Management of eclampsia in the accident and emergency department

T Munro Eclampsia is defined as the occurrence of seizures in pregnancy or within 10 days of delivery, accompanied by at least two of the following features documented within 24 hours of the seizure: hypertension, pro-teinuria, thrombocytopenia or raised as-partate amino transferase. Eclampsia complicates approximately one in 2000 pregnancies in the United Kingdom and it remains one of the main causes of mater-nal death. Up to 38 % of cases of eclampsia can occur without premonitory signs or symp-toms of pre-eclampsia—that is, hyper-tension, proteinuria, and oedema. Only 38 % of eclamptic seizures occur antepar-tum; 18 % occur during labour and a further 44 % occur postpartum. Rare cases of eclampsia have occurred over a week after delivery. Outcome is poor for mother and child. Almost one in 50 women suVering ec-lamptic seizures die, 23 % will require ven-tilation and 35 % will have at least one major complication including pulmonary oedema, renal failure, disseminated intra-vascular coagulation, HELLP syndrome, acute respiratory distress syndrome, stroke, or cardiac arrest. Stillbirth or neo-natal death occurs in approximately one in 14 cases of eclampsia. Up to one third of eclamptic seizures occur out of hospital. For this reason, ini-tial management may involve accident and emergency departments. Early in-volvement of senior obstetric staV is crucial. Optimal emergency management of seizures, hypertension, fluid balance and subsequent safe transfer is essential to minimise morbidity and mortality