A 24-year-old woman who is 37-weeks pregnant is brought to the Emergency Department because she is experiencing severe headaches, visual disturbance and abdominal pain. Shortly after arriving, she collapsed and has a seizure. Her husband states she has been treated for high blood pressure during the pregnancy. Her BP at present is 205/124 mmHg.
1. What is the most likely diagnosis?
The most likely diagnosis, in this case, is eclampsia, which is defined as the occurrence of one or more convulsions superimposed on pre-eclampsia. Eclampsia is a rare but serious complication of pre-eclampsia characterised by severely elevated blood pressure resulting in seizures. Onset may be during pregnancy or soon after delivery.
Intravenous labetalol or nicardipine are currently used as the drug treatments of choice for the reduction of BP. Sodium nitroprusside is potentially toxic to the foetus and should be avoided in pregnancy.
Magnesium sulphate is the therapy of choice to control seizures in eclampsia. The Collaborative Eclampsia Trial regimen for administration of magnesium sulphate should be used:
- A loading dose of 4 g should be given intravenously over 5 to 15 minutes
- This should be followed by an infusion of 1 g/hour maintained for 24 hours.
- If the woman has had an eclamptic seizure, the infusion should be continued for 24 hours after the last seizure
- Recurrent seizures should be treated with a further dose of 2-4 g given intravenously over 5 to 15 minutes
Delivery of the foetus and placenta is the only cure for eclampsia, and following stabilisation, the patient should be prepared for an emergency caesarean section.
Header image used on licence from Shutterstock