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Eclampsia refers to the occurrence of one or more generalized convulsions and/or coma in the setting of preeclampsia and in the absence of other neurologic conditions. The clinical manifestations can appear anytime from the second trimester to the puerperium. In the past, eclampsia was thought to be the end result of preeclampsia (hence the nomenclature); however, it is now clear that seizures should be considered merely one of several clinical manifestations of severe preeclampsia (table 1), rather than a separate disease. Despite advances in detection and management, preeclampsia/eclampsia remains a common cause of maternal death [1].

The diagnosis and management of eclampsia will be reviewed here. Issues related to preeclampsia are discussed separately. (See "Preeclampsia: Pathogenesis" and "Preeclampsia: Clinical features and diagnosis" and "Preeclampsia: Management and prognosis" and "Preeclampsia: Prevention".)


An eclamptic seizure occurs in 2 to 3 percent of severely preeclamptic women not receiving anti-seizure prophylaxis; the seizure rate is estimated to be between 0 and 0.6 percent in women with preeclampsia without severe features (previously referred to as “mild” preeclampsia) [2]. The incidence of eclampsia has been relatively stable at 1.6 to 10 cases per 10,000 deliveries in developed countries [3-8]. In developing countries, however, the incidence varies widely: from 6 to 157 cases per 10,000 deliveries [9-11].

Risk factors for eclampsia are similar to those for preeclampsia (table 2). Nonwhite, nulliparous women from lower socioeconomic backgrounds are the group at highest risk of developing eclampsia. Peak incidence is in the teenage years and low twenties, but there is also an increased incidence in women over 35 years of age.

Timing: antepartum, intrapartum, postpartum — Eclampsia prior to 20 weeks of gestation is rare and should raise the possibility of an underlying molar pregnancy or antiphospholipid syndrome. (See "Hydatidiform mole: Epidemiology, clinical features, and diagnosis" and "Pregnancy in women with antiphospholipid syndrome".)


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Literature review current through: Nov 2014. | This topic last updated: Jul 14, 2014.
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  1. (Accessed on December 04, 2013).
  2. Sibai BM. Magnesium sulfate prophylaxis in preeclampsia: Lessons learned from recent trials. Am J Obstet Gynecol 2004; 190:1520.
  3. Douglas KA, Redman CW. Eclampsia in the United Kingdom. BMJ 1994; 309:1395.
  4. Tuffnell DJ, Jankowicz D, Lindow SW, et al. Outcomes of severe pre-eclampsia/eclampsia in Yorkshire 1999/2003. BJOG 2005; 112:875.
  5. Zwart JJ, Richters A, Ory F, et al. Eclampsia in the Netherlands. Obstet Gynecol 2008; 112:820.
  6. Liu S, Joseph KS, Liston RM, et al. Incidence, risk factors, and associated complications of eclampsia. Obstet Gynecol 2011; 118:987.
  7. Tan KH, Kwek K, Yeo GS. Epidemiology of pre-eclampsia and eclampsia at the KK Women's and Children's Hospital, Singapore. Singapore Med J 2006; 47:48.
  8. Fong A, Chau CT, Pan D, Ogunyemi DA. Clinical morbidities, trends, and demographics of eclampsia: a population-based study. Am J Obstet Gynecol 2013; 209:229.e1.
  9. Geographic variation in the incidence of hypertension in pregnancy. World Health Organization International Collaborative Study of Hypertensive Disorders of Pregnancy. Am J Obstet Gynecol 1988; 158:80.
  10. Eke AC, Ezebialu IU, Okafor C. Presentation and outcome of eclampsia at a tertiary center in South East Nigeria--a 6-year review. Hypertens Pregnancy 2011; 30:125.
  11. Miguil M, Chekairi A. Eclampsia, study of 342 cases. Hypertens Pregnancy 2008; 27:103.
  12. Lubarsky SL, Barton JR, Friedman SA, et al. Late postpartum eclampsia revisited. Obstet Gynecol 1994; 83:502.
  13. Miles JF Jr, Martin JN Jr, Blake PG, et al. Postpartum eclampsia: a recurring perinatal dilemma. Obstet Gynecol 1990; 76:328.
  14. Chames MC, Livingston JC, Ivester TS, et al. Late postpartum eclampsia: a preventable disease? Am J Obstet Gynecol 2002; 186:1174.
  15. Sibai BM. Diagnosis, prevention, and management of eclampsia. Obstet Gynecol 2005; 105:402.
  16. Morriss MC, Twickler DM, Hatab MR, et al. Cerebral blood flow and cranial magnetic resonance imaging in eclampsia and severe preeclampsia. Obstet Gynecol 1997; 89:561.
  17. Sheehan HL, Lynch JB. Pathology of toxaemia of pregnancy, Williams and Wilkins, Baltimore 1973.
  18. Zeeman GG, Fleckenstein JL, Twickler DM, Cunningham FG. Cerebral infarction in eclampsia. Am J Obstet Gynecol 2004; 190:714.
  19. Sibai BM, McCubbin JH, Anderson GD, et al. Eclampsia. I. Observations from 67 recent cases. Obstet Gynecol 1981; 58:609.
  20. Sibai BM. Eclampsia. VI. Maternal-perinatal outcome in 254 consecutive cases. Am J Obstet Gynecol 1990; 163:1049.
  21. Dahmus MA, Barton JR, Sibai BM. Cerebral imaging in eclampsia: magnetic resonance imaging versus computed tomography. Am J Obstet Gynecol 1992; 167:935.
  22. van Weert JM, Hajenius PJ, Richard E, et al. [Late postpartum eclampsia]. Ned Tijdschr Geneeskd 2007; 151:414.
  23. Mattar F, Sibai BM. Eclampsia. VIII. Risk factors for maternal morbidity. Am J Obstet Gynecol 2000; 182:307.
  24. Singhal AB, Kimberly WT, Schaefer PW, Hedley-Whyte ET. Case records of the Massachusetts General Hospital. Case 8-2009. A 36-year-old woman with headache, hypertension, and seizure 2 weeks post partum. N Engl J Med 2009; 360:1126.
  25. Al-Safi Z, Imudia AN, Filetti LC, et al. Delayed postpartum preeclampsia and eclampsia: demographics, clinical course, and complications. Obstet Gynecol 2011; 118:1102.
  26. Paul RH, Koh KS, Bernstein SG. Changes in fetal heart rate-uterine contraction patterns associated with eclampsia. Am J Obstet Gynecol 1978; 130:165.
  27. Ille O, Woimant F, Pruna A, et al. Hypertensive encephalopathy after bilateral carotid endarterectomy. Stroke 1995; 26:488.
  28. Hinchey J, Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996; 334:494.
  29. Brewer J, Owens MY, Wallace K, et al. Posterior reversible encephalopathy syndrome in 46 of 47 patients with eclampsia. Am J Obstet Gynecol 2013; 208:468.e1.
  30. Schwartz RB, Feske SK, Polak JF, et al. Preeclampsia-eclampsia: clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy. Radiology 2000; 217:371.
  31. Wagner SJ, Acquah LA, Lindell EP, et al. Posterior reversible encephalopathy syndrome and eclampsia: pressing the case for more aggressive blood pressure control. Mayo Clin Proc 2011; 86:851.
  32. Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360:1903.
  33. Lindenstrøm E, Boysen G, Nyboe J. Influence of systolic and diastolic blood pressure on stroke risk: a prospective observational study. Am J Epidemiol 1995; 142:1279.
  34. Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet 2000; 356:411.
  35. Ledingham JG, Rajagopalan B. Cerebral complications in the treatment of accelerated hypertension. Q J Med 1979; 48:25.
  36. Sibai BM. Treatment of hypertension in pregnant women. N Engl J Med 1996; 335:257.
  37. von Dadelszen P, Ornstein MP, Bull SB, et al. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis. Lancet 2000; 355:87.
  38. Magee LA, Ornstein MP, von Dadelszen P. Fortnightly review: management of hypertension in pregnancy. BMJ 1999; 318:1332.
  39. Pritchard JA, Cunningham FG, Pritchard SA. The Parkland Memorial Hospital protocol for treatment of eclampsia: evaluation of 245 cases. Am J Obstet Gynecol 1984; 148:951.
  40. Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet 1995; 345:1455.
  41. Duley L, Gulmezoglu AM. Magnesium sulphate versus lytic cocktail for eclampsia. Cochrane Database Syst Rev 2001; :CD002960.
  42. Duley L, Henderson-Smart D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev 2003; :CD000127.
  43. Duley L, Henderson-Smart D. Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database Syst Rev 2003; :CD000128.
  44. Belfort MA, Moise KJ Jr. Effect of magnesium sulfate on maternal brain blood flow in preeclampsia: a randomized, placebo-controlled study. Am J Obstet Gynecol 1992; 167:661.
  45. Gerthoffer WT, Shafer PG, Taylor S. Selectivity of phenytoin and dihydropyridine calcium channel blockers for relaxation of the basilar artery. J Cardiovasc Pharmacol 1987; 10:9.
  46. Sibai BM, Lipshitz J, Anderson GD, Dilts PV Jr. Reassessment of intravenous MgSO4 therapy in preeclampsia-eclampsia. Obstet Gynecol 1981; 57:199.
  47. Delgado-Escueta AV, Wasterlain C, Treiman DM, Porter RJ. Current concepts in neurology: management of status epilepticus. N Engl J Med 1982; 306:1337.
  48. Andersen WA, Harbert GM Jr. Conservative management of pre-eclamptic and eclamptic patients: a re-evaluation. Am J Obstet Gynecol 1977; 129:260.
  49. Tukur J, Umar NI, Khan N, Musa D. Comparison of emergency caesarean section to misoprostol induction for the delivery of antepartum eclamptic patients: a pilot study. Niger J Med 2007; 16:364.
  50. American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122:1122.
  51. Seal SL, Ghosh D, Kamilya G, et al. Does route of delivery affect maternal and perinatal outcome in women with eclampsia? A randomized controlled pilot study. Am J Obstet Gynecol 2012; 206:484.e1.
  52. Alexander JM, Bloom SL, McIntire DD, Leveno KJ. Severe preeclampsia and the very low birth weight infant: is induction of labor harmful? Obstet Gynecol 1999; 93:485.
  53. Nassar AH, Adra AM, Chakhtoura N, et al. Severe preeclampsia remote from term: labor induction or elective cesarean delivery? Am J Obstet Gynecol 1998; 179:1210.
  54. Barrett HL, Nitert Dekker M, Lust K, et al. The conundrum of eclampsia and fitness to drive. Aust N Z J Obstet Gynaecol 2013; 53:540.
  55. Sibai BM, Spinnato JA, Watson DL, et al. Eclampsia. IV. Neurological findings and future outcome. Am J Obstet Gynecol 1985; 152:184.
  56. Okanloma KA, Moodley J. Neurological complications associated with the pre-eclampsia/eclampsia syndrome. Int J Gynaecol Obstet 2000; 71:223.
  57. López-Llera M. Main clinical types and subtypes of eclampsia. Am J Obstet Gynecol 1992; 166:4.
  58. Conde-Agudelo A, Kafury-Goeta AC. Case-control study of risk factors for complicated eclampsia. Obstet Gynecol 1997; 90:172.
  59. MacKay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol 2001; 97:533.
  60. Moodley J. Maternal deaths due to hypertensive disorders in pregnancy: Saving Mothers report 2002-2004. Cardiovasc J Afr 2007; 18:358.
  61. Sibai BM, Anderson GD, Abdella TN, et al. Eclampsia. III. Neonatal outcome, growth, and development. Am J Obstet Gynecol 1983; 146:307.
  62. Chesley SC, Annitto JE, Cosgrove RA. The remote prognosis of eclamptic women. Sixth periodic report. Am J Obstet Gynecol 1976; 124:446.
  63. Sibai BM, el-Nazer A, Gonzalez-Ruiz A. Severe preeclampsia-eclampsia in young primigravid women: subsequent pregnancy outcome and remote prognosis. Am J Obstet Gynecol 1986; 155:1011.
  64. Gilstrap LC 3rd, Cunningham FG, Whalley PJ. Management of pregnancy-induced hypertension in the nulliparous patient remote from term. Semin Perinatol 1978; 2:73.
  65. Sibai BM, Sarinoglu C, Mercer BM. Eclampsia. VII. Pregnancy outcome after eclampsia and long-term prognosis. Am J Obstet Gynecol 1992; 166:1757.
  66. Sibai BM, Mercer B, Sarinoglu C. Severe preeclampsia in the second trimester: recurrence risk and long-term prognosis. Am J Obstet Gynecol 1991; 165:1408.
  67. Sibai BM, Ramadan MK, Chari RS, Friedman SA. Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis. Am J Obstet Gynecol 1995; 172:125.
  68. Aukes AM, de Groot JC, Aarnoudse JG, Zeeman GG. Brain lesions several years after eclampsia. Am J Obstet Gynecol 2009; 200:504.e1.
  69. Postma IR, Bouma A, Ankersmit IF, Zeeman GG. Neurocognitive functioning following preeclampsia and eclampsia: a long-term follow-up study. Am J Obstet Gynecol 2014; 211:37.e1.
  70. Möller B, Lindmark G. Eclampsia in Sweden, 1976-1980. Acta Obstet Gynecol Scand 1986; 65:307.
  71. Sibai BM, Abdella TN, Spinnato JA, Anderson GD. Eclampsia. V. The incidence of nonpreventable eclampsia. Am J Obstet Gynecol 1986; 154:581.
  72. Campbell DM, Templeton AA. Is Eclampsia Preventable?. In: Pregnancy Hypertension, Bonnar J, MacGillivray I, Symonds ED (Eds), University Park Press, Baltimore 1980. p.483.
  73. Bailly E, Savel J, Mahouy G, Jaureguiberry G. Plasmodium falciparum: isolation and characterization of a 55-kDa protease with a cathepsin D-like activity from P. falciparum. Exp Parasitol 1991; 72:278.