doi: 10.1016/s0002-9378(11)90599-7. [DOI] [PubMed] [Google Scholar]
  8. Crowther C. A. Eclampsia at Harare Maternity Hospital. An epidemiological study. S Afr Med J. 1985 Dec 21;68(13):927–929. [PubMed] [Google Scholar]
  9. Dahmus M. A., Barton J. R., Sibai B. M. Cerebral imaging in eclampsia: magnetic resonance imaging versus computed tomography. Am J Obstet Gynecol. 1992 Oct;167(4 Pt 1):935–941. doi: 10.1016/s0002-9378(12)80015-9. [DOI] [PubMed] [Google Scholar]
  10. Douglas K. A., Redman C. W. Eclampsia in the United Kingdom. BMJ. 1994 Nov 26;309(6966):1395–1400. doi: 10.1136/bmj.309.6966.1395. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Duley L. Magnesium sulphate regimens for women with eclampsia: messages from the Collaborative Eclampsia Trial. Br J Obstet Gynaecol. 1996 Feb;103(2):103–105. doi: 10.1111/j.1471-0528.1996.tb09657.x. [DOI] [PubMed] [Google Scholar]
  12. Duley L. Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean. Br J Obstet Gynaecol. 1992 Jul;99(7):547–553. doi: 10.1111/j.1471-0528.1992.tb13818.x. [DOI] [PubMed] [Google Scholar]
  13. Fenakel K., Fenakel G., Appelman Z., Lurie S., Katz Z., Shoham Z. Nifedipine in the treatment of severe preeclampsia. Obstet Gynecol. 1991 Mar;77(3):331–337. [PubMed] [Google Scholar]
  14. Fox E. J., Sklar G. S., Hill C. H., Villanueva R., King B. D. Complications related to the pressor response to endotracheal intubation. Anesthesiology. 1977 Dec;47(6):524–525. doi: 10.1097/00000542-197712000-00013. [DOI] [PubMed] [Google Scholar]
  15. Garden A., Davey D. A., Dommisse J. Intravenous labetalol and intravenous dihydralazine in severe hypertension in pregnancy. Clin Exp Hypertens B. 1982;1(2-3):371–383. doi: 10.3109/10641958209139860. [DOI] [PubMed] [Google Scholar]
  16. Goldman R. S., Finkbeiner S. M. Therapeutic use of magnesium sulfate in selected cases of cerebral ischemia and seizure. N Engl J Med. 1988 Nov 3;319(18):1224–1225. doi: 10.1056/NEJM198811033191813. [DOI] [PubMed] [Google Scholar]
  17. Graham C., Goldstein A. Epidural analgesia and cardiac output in severe pre-eclamptics. Anaesthesia. 1980 Jul 7;35(7):709–712. doi: 10.1111/j.1365-2044.1980.tb03886.x. [DOI] [PubMed] [Google Scholar]
  18. Heller P. J., Scheider E. P., Marx G. F. Pharyngolaryngeal edema as a presenting symptom in preeclampsia. Obstet Gynecol. 1983 Oct;62(4):523–525. [PubMed] [Google Scholar]
  19. Hibbard B. M., Rosen M. The management of severe pre-eclampsia and eclampsia. Br J Anaesth. 1977 Jan;49(1):3–9. doi: 10.1093/bja/49.1.3. [DOI] [PubMed] [Google Scholar]
  20. Hodgkinson R., Husain F. J., Hayashi R. H. Systemic and pulmonary blood pressure during caesarean section in parturients with gestational hypertension. Can Anaesth Soc J. 1980 Jul;27(4):389–394. doi: 10.1007/BF03007461. [DOI] [PubMed] [Google Scholar]
  21. Hutton J. D., James D. K., Stirrat G. M., Douglas K. A., Redman C. W. Management of severe pre-eclampsia and eclampsia by UK consultants. Br J Obstet Gynaecol. 1992 Jul;99(7):554–556. doi: 10.1111/j.1471-0528.1992.tb13819.x. [DOI] [PubMed] [Google Scholar]
  22. Jouppila P., Jouppila R., Hollmén A., Koivula A. Lumbar epidural analgesia to improve intervillous blood flow during labor in severe preeclampsia. Obstet Gynecol. 1982 Feb;59(2):158–161. [PubMed] [Google Scholar]
  23. Jouppila R., Jouppila P., Hollmén A. Laryngeal oedema as an obstetric anaesthesia complication: case reports. Acta Anaesthesiol Scand. 1980 Apr;24(2):97–98. doi: 10.1111/j.1399-6576.1980.tb01514.x. [DOI] [PubMed] [Google Scholar]
  24. Mabie W. C., Gonzalez A. R., Sibai B. M., Amon E. A comparative trial of labetalol and hydralazine in the acute management of severe hypertension complicating pregnancy. Obstet Gynecol. 1987 Sep;70(3 Pt 1):328–333. [PubMed] [Google Scholar]
  25. Mahler H. The safe motherhood initiative: a call to action. Lancet. 1987 Mar 21;1(8534):668–670. doi: 10.1016/s0140-6736(87)90423-5. [DOI] [PubMed] [Google Scholar]
  26. Miles J. F., Jr, Martin J. N., Jr, Blake P. G., Perry K. G., Jr, Martin R. W., Meeks G. R. Postpartum eclampsia: a recurring perinatal dilemma. Obstet Gynecol. 1990 Sep;76(3 Pt 1):328–331. [PubMed] [Google Scholar]
  27. Moodley J., Gouws E. A comparative study of the use of epoprostenol and dihydralazine in severe hypertension in pregnancy. Br J Obstet Gynaecol. 1992 Sep;99(9):727–730. doi: 10.1111/j.1471-0528.1992.tb13872.x. [DOI] [PubMed] [Google Scholar]
  28. Moore T. R., Key T. C., Reisner L. S., Resnik R. Evaluation of the use of continuous lumbar epidural anesthesia for hypertensive pregnant women in labor. Am J Obstet Gynecol. 1985 Jun 15;152(4):404–412. doi: 10.1016/s0002-9378(85)80149-6. [DOI] [PubMed] [Google Scholar]
  29. Nelson S. H., Suresh M. S. Magnesium sulfate-induced relaxation of uterine arteries from pregnant and nonpregnant patients. Am J Obstet Gynecol. 1991 May;164(5 Pt 1):1344–1350. doi: 10.1016/0002-9378(91)90711-y. [DOI] [PubMed] [Google Scholar]
  30. Newsome L. R., Bramwell R. S., Curling P. E. Severe preeclampsia: hemodynamic effects of lumbar epidural anesthesia. Anesth Analg. 1986 Jan;65(1):31–36. [PubMed] [Google Scholar]
  31. Paterson-Brown S., Robson S. C., Redfern N., Walkinshaw S. A., de Swiet M. Hydralazine boluses for the treatment of severe hypertension in pre-eclampsia. Br J Obstet Gynaecol. 1994 May;101(5):409–413. doi: 10.1111/j.1471-0528.1994.tb11913.x. [DOI] [PubMed] [Google Scholar]
  32. Ramanathan J., Sibai B. M., Mabie W. C., Chauhan D., Ruiz A. G. The use of labetalol for attenuation of the hypertensive response to endotracheal intubation in preeclampsia. Am J Obstet Gynecol. 1988 Sep;159(3):650–654. doi: 10.1016/s0002-9378(88)80027-9. [DOI] [PubMed] [Google Scholar]
  33. Robson S. C., Redfern N., Seviour J., Campbell M., Walkinshaw S., Rodeck C., de Swiet M. Phenytoin prophylaxis in severe pre-eclampsia and eclampsia. Br J Obstet Gynaecol. 1993 Jul;100(7):623–628. doi: 10.1111/j.1471-0528.1993.tb14227.x. [DOI] [PubMed] [Google Scholar]
  34. Rosenfield A., Maine D. Maternal mortality--a neglected tragedy. Where is the M in MCH? Lancet. 1985 Jul 13;2(8446):83–85. doi: 10.1016/s0140-6736(85)90188-6. [DOI] [PubMed] [Google Scholar]
  35. Rossouw H. J., Howarth G., Odendaal H. J. Ketanserin and hydralazine in hypertension in pregnancy--a randomised double-blind trial. S Afr Med J. 1995 Jun;85(6):525–528. [PubMed] [Google Scholar]
  36. Schiff E., Friedman S. A., Sibai B. M. Conservative management of severe preeclampsia remote from term. Obstet Gynecol. 1994 Oct;84(4):626–630. [PubMed] [Google Scholar]
  37. Seabe S. J., Moodley J., Becker P. Nifedipine in acute hypertensive emergencies in pregnancy. S Afr Med J. 1989 Sep 16;76(6):248–250. [PubMed] [Google Scholar]
  38. Sibai B. M. Eclampsia. VI. Maternal-perinatal outcome in 254 consecutive cases. Am J Obstet Gynecol. 1990 Sep;163(3):1049–1055. doi: 10.1016/0002-9378(90)91123-t. [DOI] [PubMed] [Google Scholar]
  39. Sibai B. M., Ramanathan J. The case for magnesium sulfate in preeclampsia-eclampsia. Int J Obstet Anesth. 1992 May;1(3):167–175. doi: 10.1016/0959-289x(92)90024-x. [DOI] [PubMed] [Google Scholar]
  40. Skajaa K., Svane D., Andersson K. E., Forman A. Effects of magnesium and isradipine on contractile activation induced by the thromboxane A2 analog U46619 in human uteroplacental arteries in term pregnancy. Am J Obstet Gynecol. 1990 Oct;163(4 Pt 1):1323–1333. doi: 10.1016/0002-9378(90)90714-i. [DOI] [PubMed] [Google Scholar]
  41. Waisman G. D., Mayorga L. M., Cámera M. I., Vignolo C. A., Martinotti A. Magnesium plus nifedipine: potentiation of hypotensive effect in preeclampsia? Am J Obstet Gynecol. 1988 Aug;159(2):308–309. doi: 10.1016/s0002-9378(88)80072-3. [DOI] [PubMed] [Google Scholar]
  42. Walker J. J. Care of the patient with severe pregnancy induced hypertension. Eur J Obstet Gynecol Reprod Biol. 1996 Mar;65(1):127–135. doi: 10.1016/0028-2243(95)02318-m. [DOI] [PubMed] [Google Scholar]
  43. Walker J. J. Hypertensive drugs in pregnancy. Antihypertension therapy in pregnancy, preeclampsia, and eclampsia. Clin Perinatol. 1991 Dec;18(4):845–873. [PubMed] [Google Scholar]
  44. Walker J. J., Leitch C. R. The death of eclampsia. 1994 Feb 16-Mar 1Br J Hosp Med. 51(4):148–149. [PubMed] [Google Scholar]

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