eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Pregnancy, Eclampsia: Differential Diagnoses & Workup

Author: Allysia M Guy, MD, Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
Coauthor(s): Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Contributor Information and Disclosures

Updated: Aug 11, 2009

Differential Diagnoses

Adrenal Insufficiency and Adrenal Crisis
Shock, Septic
Encephalitis
Stroke, Hemorrhagic
Hypertensive Emergencies
Stroke, Ischemic
Hypoglycemia
Subarachnoid Hemorrhage
Meningitis
Systemic Lupus Erythematosus
Neoplasms, Brain
Withdrawal Syndromes
Pregnancy, Preeclampsia

Workup

Laboratory Studies

  • Urinalysis to detect for proteinuria (>300 mg/24 h or > 1 g/L): A timed collection has been the criterion standard. Protein per unit time measured over 24 hours has been used traditionally; however, 12-hour collections have been proven to be as accurate.8
  • The CBC may reveal the following:
    • Anemia due to microangiopathic hemolysis, hemoconcentration due to third spacing, or physiologic hemodilution of pregnancy
    • Peripheral smear (schistocytes, burr cells, echinocytes)
    • Increased bilirubin >1.2 mg/dL
    • Thrombocytopenia (<100,000) due to hemolysis and low platelet count associated with HELLP syndrome (seen in 20-25% of patients with eclampsia)2
    • Low serum haptoglobin levels
    • Elevated lactate dehydrogenase (LDH) levels (threshold of 180–600 U/L)
  • The serum creatinine level is elevated because of decreased intravascular volume and a decreased glomerular filtration rate (GFR). Creatinine clearance (CrCl) may be less than 90 mL/min/1.73 m2.
  • Liver function test results may reveal the following (20-25% of patients with eclampsia):
    • Aspartate aminotransferase (SGOT) level higher than 72 IU/L, total bilirubin levels higher than 1.2 mg/dL, and LDH level higher than 600 IU/L2
    • Elevated levels due to hepatocellular injury and HELLP syndrome
  • The coagulation profile may reveal normal prothrombin (PT) and activated partial thromboplastin (aPTT) times, fibrin split products, and fibrinogen levels. Rule out associated disseminated intravascular coagulation (DIC).
  • Rule out hypoglycemia as cause of seizure or result of seizure, and rule out hyperglycemia as cause of mental status changes.
  • Uric acid levels may be increased mildly.

Imaging Studies

  • Head CT scanning
    • Obtain a CT scan of the head in patients with severe preeclampsia or eclampsia and associated neurologic deficits or severe headache.
    • CT scan is used to assess intracranial hemorrhage, subarachnoid hemorrhages, or cerebrovascular accidents.
  • Transabdominal ultrasonography
    • Transabdominal ultrasonography is used to estimate gestational age.
    • This may also be used to rule out abruptio placentae that can complicate eclampsia.

More on Pregnancy, Eclampsia

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

  1. Craici I, Wagner S, Garovic VD. Preeclampsia and future cardiovascular risk: formal risk factor or failed stress test?. Ther Adv Cardiovasc Dis. Aug 2008;2(4):249-59. [Medline].

  2. Gabbe. Hypertension. In: Obstetrics: Normal and Problem Pregnancies. 5th ed. Churchill Livingstone, An Imprint of Elsevier; 2007:[Full Text].

  3. Reddy A, Suri S, Sargent IL, Redman CW, Muttukrishna S. Maternal circulating levels of activin A, inhibin A, sFlt-1 and endoglin at parturition in normal pregnancy and pre-eclampsia. PLoS One. 2009;4(2):e4453. [Medline].

  4. Banerjee S, Randeva H, Chambers AE. Mouse models for preeclampsia: disruption of redox-regulated signaling. Reprod Biol Endocrinol. Jan 15 2009;7:4. [Medline].

  5. Cadden KA, Walsh SW. Neutrophils, but not lymphocytes or monocytes, infiltrate maternal systemic vasculature in women with preeclampsia. Hypertens Pregnancy. 2008;27(4):396-405. [Medline].

  6. Nodler J, Moolamalla SR, Ledger EM, Nuwayhid BS, Mulla ZD. Elevated antiphospholipid antibody titers and adverse pregnancy outcomes: analysis of a population-based hospital dataset. BMC Pregnancy Childbirth. Mar 16 2009;9:11. [Medline].

  7. Rivers EP. Preeclampsia, eclampsia, and other hypertensive disorders of pregnancy. In: The Clinical Practice of Emergency Medicine. 2nd ed. 1996:315-21.

  8. Hofmeyr GJ, Belfort M. Proteinuria as a predictor of complications of pre-eclampsia. BMC Med. Mar 24 2009;7:11. [Medline].

  9. ACOG. ACOG Practice Bulletin: Diagnosis and Management of Preeclampsia and Eclampsia: The American College of Obstetricians and Gynecologists Number 33. Jan 2002.

  10. [Guideline] Milne F, Redman C, Walker J, Baker P, Bradley J, Cooper C, et al. The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community. BMJ. Mar 12 2005;330(7491):576-80. [Medline]. [Full Text].

  11. [Guideline] Tuffnell DJ, Shennan AH, Waugh JJ, Walker JJ. The management of severe pre-eclampsia/eclampsia. London (UK): Royal College of Obstetricians and Gynaecologists. Mar 2006;[Full Text].

  12. [Guideline] Magee LA, Helewa M, Moutquin JM, von Dadelszen P, Hypertension Guideline Committee, Society of Obstetricians and Gynaecologists of Canada. Prediction, prevention, and prognosis of preeclampsia. In: Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. J Obstet Gynaecol Can. Mar 2008;30(3 Suppl 1):S16-23. [Full Text].

  13. Abbott J. Complications related to pregnancy. In: Emergency Medicine: Concepts and Clinical Practice. 3rd ed. 1992:1984-7.

  14. Brady WJ, DeBehnke DJ, Carter CT. Postpartum toxemia: hypertension, edema, proteinuria and unresponsiveness in an unknown female. J Emerg Med. Sep-Oct 1995;13(5):643-8. [Medline].

  15. Coomarasamy A, Honest H, Papaioannou S. Aspirin for prevention of preeclampsia in women with historical risk factors: a systematic review. Obstet Gynecol. Jun 2003;101(6):1319-32. [Medline].

  16. Duley L, Henderson-Smart D, Knight M, King J. Antiplatelet drugs for prevention of pre-eclampsia and its consequences: systematic review. BMJ. Feb 10 2001;322(7282):329-33. [Medline].

  17. [Guideline] Hals G, Crump T. The pregnant patient: guidelines for management of common life-threatening medical disorders in the emergency department. Emerg Med Rep. Mar 13 2000;21(6):57-9.

  18. Hansen WF. Problems in pregnancy. In: Emergency Medicine: A Comprehensive Study Guide. 4th ed. 1996:573.

  19. Moussouttas M, Abubakr A, Grewal RP. Eclamptic subarachnoid haemorrhage without hypertension. J Clin Neurosci. May 2006;13(4):474-6. [Medline].

  20. Rigourd V, Chauvet C, Chelbi ST, Rebourcet R, Mondon F, Letourneur F, et al. STOX1 overexpression in choriocarcinoma cells mimics transcriptional alterations observed in preeclamptic placentas. PLoS One. 2008;3(12):e3905. [Medline].

  21. Robinson CJ, Johnson DD, Chang EY. Evaluation of placenta growth factor and soluble Fms-like tyrosine kinase 1 receptor levels in mild and severe preeclampsia. Am J Obstet Gynecol. Jul 2006;195(1):255-9. [Medline].

  22. Stennett AK, Khalil RA. Neurovascular mechanisms of hypertension in pregnancy. Curr Neurovasc Res. May 2006;3(2):131-48. [Medline].

  23. Thangaratinam S, Coomarasamy A, O'Mahony F, Sharp S, Zamora J, Khan KS, et al. Estimation of proteinuria as a predictor of complications of pre-eclampsia: a systematic review. BMC Med. Mar 24 2009;7:10. [Medline].

  24. Which anticonvulsant for women with eclampsia?. Evidence from the Collaborative Eclampsia Trial. Lancet. Jun 10 1995;345(8963):1455-63. [Medline].

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Further Reading

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Keywords

eclampsia, hypertension of pregnancy, seizures in pregnancy, toxemia of pregnancy, coma in pregnancy, preeclampsia, hypertensive disorder, proteinuria

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Contributor Information and Disclosures

Author

Allysia M Guy, MD, Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Medicines Company Consulting fee Consulting; Pfizer Salary Employment

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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