Eclampsia and PRES: Clinical Manifestations and Management

Clinical Presentation and Pathophysiology

The European Society of Cardiology recommends that occipital lobe blindness, hyperreflexia, and clonus indicate severe disease, with a vasogenic theory explaining cerebrovascular injury due to severe hypertension exceeding cerebral autoregulation limits, causing endothelial dysfunction, blood-brain barrier breakdown, and vasogenic edema 1, 2

The American College of Obstetricians and Gynecologists suggests that proteinuria ≥300 mg/24 hours defines preeclampsia but does not predict PRES severity, with thrombocytopenia <100×10⁹/L increasing risk of abnormal coagulation and hemorrhagic complications 4
The European Heart Journal recommends blood pressure control as the cornerstone of treatment, with severe hypertension (≥160/110 mmHg) requiring urgent treatment with IV labetalol or IV hydralazine, and non-severe hypertension managed with oral labetalol, nifedipine, or methyldopa targeting diastolic BP 85 mmHg and systolic 110-140 mmHg 3, 5

The American College of Obstetricians and Gynecologists recommends definitive treatment is delivery of the placenta and fetus once maternal stabilization is achieved, with delivery at 37 weeks or earlier if severe hypertension is refractory, thrombocytopenia progresses, liver/renal function deteriorates, pulmonary edema develops, or fetal status is non-reassuring 5
The European Society of Cardiology suggests high-dependency or ICU monitoring for 24-48 hours postpartum with central venous pressure, urinary output, BP, ECG, and oxygen saturation monitoring, and fluid restriction to 60-80 mL/hour to prevent pulmonary edema 3, 5

The American Heart Association recommends follow-up at 3 months postpartum to ensure BP, urinalysis, and laboratory normalization, with persistent abnormalities requiring further investigation, as women with preeclampsia/eclampsia history have increased lifetime risks of cardiovascular disease, stroke, diabetes mellitus, venous thromboembolism, and chronic kidney disease 5
The European Heart Journal suggests that magnesium sulfate provides both seizure prophylaxis and fetal neuroprotection if delivery occurs <32 weeks, with magnesium sulfate mandatory for all eclamptic patients: 4 g IV loading dose, then 1 g/hour maintenance for 24 hours postpartum 6, 3