Eclampsia is a severe, life-threatening manifestation of preeclampsia. While long-term neurologic damage is rare, there is risk of maternal hypoxia and death. Most women will experience signs such as headaches or visual changes prior to a seizure.
Note: Not all women will demonstrate classic features of preeclampsia (hypertension, proteinuria)
Note: Magnesium sulfate should not be considered an antihypertensive agent
Delivery and Postpartum
National Partnership for Maternal Safety: Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period
ACOG Practice Bulletin 222: Gestational Hypertension and Preeclampsia
Management of pre-eclampsia: issues for anaesthetists
Acute pulmonary oedema in pregnant women
Cochrane Review: Magnesium sulphate and other anticonvulsants for women with pre-eclampsia
Multiple guidelines have been released to decrease severe morbidity and mortality associated with preeclampsia but data remains limited as to impact of these recommendations on adverse events. This study by Shields et al. (AJOG, 2017) aimed to determine if standardized guideline-based protocols to treat severe hypertension/preeclampsia are associated with improved outcomes.
Multicentered, Prospective Quality Improvement Project. The standardized protocol included IV anti-hypertensive medication and magnesium sulfate when systolic BP ≥160 mm Hg and/or diastolic BP was ≥110 mm Hg. The study was designed to compare 6 months of data prior to establishing the standardized protocol to data collected in the year following implementation.
During the study (including baseline and later data), there were 69,449 births, 2,034 of which had critically elevated blood pressure, preeclampsia, or superimposed preeclampsia. Compliance steadily increased over the year of the study interval. Rates of eclampsia decreased by 42.6% (1.15 ± 0.15/1000 to 0.62 ± 0.09/1000 births) and severe maternal morbidity decreased by 16.7% (2.4 ± 0.10% to 2.0 ± 0.15%) with P < .01. The authors conclude that (1) preeclampsia guideline compliance outside of studies may be low; (2) compliance can be improved quickly; (3) standardization of protocols using professional guidelines can positively impact adverse outcomes in the setting of severe preeclampsia.
Early standardized treatment of critical blood pressure elevations is associated with a reduction in eclampsia and severe maternal morbidity
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