Eclamptic Seizure Management

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