Pre-eclampsia and epilepsy

• Pre-eclampsia


  New onset of hypertension (over 140 mmHg systolic or over 90 mmHg diastolic) after 20 weeks gestation and the coexistence of 1 or more of the following new-onset conditions: significant proteinuria or other maternal organ dysfunction
• Aetiology of Pre-eclampsia


  • Not well understood, but most convincing theory due to placental malperfusion secondary to deficient spiral artery conversion
• Signs and Symptoms of Pre-eclampsia


  • Common: Raised BP, Proteinuria, Oedema, Right Upper Quadrant or Epigastric Pain, IUGR/Reduced Fetal Movements, Severe headaches
  • Less Common: Visual Disturbances, Seizures, Breathlessness, Oliguria, Clonus
• Risk Factors for Pre-eclampsia

  • Nulliparity
  • Previous Pre-eclampsia
  • Family Hx of Pre-eclampsia
  • Hypertensive in previous pregnancy/ Chronic Hypertension / Gestational Hypertension
  • BMI 30+
  • Pre-existing diabetes
  • Multiple Pregnancy
  • Extremes of Maternal Age
  • Autoimmune Disease
  • Renal Disease
  • Pregnancy interval of 10 years+
  • IVF pregnancy
• Severe Pre-eclampsia

  Severe hypertension (160/100) and proteinuria (PCR>30mg/mmol) OR Mild or moderate hypertension and proteinuria with at least one of the following: Severe headache, Visual disturbances, Severe pain just below ribs or vomiting, Papilloedema, Signs of Clonus, Liver tenderness, HELLP Syndrome, Platelet count < 100 x 10^9/L, Abnormal Liver Enzymes
• Severe Pre-eclampsia Management


  1. STABILISE: Control Blood Pressure, Prevent Seizures

  2. MONITOR: Vital Signs, Oxygen sats, Reflexes, Urinary output, Blood tests, Neurological Status, Fetal Condition

  3. PLAN FOR BIRTH: Continuous fetal monitoring, Consider epidural, Shorten second stage if symptomatic or BP uncontrolled, Give syntocinon or cabetocin, Avoid NSAIDs, Consider Thromboprophylaxis, BP Monitoring
• Eclampsia


  New occurrence of seizures in pregnancy or up to 10 days postnatal with hypertension, proteinuria, thrombocytopenia or raised AAT. Generalised seizures, Jerking, Incontinence, Bite tongue, Last approximately 90 seconds
• Majority of women will not be hypertensive or have proteinuria prior to their first eclamptic fit
• 44% of eclamptic fits occur postnatally, 38% antenatally and 18% intrapartum
• Reoccurrence rate of another eclamptic fit is 5-30% even with treatment
• Eclampsia has a high rate of maternal morbidity and perinatal mortality
• Causes of Eclamptic Fit

  Largely unknown, but may be related to hypertension, PRES (Posterior reversible encephalopathy syndrome), Vasogenic oedema, Ischaemic brain injury
• How to manage an Eclamptic Fit


  Call for help, Basic life support measures, Left lateral, Do not restrain, Use Eclampsia box, Give Magnesium Sulphate
• Magnesium Sulphate


  The only medication that should be used to manage eclampsia. Given as a loading dose of 4g over 5 mins IV, then maintenance dose of 1g/hour until 24 hours post seizure. Has a neuroprotective effect for the fetus if given antepartum. Can cause magnesium toxicity.
• Magnesium Sulphate Emergency Protocol


  Stop Infusion, Start Basic Life Support, Give 1g Calcium Gluconate (or Chloride) IV, Intubate early and ventilate until respiration resumes
• Potential Maternal Risks/Complications of Pre-eclampsia/Eclampsia

  • Assisted Ventilation, Cardiac Arrest, HELLP, DIC, Acute Renal or Liver Failure, Sepsis, Placental Abruption, Death, Cerebrovascular Disorder
• Potential Fetal Risks/Complications of Pre-eclampsia/Eclampsia

  • IUGR, Pre-term, Stillbirth, Neonatal Death
• Increased risk of recurrence of pre-eclampsia in future pregnancies (about 1 in 4)
• Advise women who have had pre-eclampsia to achieve and keep a BMI within the healthy range before their next pregnancy (18.5–24.9 kg/m2)
• Advise pregnant women at high risk of pre-eclampsia to take 75–150 mg of aspirin daily from 12 weeks until the birth of the baby
• Women who have had pre-eclampsia have an increased risk of hypertension and its complications in future life