A Review of the Management of Eclampsia: Practical Issues

Abstract

We reviewed 90 cases of eclampsia, an obstetric emergency associated with high blood pressure and convulsions, treated in two hospitals in Durban, South Africa. We present a protocol for the management of eclampsia based on this review and extensive clinical experience on this subject, which includes hemodynamic stabilization of the mother, prevention of recurrent convulsions, prompt delivery, and intensive monitoring in the immediate post-partum period.

Eclampsia: Still a major problem in rural KwaZulu-Natal Province, South Africa

“…This was also a finding in other reports and forms part of our clinical protocol to 'stabilise' the patient within 2 -4 hours and resort to abdominal delivery if the patient is not in labour or unlikely to deliver within 6 -8 hours. [4,5] It should also be noted that the mean gestational age of the cases of eclampsia in our study was approximately 34 weeks. Induction of labour in such patients with eclampsia generally takes hours with intense monitoring of mother and fetus.…”

“…[3] Lowering of sustained severe acute hypertension in pregnancy therefore warrants judicious use of rapid-acting antihypertensive agents as immediate management. [4][5][6][7][8] It is plausible that some health professionals are of the view that magnesium sulphate may have antihypertensive properties and that acute lowering of high blood pressure may cause hypotension. If magnesium sulphate has antihypertensive properties, this is probably based on its sedative effects.…”

“…These figures were similar to other reports originating from SA. [5] They imply that platelet counts should be routinely done in all cases of preeclampsia and observational studies suggest that eclamptics with severe hypertension and low platelets are very likely to develop cerebral haemorrhage. [4] Therefore lowering of very high blood pressure in a controlled fashion is critical in the management of severe hypertension, imminent eclampsia and eclampsia if we are to reduce cerebral haemorrhage.…”

“…This should lower high blood pressure within 20 -30 minutes. [4,5] High blood pressure should be reduced to levels of approximately 110 -140 mmHg systolic and 90 -110 mmHg diastolic. Labetalol given intravenously should be the preferred agent at district and regional hospitals.…”

Antepartum eclampsia <34 weeks case series: advisable to postpone delivery to administer corticosteroids for fetal pulmonary benefit?

“…Thus, some consider eclampsia to be 'an absolute contraindication to expectant management'; [4][5][6] definitive treatment is recommended by some to be prompt termination of the pregnancy 'as soon as maternal hemodynamic stabilization is achieved'. 7,8 Concerns about delay of delivery include fear of disease progression with multiorgan system deterioration, especially in the maternal central nervous system and sudden placental abruption that could threaten fetal wellbeing in utero and thereafter.…”