eMedicine Specialties > Obstetrics and Gynecology > Obstetrical Complications

Eclampsia: Differential Diagnoses & Workup

Author: Michael G Ross, MD, MPH, Professor of Obstetrics and Gynecology, David Geffen School of Medicine, University of California at Los Angeles; Professor, Department of Community Health Sciences, University of California at Los Angeles School of Public Health; Chair, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center
Contributor Information and Disclosures

Updated: Apr 1, 2009

Differential Diagnoses

Angiomas
Hyperaldosteronism, Primary
Cerebellar Hemorrhage
Meningitis
Cerebral Aneurysms
Metabolic disorders
Cerebral vasculitis
Seizures and Epilepsy: Overview and Classification
Cerebral Venous Thrombosis
Thrombotic thrombocytopenic purpura
Drug overdose
Undiagnosed brain tumors
Encephalopathy, Hypertensive
Gestational Trophoblastic Neoplasia
Head trauma

Workup

Laboratory Studies

  • No single laboratory test or set of laboratory determinations is useful in predicting maternal or neonatal outcome in women with eclampsia.
  • Laboratory studies that should be ordered include the following:
    • Complete blood cell count
    • Platelet count
    • Blood type and screen
    • Urinalysis for proteinuria
    • Electrolytes, serum calcium and magnesium
    • Liver function tests (ie, lactate dehydrogenase [LDH], aspartate aminotransferase [AST])
    • Serum glucose
    • Pulse oximetry
  • The most common hematologic abnormality is thrombocytopenia, which occurs in 17% of patients with eclampsia.
  • Disseminated intravascular coagulation (DIC) is uncommon in patients with eclampsia.

Imaging Studies

Imaging studies may be indicated after initial stabilization especially if there is doubt about the diagnosis or possible injuries secondary to seizure activity .

  • CT scan of the head, with or without contrast can exclude cerebral venous thrombosis, intracranial hemorrhage, and central nervous system lesions, all of which can occur in pregnancy and present with seizures.
    • Consider CT in patients who (1) have been involved in trauma, (2) are refractory to magnesium sulfate therapy, or (3) have atypical presentations (eg, seizures >24 h after delivery).
    • Although obtaining a CT scan in eclampsia is not routine, abnormalities have been observed in up to 50% of women imaged.
    • Characteristic CT findings include cortical hypodense areas, particularly in the occipital lobes, and diffuse cerebral edema, which is believed to correspond to petechial hemorrhages and diffuse edema noted in postmortem studies.
    • CT findings may include the following:
      • Cerebral edema
      • Diffuse white matter low-density areas
      • Patchy area of low density
      • Occipital white matter edema
      • Loss of normal cortical sulci
      • Reduced ventricular size
      • Cerebral hemorrhage
      • Intraventricular hemorrhage
      • Parenchymal hemorrhage (high density)
      • Cerebral infarction
      • Low attenuation areas
      • Basal ganglia infarctions
  • Magnetic resonance imaging of the head
    • Abnormal findings have been reported in up to 90% of women imaged.
    • MRI findings  
      • Increased signal at the grey-white matter junction on T2-weighted images
      • Cortical edema and hemorrhage

Other Tests

EEG and cerebral spinal fluid studies are rarely useful in management; however, they may be indicated if epilepsy or meningitis is considered in the diagnosis.

More on Eclampsia

Overview: Eclampsia
Differential Diagnoses & Workup: Eclampsia
Treatment & Medication: Eclampsia
Follow-up: Eclampsia
References
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References

  1. Douglas KA, Redman CW. Eclampsia in the United Kingdom. BMJ. Nov 26 1994;309(6966):1395-400. [Medline].

  2. Mattar, F, Sibai BM. Eclampsia. VIII. Risk Factors for maternal morbidity. Am J Obstet Gynecol. 1990;163:1049-55.

  3. Zhang J, Meikle S, Trumble A. Severe maternal morbidity associated with hypertensive disorders in pregnancy in the United States. Hypertens Pregnancy. 2003;22(2):203-12. [Medline].

  4. Sahin, G. Incidence, morbidity and mortality of pre-eclampsia and eclampsia. Available at www.gfmer.ch/Endo/Course2003/eclampsia.htm. Accessed February 18, 2009.

  5. Sibai BM. Diagnosis, prevention, and management of eclampsia. Obstet Gynecol. Feb 2005;105(2):402-10. [Medline].

  6. Sibai BM, Sarinoglu C, Mercer BM. Eclampsia. VII. Pregnancy outcome after eclampsia and long-term prognosis. Am J Obstet Gynecol. Jun 1992;166(6 Pt 1):1757-61; discussion 1761-3. [Medline].

  7. MacKay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol. Apr 2001;97(4):533-8. [Medline].

  8. Lucas MJ, Leveno KJ, Cunningham FG. A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med. Jul 27 1995;333(4):201-5. [Medline].

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Further Reading

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Keywords

eclampsia, seizures in pregnancy, toxemia of pregnancy, coma in pregnancy, preeclampsia, cerebral vasospasm, focal ischemia, hypertensive encephalopathy

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Contributor Information and Disclosures

Author

Michael G Ross, MD, MPH, Professor of Obstetrics and Gynecology, David Geffen School of Medicine, University of California at Los Angeles; Professor, Department of Community Health Sciences, University of California at Los Angeles School of Public Health; Chair, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center
Michael G Ross, MD, MPH is a member of the following medical societies: American Association for the Advancement of Science, American College of Obstetricians and Gynecologists, American Federation for Clinical Research, American Gynecological and Obstetrical Society, American Physiological Society, American Public Health Association, Association of Professors of Gynecology and Obstetrics, Perinatal Research Society, Phi Beta Kappa, Society for Gynecologic Investigation, Society for Maternal-Fetal Medicine, and Society for Neuroscience
Disclosure: Nothing to disclose.

Medical Editor

Bruce A Meyer, MD, MBA, Vice President for Medical Affairs, Associate Dean for Health System Affairs and Director of the Faculty Practice Plan, Professor, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School
Bruce A Meyer, MD, MBA is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Physician Executives, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Medical Group Management Association, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Antonio V Sison, MD, Medical Director, Ob/Gyn Group, Robert Wood Johnson University Hospital at Hamilton
Antonio V Sison, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and Association of Professors of Gynecology and Obstetrics
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals OB/GYN Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board; Vice Chair for Research and Education, Dept of OB/GYN, Tufts Medical Center
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

 
 
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