How are preeclampsia and eclampsia managed during pregnancy?

Updated: Nov 08, 2018
  • Author: Carmel Armon, MD, MSc, MHS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

There are a number of neurologic complications that occur with some frequency during pregnancy or around the time of delivery in women who were previously free of neurologic disease. Fortunately, serious complications are rare.

Preeclampsia and eclampsia

Eclampsia is defined as the triad of hypertension, proteinuria, and seizures; of these, seizures are the most serious consequence. Preeclampsia is usually diagnosed on the basis of the onset of hypertension and proteinuria in the late second or third trimester.

Preeclampsia can lead to eclampsia. The only known cure for this disease process is delivery. Therefore, when women develop preeclampsia at term, delivery is recommended. However, when preeclampsia occurs at a premature gestational age, attempts may be made to prolong the gestation if it is thought to be in the best interest of the fetus and if the mother’s condition remains stable.

The obstetric conditions usually dictate the mode of delivery. In general, most patients with preeclampsia are treated with magnesium sulfate infusions during labor and for a short time after delivery to prevent eclamptic seizures.

Symptoms usually emerge during gestation. If left untreated, they tend to worsen, with a peak risk at or around the time of delivery. However, the initial presentation may be involved with postpartum seizures in the absence of previously recognized hypertension or current proteinuria.

Patients who have seizures invariably undergo imaging studies to exclude bleeding secondary to hypertension or other structural pathologic conditions. Evidence of reversible posterior leukoencephalopathy (RPLE) (see below) is occasionally seen on imaging studies. [5] Brain images are usually normal.

Treatment of seizures usually includes magnesium sulfate, but benzodiazepines or rapidly acting antiepileptic drugs (AEDs), such as phenytoin, may be required. Generally, long-term AED treatment is not needed once the patient’s blood pressure has returned to normal and stabilized. However, no data are available to determine precisely how long short-term treatment should last; for the most part, local clinical practice prevails.


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