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Hypertensive Urgency and Eclampsia


Learning Objectives

  • Recognize the presentation of eclampsia.

  • Describe management priorities for a patient with eclampsia.

Eclampsia is defined as new-onset, generalized, tonic-clonic seizures or coma in a patient with preeclampsia. It is one of the several clinical manifestations of severe preeclampsia. Preeclampsia/eclampsia constitutes a common cause of maternal morbidity and mortality ( Fig. 20.1 ) .

Fig. 20.1
Organ systems affected by preeclampsia.

Risk Factors

  • Primiparity

  • Personal or family history of preeclampsia or eclampsia

  • Chronic hypertension

  • Chronic renal disease

  • History of thrombophilia

  • Multifetal gestation

  • In vitro fertilization

  • Diabetes mellitus

  • Obesity

  • System lupus erythematosus

  • Advanced maternal age

Diagnosis

Eclampsia is defined by new-onset grand mal seizures in a patient with preeclampsia. Diagnostic criteria for preeclampsia are as follows:

  • Hypertension (BP greater than or equal to 140/90 on two occasions at least 4 hours apart) AND

  • Proteinuria (more than 300 mg protein in 24-hour collection or protein:creatinine ratio greater than or equal to 0.3)

  • In the absence of proteinuria, preeclampsia can still be diagnosed if there is new-onset hypertension and any one or more of the following:

    • Platelet count less than 100 K/μL

    • Serum creatinine greater than 1.1 mg/dL or twice baseline (in the absence of other renal disease)

    • Liver transaminases elevated to twice normal

    • Pulmonary edema

    • Cerebral or visual symptoms

Management

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