eMedicine Specialties > Obstetrics and Gynecology > Obstetrical Complications

Eclampsia: Follow-up

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

Follow-up

Further Inpatient Care

Continue to monitor blood pressure, neurologic status, and urine output until the patient is stable after delivery. Patients may require antihypertensive therapy after delivery and hospital discharge.

Further Outpatient Care

Follow up 1-2 weeks after delivery to evaluate for blood pressure control and any residual deficits from the eclamptic seizure. Patients with persistent hypertension past 8 weeks' puerperium or neurologic changes may need medical referral.

Inpatient & Outpatient Medications

This disease is treated on an inpatient basis, as described above. Outpatient care plays no role in management.

Transfer

Eclampsia clearly poses a risk of considerable maternal and neonatal morbidity and mortality. Patients with eclampsia may benefit from management at a tertiary care center.

Deterrence/Prevention

• Routine prenatal care
• Early diagnosis and aggressive management of preeclampsia

Complications

• As many as 56% of patients with eclampsia may have transient deficits, including cortical blindness.
• Studies have failed to demonstrate evidence of persisting neurologic deficits after uncomplicated eclamptic seizures during the follow-up period.⁶
• Maternal, as well as fetal, death can be a consequence of eclampsia and its complications.

Prognosis

• About 25% of women with eclampsia have hypertension in subsequent pregnancies.
• 5% of patients with hypertension develop severe preeclampsia.
• About 2% of women with eclampsia develop eclampsia with future pregnancies.
• Multiparous women with eclampsia have the following:
  • A higher risk for development of essential hypertension
  • A higher mortality rate in subsequent pregnancies as compared with primiparous women

Patient Education

• The patient should be advised and educated on the course of the disease and any residual problems.
• The patient should be educated on the importance of adequate prenatal care in subsequent pregnancies.
• If the patient has preexisting hypertension, she should have good control prior to conception and throughout pregnancy. Her case should be followed for recognition and treatment of preeclampsia.

Miscellaneous

Medicolegal Pitfalls

• The mode of delivery should be based on obstetric indications, with the understanding that vaginal delivery is preferable from a maternal standpoint.
• When emergent cesarean delivery is indicated, substantiating the absence of DIC prior to the procedure is important.
• Fetal bradycardia is common following an eclamptic seizure and usually resolves within 10 minutes. Consider placental abruption if uterine hyperactivity remains and fetal bradycardia persists.
• Cervical examination should not be overlooked. The delivery mode may be largely dependent on the cervical status.
• Fluid management is critical in patients with eclampsia.
• Avoid the use of multiple agents, unless necessary, to abate eclamptic seizures.
• Ruling out eclampsia in an obstetrical patient who has been involved in an unexplained trauma is important.

Special Concerns

• Do not overlook other neurologic causes, particularly if the seizure occurs more than 24 hours after delivery.
• When preeclampsia occurs in the early second trimester (ie, 14-20 weeks' gestation), the diagnosis of hydatiform mole or choriocarcinoma should be considered.
• Eclampsia always should be considered in a pregnant patient with a seizure episode.
• A pregnant patient who has been involved in an unexplained trauma (such as a single-vehicle auto accident) and has exhibited seizure activity should be evaluated for eclampsia.

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Stephanie R Fugate, DO and coauthor Gregory E Chow, MD to the development and writing of this article.

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