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Definition:Eclampsia is a serious complication of pregnancy. It is the occurrence of seizures (convulsions) that are unrelated to brain conditions. Usually eclampsia occurs after the onset of pre-eclampsia though sometimes no pre-eclamptic symptoms are recognisable. The convulsions may appear before, during or after labour, though cases of eclampsia after just 20 weeks of pregnancy have been recorded.
Eclampsia, a life-threatening complication of pregnancy, results when a pregnant woman previously diagnosed with preeclampsia (high blood pressure and protein in the urine) develops seizures or coma. In some cases, seizures or coma may be the first recognizable sign that a pregnant woman has preeclampsia. Key warning signs of eclampsia in a woman diagnosed with preeclampsia may be severe headaches, blurred or double vision, or seeing spots. Toxemia is a common name used to describe preeclampsia and eclampsia.
There has never been any evidence suggesting an orderly progression of disease beginning with mild preeclampsia progressing to severe preeclampsia and then on to eclampsia. The disease process can begin mild and stay mild, or can be initially diagnosed as eclampsia without prior warning.
* Approximately 5-7% of all pregnancies are complicated by preeclampsia.
* Preeclampsia usually occurs in a woman’s first pregnancy but may occur for the first time in a subsequent pregnancy.
* Less than one in 100 women with preeclampsia will develop eclampsia or (convulsions or seizures) or coma.
* Up to 20% of all pregnancies are complicated by high blood pressure. Complications resulting from high blood pressure, preeclampsia, and eclampsia may account for up to 20% of all deaths that occur in pregnant women.
Causes:
The cause of eclampsia is not well understood. Researchers believe a person’s genes, diet, blood vessels, and neurological factors may play a role. However, no theories have yet been proven.
Eclampsia follows preeclampsia, a serious complication of pregnancy marked by high blood pressure, weight gain, and protein in the urine.
It is difficult to predict which women with preeclampsia will go on to have seizures. Women with very high blood pressure, headaches, vision changes, or abnormal blood tests have severe preeclampsia and are at high risk for seizures.
The rate of eclampsia is approximately 1 out of 2000 to 3000 pregnancies.
The following increase a woman’s chance for preeclampsia:
* First pregnancies
* Teenage pregnancies
* Being 35 or older
* Being African-American
* Multiple pregnancies (twins, triplets, etc.)
* History of diabetes, hypertension, or renal (kidney) disease
.
* Since we don’t know what causes preeclampsia or eclampsia, we don’t have any effective tests to predict when preeclampsia or eclampsia will occur, or treatments to prevent preeclampsia or eclampsia from occurring (or recurring).
* Preeclampsia usually occurs with first pregnancies. However, preeclampsia may be seen with twins (or multiple pregnancies), in women older than 35 years, in women with high blood pressure before pregnancy, in women with diabetes, and in women with other medical problems (such as connective tissue disease and kidney disease).
* For unknown reasons, African American women are more likely to develop eclampsia and preeclampsia than white women.
* Preeclampsia may run in families, although the reason for this is unknown.
* Preeclampsia is also associated with problems with the placenta, such as too much placenta, too little placenta, or how the placenta attaches to the wall of the uterus. Preeclampsia is also associated with hydatidiform mole pregnancies, in which no normal placenta and no normal baby are present.
* There is nothing that any woman can do to prevent preeclampsia or eclampsia from occurring. Therefore, it is both unhealthy and not helpful to assign blame and to review and rehash events that occurred either just prior to pregnancy or during early pregnancy that may have contributed to the development of preeclampsia.
Symptoms:
* Seizures
* Severe agitation
* Unconsciousness
* Muscle aches and pains
Symtoms of preeclampsia include swelling of hands and face, gaining more than 2 pounds per week, headache, vision problems, and stomach pain.
The majority of cases are heralded by pregnancy-induced hypertension and proteinuria but the only true sign of eclampsia is an eclamptic convulsion, of which there are four stages. Patients with edema and oliguria may develop renal failure or pulmonary edema.
Premonitory stage
this stage is usually missed unless constantly monitored, the woman rolls her eyes while her facial and hand muscles twitch slightly.
Tonic stage
soon after the premonitory stage the twitching turns into clenching. Sometimes the woman may bite her tongue as she clenches her teeth, while the arms and legs go rigid. The respiratory muscles also spasm, causing the woman to stop breathing, leading to cyanosis. This stage continues for around 30 seconds.
Clonic stage
the spasm stops but the muscles start to jerk violently. Frothy, slightly bloodied saliva appears on the lips and can sometimes be inhaled. After around two minutes the convulsions stop, leading into a temporary unconscious stage.
Comatose stage
the woman falls deeply unconscious, breathing noisily. This can last only a few minutes or may persist for hours.
* A common belief is that the risk of eclampsia rises as blood pressure increases above 160/110 mm Hg.
* The kidneys are unable to efficiently filter the blood (as they normally do). This may cause an increase in protein to be present in the urine. The first sign of excess protein is commonly seen on a urine sample obtained in your provider’s office. Rarely does a woman note any changes or symptoms associated with excess protein in the urine. In extreme cases affecting the kidneys, the amount of urine produced decreases greatly.
* Nervous system changes can include blurred vision, seeing spots, severe headaches, convulsions, and even occasionally blindness. Any of these symptoms require immediate medical attention.
* Changes that affect the liver can cause pain in the upper part of the abdomen and may be confused with indigestion or gallbladder disease. Other more subtle changes that affect the liver can affect the ability of the platelets to cause blood to clot; these changes may be seen as excessive bruising.
* Changes that can affect your baby can result from problems with blood flow to the placenta and therefore result in your baby not getting proper nutrients. As a result, the baby may not grow properly and may be smaller than expected, or worse the baby will appear sluggish or seem to decrease the frequency and intensity of its movements. You should call your doctor immediately if you notice your baby’s movements slow down.
Diagnosis:
If you experience any of the above symptoms call your provider immediately and expect to come to the office or hospital.
* Be sure to review all of your signs, symptoms, and concerns with your provider. Your provider should check your blood pressure, weight, and urine at every office visit.
* If your provider suspects that you have preeclampsia, he or she will order blood tests to check your platelet count, liver function, and kidney function. They will also check a urine sample in the office or possibly order a 24-hour urine collection to check for protein in the urine. The results of these blood tests should be available within 24 hours (if sent out), or within several hours if performed at a hospital.
* The well-being of your baby should be checked by placing you on a fetal monitor. Further tests may include nonstress testing, biophysical profile (ultrasound), and an ultrasound to measure the growth of the baby (if it has not been done within the previous 2-3 weeks).
Treatment:
A woman with eclampsia should be continously monitored. Delivery is the treatment of choice for eclampsia in a pregnancy over 28 weeks. For pregnancies less than 24 weeks, the start of labor is recommended, although the baby may not survive.
Prolonging pregnancies in which the woman has eclampsia results in danger to the mother and infant death in approximately 87% of cases.
Women may be given medicine to prevent seizures (anticonvulsant). Magnesium sulfate is a safe drug for both the mother and the baby.
Medication may be used to lower the high blood pressure. The goal is to manage severe cases until 32-34 weeks and mild cases until 36 weeks of the pregnancy have passed. The condition is then relieved with the delivery of the baby. Delivery may be induced if blood pressure stays high despite medication.
The treatment of seizures in eclampsia consists of:
* Prevention of convulsion
* Control the blood pressure
* Delivery of fetus
Prevention of convulsion is usually done using magnesium sulfate with a loading of Magnesium sulfate 20% solution, 4 g IV over 5 minutes. Then maintain with 1 g magnesium sulfate (10%solution) in 1000 ml fluid drip 1g/hr.
The blood pressure may be controlled by hydralazine 5 mg IV slowly every 5 minutes until blood pressure is lowered. Repeat hourly as needed or give hydralazine 12.5 mg IM every 2 hours as needed.
Delivery should take place as soon as the woman’s condition has stabilized. Delaying delivery to increase fetal maturity is unsafe for both the woman and the fetus, after delivery the womans health relative to the condition is improved drastically. Delivery should occur regardless of the gestational age.
The closer you are to your due date, the more likely your cervix will be ripe (ready for delivery), and that induction of labor will be successful. Sometimes medications, such as oxytocin (Pitocin), are given to help induce labor.
* The earlier in pregnancy (24-34 weeks), the less chance of a successful induction (although induction is still possible). It is more common to have a cesarean delivery when eclampsia necessitates delivery early in pregnancy.
* If the baby shows signs of compromise, such as decreased fetal heart rate, an immediate cesarean delivery will be performed.
Modern Medications:
* You may require medication to treat your high blood pressure during labor or after delivery. It is unusual to require medication for high blood pressure after six weeks following delivery (unless you have a problem with high blood pressure that is unrelated to pregnancy).
* During labor (and for 24-48 hours after delivery) you will be given a medication called magnesium sulfate. This is to decrease your chances of having a recurrent seizure.
* Medications such as oxytocin (Pitocin) or prostaglandins are given to induce labor and/or ripen your cervix. A Foley catheter is sometimes placed in the cervix to mechanically “speed” the dilation process.
Prognosis:
Women in the United States rarely die from eclampsia.
Most women will have good outcomes for their pregnancies complicated by preeclampsia or eclampsia. Some women will continue to have problems with their blood pressure and will need to be followed closely after delivery.
Most babies will do well. Babies born prematurely will usually stay in the hospital longer. A rule of thumb is to expect the baby to stay in the hospital until their due date.
Unfortunately, a few women and babies experience life-threatening complications from preeclampsia or eclampsia.
Possible Complications:
There is a higher risk for placenta seperation (placenta abruptio) with preeclampsia or eclampsia. There may be baby complications due to premature delivery.
Click to know details of Eclampsia , pre-eclampsia: the facts and Unifying hypothesis of pre-eclampsia pathophysiology
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose
Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000899.htm
http://en.wikipedia.org/wiki/Eclampsia
http://www.emedicinehealth.com/eclampsia/article_em.htm
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