Eclampsia

Definition

Eclampsia is the onset of tonic-clonic seizures in a woman with preeclampsia, during pregnancy (>20 weeks), labor, or up to 6 weeks postpartum. It represents severe maternal and fetal compromise and can be fatal.

Warning Signs (Preeclampsia)

• BP ≥ 140/90 with proteinuria
• Severe headache
• Visual changes (blurred vision, scotomas)
• Epigastric/RUQ pain
• Hyperreflexia with clonus
• Elevated liver enzymes (HELLP syndrome)
• Rapid weight gain, edema

Emergency Management

Magnesium sulfate IV loading dose 4 to 6 g over 15 to 20 minutes, then 1 to 2 g/hour maintenance to prevent seizures. Monitor Mg level (therapeutic 4 to 7 mg/dL), deep tendon reflexes, respirations (>12/min), and urine output (>30 mL/hr). Antidote: calcium gluconate for magnesium toxicity, such as antihypertensives (hydralazine, labetalol) for BP. Delivery is definitive treatment.

Nursing Interventions

Seizure precautions, left lateral position, oxygen, IV access, continuous fetal monitoring, such as quiet, dimly lit environment. Notify OB immediately.

NCLEX Relevance

Magnesium sulfate is first-line. Calcium gluconate is the antidote.