Eclampsia

Eclampsia is a new-onset generalized seizure during pregnancy or after birth that occurs within the preeclampsia spectrum and is not better explained by another neurological or metabolic condition. It may appear before labour, during labour, or postpartum, including several weeks after delivery. A normal blood pressure on admission does not exclude it. The underlying problem begins with placental ischemia. Widespread endothelial dysfunction and vasospasm disturb vascular tone and cerebral autoregulation. The brain may then experience hyperperfusion, vessel leakage, and cerebral edema, lowering the threshold for a generalized tonic-clonic seizure. The seizure is therefore not simply a response to one elevated blood-pressure reading; it is a manifestation of systemic disease. Preeclampsia is defined by new hypertension after 20 weeks of gestation—systolic pressure of at least 140 mm Hg or diastolic pressure of at least 90 mm Hg—together with proteinuria or acute end-organ dysfunction. Severe features include blood pressure at least 160/110 mm Hg, thrombocytopenia, renal insufficiency, hepatic dysfunction, pulmonary edema, and neurological symptoms such as severe headache or visual disturbance. These findings indicate a high-risk disease state in which magnesium sulfate...