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Eclamptic Seizure Management
Aka: Eclamptic Seizure Management, PIH Seizure Prophylaxis, PIH Seizure Management
- Management: Seizure Prophylaxis
- See Magnesium Sulfate
- Magnesium Sulfate offers best PIH Seizure prevention
- Reference
- Lucas (1995) N Engl J Med 333:201-5 [PubMed]
- Management: Seizure
- Anticonvulsant Medications
- Magnesium Sulfate (if not already started)
- Loading dose: 4-6 grams IV over 15-20 minutes
- Maintenance: 2 grams per hour
- Consider rebolus of 2 grams if Seizure recurs (do not exceed >8 g bolus between prior bolus and rebolus)
- Obtain Serum Magnesium level at 4 hours
- Anticonvulsant not recommended routinely in Eclampsia
- Magnesium Sulfate best option for Seizure control
- Concurrent anticonvulsant depresses respiration
- Avoid Polypharmacy if possible
- Consider anticonvulsant if Seizure prolonged (caution adverse fetal effects)
- Amobarbital 250 mg IV in 10cc NS over 3 minutes
- Diazepam 5-10 mg IV slow push
- Pentobarbital 125mg IV
- Airway and respiratory management
- Protect airway from aspiration
- Place patient in left lateral decubitus position
- Suction oral secretions
- Anesthesia or other skilled clinician (e.g. emergency medicine) at bedside for possible intubation
- Consider Oral Airway
- Supplemental Oxygen
- Arterial Blood Gas
- Avoid Sodium Bicarbonate unless pH <7.10
- Prevent injury
- Padding on side rails of bed
- Other post-Seizure measures
- Foley Catheter
- Internal fetal monitor (Internal Scalp electrode)
- Consider Central Venous Pressure catheter
- Single Seizure does not mandate cesarean delivery
- Complications
- Maternal mortality
- Mortality in U.S.: 0.4% of Eclampsia cases
- Mortality in Mexico: 14% of ecamplsia cases
- Abruptio Placenta: 5.5 to 23% of Eclampsia cases
- Fetal anoxia with severe neurologic deficits: 7%
- Sibai (1983) Am J Obstet Gynecol 146:307-13 [PubMed]
- References
- Fontaine (2000) in ALSO, B:1-36
- Sibai in Gabbe (2002) Obstetrics, p. 945-74
- (2000) Am J Obstet Gynecol 183(1):S1-22 [PubMed]
- Zamorski (2001) Clin Fam Pract 3:329-47 [PubMed]