Management of eclampsia

Eclampsia refers to the occurrence of one or more generalized grand mal tonic-clonic seizures and/or coma in the setting of preeclampsia and in the absence of underlying neurological disease. The origin of the word is from the Greek “eklampsis,” meaning a “shining forth” [1], although other origins have been proposed including “bolt from the blue,” a “lightning bolt,” and other such terms to describe the aura that commonly precedes the seizure. Eclampsia was at one time thought to be the end result of preeclampsia, hence the nomenclature. It is now clear, however, that seizures are but one clinical manifestation of “severe” preeclampsia. Incidence Despite recent advances in detection and management, preeclampsia remains the second most common cause of maternal death in the United States (after thromboembolism), accounting for approximately 15% of all maternal deaths [2]. It is estimated that eclampsia is a factor in up to 10% of all maternal deaths in developed countries, and probably accounts for around 50 000 maternal deaths per year worldwide [3]. In the United States and other developed countries, the incidence of eclampsia is relatively stable at around 4-5 per 10 000 live births [4]. In developing countries, however, the reported incidence varies widely from 6-7 to as high as 100 cases per 10 000 live births [5], which reflects in part the lack of adequate prenatal care. Occurrence rates are highest amongst non-white nulliparous women from lower socioeconomic backgrounds.