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Eclampsia

E-clamp
Picmonic
When severe preeclampsia progresses further, the pregnant woman can develop eclampsia. Eclampsia is characterized by seizure activity or coma in the pregnant woman with severe preeclampsia. The seizure activity can occur before, during, or after birth. Eclampsia occurs due to neurologic complications related to preeclampsia. These neurologic complications result in increased central nervous system (CNS) irritability.
10 KEY FACTS
MECHANISM OF ACTION
Increased Central Nervous System Irritability
Up-arrow CNS-brain Irritated

In severe preeclampsia, the CNS becomes irritated as a result of vasospasm and decreased organ perfusion. This causes a cortical brain spasm that results in headaches, hyperreflexia, seizure activity and the progression to eclampsia.

SIGNS AND SYMPTOMS
Hyperreflexia
Hiker-reflex-hammer

Due to CNS irritability and cortical brain spasm, the pregnant woman’s reflexes become hyper-exaggerated, signifying the possible development of eclampsia.

Positive Ankle Clonus
Positive Ankle Clowns

Due to the cortical brain spasm, the ankle may display rapid muscular contraction and relaxation appearing as a rhythmic tremor.

Headaches
Head-egg-lump

As hypertension progresses without proper management, the pregnant woman may experience severe headaches significant of increased pressures within the vessels of the brain.

Visual Disturbances
Wavy Eyes

Visual disturbances may occur as a result of retinal arteriolar spasm that develops due to progression of hypertension and vasospasm that occurs in severe preeclampsia.

Epigastric or RUQ Pain
E-pick-gas and RUQ Pain-bolts

Epigastric or right upper quadrant (RUQ) pain is usually an ominous sign and the woman frequently complains of this pain immediately before the onset of the seizure. In many cases, this pain/feeling is a harbinger of impending seizure. This could also represent worsening hepatopathy from pre-eclampsia.

Seizures
Caesar

Due to cortical brain spasm and increased CNS irritability, seizures can occur in the pregnant woman. These seizures can occur before birth, during birth, or after birth and are significant to eclampsia. Typical seizure care includes airway management, administration of oxygen, turning the patient on their side, and padding side rails.

Coma
Comb

Due to severely increased CNS irritability, the patient can progress to a comatose state. This is a severe complication of eclampsia.

CONSIDERATIONS
Don't Leave Bedside
Not Allowed to Leave Bedside

It is imperative in this obstetric emergency to call for help and not leave the patient alone.

Magnesium Sulfate
Magnesium-magazine with Sulfur-matches

This medication is given to control seizures in the woman with eclampsia. Calcium gluconate should be available to reverse any effects of magnesium toxicity (depressed DTRs, bradypnea, oliguria), as the woman has more than likely been receiving magnesium sulfate prior to the onset of seizure activity. It is crucial to monitor for respiratory depression.

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