Eclampsia Management: A Comprehensive Guide for Nurses

Eclampsia is a severe and life-threatening complication of preeclampsia characterized by the onset of seizures in a pregnant or postpartum woman without another identifiable cause. It requires immediate medical intervention to prevent maternal and fetal morbidity and mortality. Nurses play a vital role in identifying symptoms, managing acute episodes, and supporting patients during and after treatment.

Definition

Eclampsia is the occurrence of new-onset generalized tonic-clonic seizures in the setting of preeclampsia (characterized by hypertension and proteinuria or end-organ dysfunction).

Risk Factors

1. Maternal Factors:

• Nulliparity.
• Age <20 or >35 years.
• Family or personal history of preeclampsia/eclampsia.

1. Pregnancy-Related Factors:

• Multiple gestation.
• Molar pregnancy.
• Chronic hypertension or renal disease.

1. Other Factors:

• Obesity.
• Diabetes mellitus.
• Autoimmune disorders (e.g., lupus, antiphospholipid syndrome).

Clinical Presentation

Symptoms (Preceding Seizures):

• Persistent headache.
• Visual disturbances (e.g., blurred vision, scotoma).
• Epigastric or right upper quadrant pain.
• Severe hypertension (>160/110 mmHg).
• Nausea and vomiting.
• Oliguria.

During the Seizure:

• Generalized tonic-clonic movements.
• Loss of consciousness.
• Cyanosis or apnea.

Postictal State:

• Confusion, agitation, or drowsiness.
• Amnesia of the seizure event.

Complications of Eclampsia

1. Maternal:

• Intracranial hemorrhage.
• Pulmonary edema.
• Acute kidney injury.
• Disseminated intravascular coagulation (DIC).
• Death.

1. Fetal:

• Hypoxia and acidosis.
• Preterm birth.
• Intrauterine growth restriction (IUGR).
• Fetal demise.

Management of Eclampsia

Goals of Management:

1. Control seizures.
2. Manage hypertension.
3. Prevent recurrent seizures and complications.
4. Optimize maternal and fetal outcomes.

1. Seizure Management:

• Positioning:
• Place the patient in a left lateral position to improve venous return and reduce aspiration risk.
• Airway Protection:
• Ensure patency; use a jaw thrust if necessary.
• Administer supplemental oxygen via mask or nasal cannula to maintain oxygen saturation >94%.
• Seizure Termination:
• Administer magnesium sulfate:
• Loading dose: 4–6 g IV over 15–20 minutes.
• Maintenance dose: 1–2 g/hour IV via continuous infusion.
• Monitor for signs of magnesium toxicity (e.g., loss of patellar reflexes, respiratory depression, lethargy).
• If seizures persist:
• Administer benzodiazepines (e.g., lorazepam 4 mg IV or diazepam 5–10 mg IV).

2. Blood Pressure Control:

• Target Blood Pressure:
• Maintain systolic BP <160 mmHg and diastolic BP <110 mmHg.
• Antihypertensive Medications:
• Labetalol:
• Initial dose: 20 mg IV, followed by 40–80 mg every 10–15 minutes (maximum: 300 mg).
• Hydralazine:
• 5–10 mg IV every 20–30 minutes as needed.
• Nifedipine:
• 10–20 mg oral immediate-release for acute management.

3. Delivery Planning:

• Timing:
• Expedite delivery once the patient is stabilized, as delivery is the definitive treatment for eclampsia.
• Mode:
• Vaginal delivery is preferred if the cervix is favorable.
• Cesarean section may be necessary for maternal or fetal indications.

4. Post-Seizure Care:

• Continuous maternal and fetal monitoring.
• Monitor for complications such as DIC, pulmonary edema, or acute kidney injury.
• Assess neurologic status regularly.

Nursing Interventions

1. Monitoring:

• Regularly assess vital signs (BP, pulse, respiratory rate).
• Monitor urine output (goal: >30 mL/hour) for renal function.
• Perform frequent neurologic checks for signs of intracranial pressure.
• Assess fetal heart rate and uterine contractions.

2. Magnesium Sulfate Administration:

• Monitor therapeutic levels (4–7 mEq/L).
• Observe for signs of magnesium toxicity:
• Respiratory depression (<12 breaths/min).
• Loss of deep tendon reflexes.
• Decreased urine output.
• Antidote: Administer calcium gluconate (1 g IV over 3 minutes) for magnesium toxicity.

3. Seizure Precautions:

• Maintain side rails padded and raised.
• Keep suction equipment and oxygen readily available.

4. Psychosocial Support:

• Reassure the patient and family.
• Provide clear explanations of interventions and expected outcomes.

5. Documentation:

• Record seizure activity (duration, type, and interventions).
• Document maternal and fetal responses to treatment.

Prevention of Eclampsia

1. Preeclampsia Screening and Management:

• Regular antenatal care to monitor BP, proteinuria, and signs of preeclampsia.
• Administer low-dose aspirin starting at 12–16 weeks for high-risk patients.

1. Early Identification:

• Educate patients on warning signs (severe headache, visual disturbances, abdominal pain).

1. Magnesium Sulfate Prophylaxis:

• For patients with severe preeclampsia to prevent progression to eclampsia.

Complications to Monitor

1. Maternal:

• Pulmonary edema.
• HELLP syndrome (hemolysis, elevated liver enzymes, low platelets).
• Stroke or intracranial hemorrhage.

1. Fetal:

• Preterm delivery and associated complications.
• Intrauterine fetal demise (IUFD).

Conclusion

Eclampsia is a critical obstetric emergency that requires swift and effective management. Nurses play a pivotal role in identifying signs of impending eclampsia, implementing evidence-based interventions, and ensuring the safety of both the mother and fetus. Through vigilant monitoring and timely action, nurses can significantly improve outcomes and support patients during this life-threatening condition.