Obstetrics Quick Reference – Key NCLEX Nursing Topics
Eclampsia
Eclampsia
Eclampsia is a serious and life-threatening complication of pregnancy characterized by the onset of seizures in a woman with preeclampsia (high blood pressure, protein in urine, and other signs of organ dysfunction). It usually occurs in the third trimester, during labor, or postpartum. Symptoms may include headache, visual disturbances, right upper abdominal pain, and sudden seizures. Eclampsia can lead to complications such as placental abruption, stroke, coma, and even maternal or fetal death. Immediate treatment involves magnesium sulfate to control seizures, blood pressure management, and often emergency delivery of the baby. Early detection and management of preeclampsia are key to preventing eclampsia.
1. Pathogenesis Triad
- Vasospasm → End-organ ischemia
- Endothelial Injury → Proteinuria/edema
- Cerebral Dysregulation → Seizures
Key Mechanism:
- Imbalance in angiogenic (PlGF) vs anti-angiogenic (sFlt-1) factors
2. Risk Stratification (PRE-ECLAMP Mnemonic)
| High Risk (5x↑) | Moderate Risk (2x↑) |
|---|---|
| Prior eclampsia | Nulliparity |
| Renal disease | Age >40 or <18 |
| Chronic hypertension | BMI >35 |
| Multifetal gestation | Family history |
| APS/Thrombophilia | IVF pregnancy |
3. Diagnostic Criteria
Required:
- Seizures in pregnant/postpartum woman + ONE of:
- BP ≥160/110 mmHg
- Proteinuria ≥300mg/24h
- End-organ dysfunction (Cr >1.1, ALT >40, platelets <100K)
Red Flags for Impending Seizure:
- HEADACHE (Persistent, opioid-resistant)
- VISION CHANGES (Scotomas, blurred vision)
- EPIGASTRIC PAIN (Liver capsule distension)
4. Emergency Management
A. Acute Seizure Response (TIME-CRITICAL)
- Position: Left lateral to prevent aspiration
- Oxygen: 10L/min via non-rebreather
- Mag Sulfate:
- Load: 6g IV over 15-20 min
- Maintenance: 2g/hr IV (therapeutic level 4-7 mEq/L)
- BP Control:
- 1st Line: Labetalol 20mg IV → 40mg → 80mg q10min (max 300mg)
- 2nd Line: Hydralazine 5-10mg IV q20min
B. Delivery Decision
- Category 1 C-section if:
- Recurrent seizures despite MgSO₄
- Non-reassuring fetal status
- Maternal multiorgan failure
5. Monitoring Parameters
| System | Assessment | Frequency |
|---|---|---|
| Neurologic | Patellar reflexes, RR (↓ if <12) | Q1h |
| Cardiovascular | BP (target <160/110) | Q15min acute phase |
| Renal | UOP (>30mL/hr), Cr | Q4h |
| Fetal | Continuous CTG | Until delivery |
MagSO₄ Toxicity Checklist:
Absent DTRs
RR <12
UOP <30mL/hr
6. Nursing Action Plan
A. Safety Measures
- Bed in lowest position, padded rails
- Airway kit at bedside
B. Fluid Management
- Strict I/O (limit to 80mL/hr unless bleeding)
- Watch for pulmonary edema (crackles, SpO₂ <94%)
C. Patient Education
- "Report any new headache or visual changes"
- "No sudden BP drops" (risk placental hypoperfusion)
7. Complications & Prognosis
Maternal Risks:
- HELLP (15% of cases)
- Postpartum stroke (BP lability x48h)
Fetal Risks:
- Abruption (20%)
- IUGR (30%)
Survival Rates:
- Maternal mortality <1% with treatment
- Perinatal mortality 5-10%
8. Prevention Strategy
High-Risk Patients:
- Low-dose aspirin (81mg daily) starting at 12w
- Calcium 1g/day if dietary intake low
Postpartum Monitoring:
- BP checks q15min x2h → q1h x24h
- MagSO₄ continued x24h postpartum
Clinical Pearls
- "MgSO₄ First": Antihypertensives should NEVER delay seizure prophylaxis
- No Phenytoin: Ineffective for eclamptic seizures
- Delivery Cure: Symptoms may worsen initially postpartum (48h critical window
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