Eclampsia definition
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Eclampsia — Definition
Eclampsia is the new onset of generalized tonic-clonic seizures and/or coma occurring in a woman with preeclampsia, in the absence of any other underlying neurological cause to explain the seizures.
Core Components
| Element | Detail |
|---|---|
| Seizure type | Generalized tonic-clonic (typically lasting 60–90 seconds) |
| Setting | Occurs in the context of a hypertensive disorder of pregnancy (preeclampsia) |
| Timing | After 20 weeks of gestation, during labor, or postpartum (up to 4–6 weeks after delivery) |
| Exclusion | No other etiology for seizures (e.g., epilepsy, metabolic disturbance, intracranial pathology) |
Relationship to Preeclampsia
Eclampsia represents a severe end of the preeclampsia spectrum. Preeclampsia is classically defined by:
- Hypertension (BP ≥140/90 mmHg on two occasions ≥4 hours apart, after 20 weeks' gestation)
- Proteinuria (>300 mg/24h) and/or signs of end-organ damage (thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, new-onset headache, or visual disturbances)
Eclampsia = preeclampsia + seizures/coma
Importantly, eclamptic seizures can occasionally precede the classic clinical triad of preeclampsia, and the ACOG (2013) eliminated the requirement for proteinuria — recognizing preeclampsia as a syndromic diagnosis.
Key Points
- Epidemiology: Complicates ~0.005% of deliveries in developed countries; up to 1% in developing countries
- Postpartum eclampsia: Neurological symptoms are more likely when onset is postpartum
- Not limited to seizures: The broader syndrome includes headache, visual disturbances, hyperreflexia, oliguria, pulmonary edema, DIC, and hepatic hemorrhage — the seizure-only definition has been criticized as overly restrictive
- Treatment: IV magnesium sulfate is the drug of choice — reduces risk of eclampsia by >50% in women with preeclampsia
Sources: Bradley and Daroff's Neurology in Clinical Practice; Medscape; Merck Manual; WHO
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