Preeclampsia vs Eclampsia
How to tell Preeclampsia and Eclampsia apart when a board question makes them look alike.
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Occurrence of seizure is the immediate discriminator that upgrades preeclampsia to eclampsia.
Side by side
New hypertension after 20 weeks with proteinuria or severe-feature end-organ findings without seizures indicates preeclampsia.
Generalized tonic-clonic seizure in a patient with preeclampsia indicates eclampsia and requires immediate seizure management plus delivery planning.
Abnormal placentation causes endothelial dysfunction, vasospasm, and multiorgan injury.
Progressive endothelial and cerebral dysfunction triggers seizure activity in severe hypertensive disease of pregnancy.
Diagnostic thresholds include BP at or above 140/90 mm Hg on two readings and proteinuria at or above 300 mg per 24 hours or protein/creatinine ratio at or above 0.3; severe features include platelets below 100000 per uL, creatinine above 1.1 mg/dL, AST or ALT at least twice normal, pulmonary edema, or neurologic symptoms.
Eclampsia is clinical seizure in this setting; evaluate glucose, CBC, CMP, uric acid, and fetal status, but treatment with magnesium should not wait for full lab return.
The trap
A frequent error is treating seizure with benzodiazepine alone while delaying magnesium and delivery planning. The resolving clue is pregnancy-associated hypertension plus seizure, which mandates magnesium sulfate protocol and obstetric escalation.
The repair move
Next best step: protect airway and start magnesium sulfate immediately with 4 to 6 g IV loading dose followed by 2 g/hour infusion. Control severe blood pressure with IV labetalol 20 mg then escalating doses or IV hydralazine, monitor reflexes and urine output, and proceed to delivery after maternal stabilization.
Try a free question
CoreA pregnant patient at 33 weeks with preeclampsia develops generalized seizure. What is the next best step in management?
Show answer and explanation
Answer: A. Administer magnesium sulfate loading dose immediately. Eclamptic seizure is treated first with magnesium sulfate and maternal stabilization.
Why the other choices are tempting
- B. Valproate alone is not first-line acute eclampsia management.
- C. Discharge is unsafe after obstetric seizure.
- D. Delaying therapy for imaging increases maternal-fetal risk.
- E. Blood pressure control alone does not prevent recurrent seizures.
Flashcards
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What event converts preeclampsia into eclampsia?
A generalized seizure in a patient with preeclampsia.
What is the first-line anticonvulsant therapy in eclampsia?
Magnesium sulfate, not routine chronic antiepileptics.
Quick answers
What is the fastest way to tell Preeclampsia from Eclampsia?
Occurrence of seizure is the immediate discriminator that upgrades preeclampsia to eclampsia.
What is the key clue for Preeclampsia?
New hypertension after 20 weeks with proteinuria or severe-feature end-organ findings without seizures indicates preeclampsia.
What is the key clue for Eclampsia?
Generalized tonic-clonic seizure in a patient with preeclampsia indicates eclampsia and requires immediate seizure management plus delivery planning.
What is the common trap with Preeclampsia vs Eclampsia?
A frequent error is treating seizure with benzodiazepine alone while delaying magnesium and delivery planning. The resolving clue is pregnancy-associated hypertension plus seizure, which mandates magnesium sulfate protocol and obstetric escalation.