Diagnosis

Eclamptic convulsions classically occur in the second half of pregnancy and up to 10 days after delivery. Postpartum convulsions occur in 30 to 40 per cent and, within this group, the first convulsion occurs more than 48 h after delivery in 30 per cent of cases ( Sibai 1990). Eclamptic convulsions are epileptiform in type; a tonic phase of muscular contraction is followed by clonic movements that may last a minute or longer, after which the woman passes into a brief period of coma (postictal state). Although most convulsions occur without a preceding aura, many women will manifest excitability or hyper-reflexia prior to the onset of the seizure.

The diagnosis of eclampsia is straightforward when convulsions occur in a woman admitted with pre-eclampsia. However, 38 per cent do not have established proteinuria and hypertension before the first fit, and less than 60 per cent have antecedent symptoms such as headache, visual disturbance, and epigastric pain (DpugJas. aDd RedmaD...1994). The diagnosis is more difficult if a woman is found unconscious. If she is hypertensive or has proteinuria, the working diagnosis is eclampsia. Observation over 30 min may confirm that she is postictal, but persistent coma or the development of localizing signs will raise the possibility of a cerebral accident. Other pathologies, including encephalitis, meningitis, drug withdrawal, and metabolic disturbances, together with iatrogenic causes (lidocaine (lignocaine) toxicity or water intoxication from inappropriate fluid and oxytocin use) should be considered if there are prolonged convulsions.

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