Reassessing seizure risk in preeclampsia: Potential for selective prophylaxis

OBJECTIVE: Routine seizure prophylaxis is common in preeclampsia management. Recently the efficacy of this practice ha.s been challenged. We review our recent experience with eclampsia to identify preseizure risks factors that may guide future protocols for selective seizure prophylaxis. STUDY DESIGN: From 199(1-94 preeclamptic/eclamptic patients were identified from the medical record data base by ICD-9 codes. Eclamptic patient charts were reviewed for demographics, preeclamptic signs and symptoms, and timing of seizures. RESULTS: Preeclampsia occurred in 4.6% of all deliveries, with 25.0% classified as severe. Eclamptic seizures occurred in 37 patients (0.1% of deliveries). Mean maternal age was 19.9 yrs. 68% were nulliparous. Mean gesiational age at del Ken7 was 35.7 ±3.7 wks. Severe preeclampsia was reported in 34 (91.9%) of the eclamptic patients: headache (59.5%), elevated transaminases (48.6%), urine protein >2 + (32.4%), visual changes ( 18.9%), thrombocvtopenia ( 13.5%), epigastric pain (5.4%). Prior to sei/ure (or on admission) mean systolic and diastolic blood pressures were 105.7 ±31.9 and 97.6 ±22.5 mmHg, respectively, with 54.1% > 100/110 mniHg. Postpartum seizures occurred in 11 (29.7%) patients: 4 (30.4%) were within 12 hrs and the other 7 (54.5%) seized =:48 hrs after deinen. Seizures occurred on MgSO4 in 8 (21.0%) patients. Of the three eclamptics without a prior diagnosis of severe preeclampsia, two seized imrapartum and one postpartum: none met criteria for preeclampsia and were not candidates for prophylaxis. There were no maternal deaths. CONCLUSIONS: Eclampsia is an extremely uncommon complication of pregnancv, and occurs almost exclusively in association with severe preeclampsia. 'Miere is the potential for significant cost savings, without increasing morbidity, by selective!) using MgSO₄ prophylaxis.