What is eclampsia. How does it differ from preeclampsia. What are the risk factors for developing eclampsia. How is eclampsia diagnosed and treated. What are the potential complications of eclampsia for mother and baby.

Understanding Eclampsia: A Severe Pregnancy Complication

Eclampsia is a serious pregnancy complication characterized by the onset of seizures in women with preeclampsia. It represents a severe progression of preeclampsia and poses significant risks to both the mother and fetus if not promptly identified and treated. To fully grasp the implications of eclampsia, it’s crucial to understand its relationship with preeclampsia and the broader context of hypertensive disorders during pregnancy.

Defining Preeclampsia and Eclampsia

Preeclampsia is defined as new-onset hypertension after 20 weeks of gestation, accompanied by either proteinuria or evidence of end-organ dysfunction. The diagnostic criteria for preeclampsia have evolved over time, no longer requiring proteinuria as a mandatory feature. Eclampsia, on the other hand, is characterized by the occurrence of generalized tonic-clonic seizures in a woman with preeclampsia.

When Can Eclampsia Occur?

Eclamptic seizures can manifest at various stages of pregnancy and the postpartum period:

• Antepartum (after 20 weeks of gestation)
• Intrapartum (during labor)
• Postpartum (following delivery)

While rare, seizures before 20 weeks have been documented in cases of gestational trophoblastic disease.

The Etiology and Pathophysiology of Eclampsia

Despite significant advances in understanding preeclampsia, the exact etiology of eclampsia remains elusive. However, researchers have proposed several mechanisms that may contribute to its development.

Blood-Brain Barrier Dysfunction

One hypothesis suggests that eclampsia results from increased permeability of the blood-brain barrier during preeclampsia. This alteration leads to disrupted cerebral blood flow due to impaired autoregulation.

Abnormal Placentation and Endothelial Dysfunction

The pathogenesis of preeclampsia, which can progress to eclampsia, is linked to abnormal placentation. In normal pregnancies, fetal cytotrophoblasts migrate into the maternal uterus, remodeling the endometrial vasculature to support placental blood supply. In preeclampsia, this process is impaired, leading to:

1. Inadequate invasion of cytotrophoblasts
2. Poor remodeling of spiral arteries
3. Reduced blood supply to the placenta
4. Increased uterine arterial resistance and vasoconstriction
5. Placental ischemia and oxidative stress

The resulting oxidative stress triggers the release of free radicals and cytokines, such as vascular endothelial growth factor 1 (VEGF), causing endothelial damage. This endothelial disruption affects not only the uterus but also the cerebral endothelium, potentially leading to neurological disorders, including eclampsia.

Autoregulation Dysfunction

Another proposed mechanism suggests that the elevated blood pressure associated with preeclampsia leads to dysfunction in the autoregulation of cerebral blood flow, contributing to the development of eclampsia.

Epidemiology and Risk Factors for Eclampsia

Hypertensive disorders, including eclampsia, affect approximately 10% of all pregnancies worldwide and are responsible for about 10% of maternal deaths in the United States. The incidence of preeclampsia has increased over the past few decades, leading to higher morbidity and mortality rates among mothers and neonates.

Demographic Disparities

In the United States, African American women experience a higher incidence of preeclampsia, with a threefold higher rate of maternal mortality compared to their white counterparts. This disparity highlights the need for targeted interventions and improved access to prenatal care for at-risk populations.

Key Risk Factors

Several factors increase the risk of developing preeclampsia and, consequently, eclampsia:

• Maternal age over 40
• Prior history of preeclampsia
• Multifetal gestation
• Obesity
• Chronic hypertension
• Pregestational diabetes
• Renal disease
• Antiphospholipid syndrome
• Thrombophilia
• Systemic lupus erythematosus
• In vitro fertilization

Diagnosing Eclampsia: Signs and Symptoms

Recognizing the signs and symptoms of eclampsia is crucial for timely intervention and management. Healthcare providers must be vigilant in monitoring pregnant women for potential progression from preeclampsia to eclampsia.

Clinical Presentation

The hallmark of eclampsia is the occurrence of generalized tonic-clonic seizures in a woman with preeclampsia. However, other symptoms may precede or accompany the seizures:

• Severe headache
• Visual disturbances (blurred vision, flashing lights, or spots)
• Upper abdominal pain
• Altered mental status
• Hyperreflexia

Diagnostic Criteria

To diagnose eclampsia, healthcare providers must first establish the presence of preeclampsia. The diagnostic criteria for preeclampsia include:

1. New-onset hypertension (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg) after 20 weeks of gestation
2. Proteinuria and/or evidence of end-organ dysfunction, such as:
   • Renal dysfunction
   • Liver dysfunction
   • Central nervous system disturbances
   • Pulmonary edema
   • Thrombocytopenia

The diagnosis of eclampsia is confirmed when a woman with preeclampsia experiences new-onset generalized tonic-clonic seizures.

Management and Treatment of Eclampsia

Eclampsia is a medical emergency that requires immediate intervention to prevent maternal and fetal complications. The primary goals of treatment are to control seizures, manage hypertension, and expedite delivery when appropriate.

Seizure Control

Magnesium sulfate is the first-line treatment for preventing and controlling eclamptic seizures. It is administered intravenously or intramuscularly and continued for 24 hours postpartum or after the last seizure, whichever is later.

Blood Pressure Management

Antihypertensive medications are used to control severe hypertension (systolic BP ≥160 mmHg or diastolic BP ≥110 mmHg). Common agents include:

• Labetalol
• Hydralazine
• Nifedipine

Delivery Considerations

For women with eclampsia, delivery is often necessary to prevent further complications. The timing and mode of delivery depend on various factors, including gestational age, fetal status, and maternal condition.

Supportive Care

Additional supportive measures may include:

• Fluid management
• Oxygen therapy
• Fetal monitoring
• Management of other organ system complications

Potential Complications and Long-Term Consequences of Eclampsia

Eclampsia can lead to severe complications for both the mother and the fetus if not promptly treated. Understanding these potential outcomes is crucial for healthcare providers and patients alike.

Maternal Complications

Women who experience eclampsia are at risk for several serious complications:

• Placental abruption
• HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets)
• Pulmonary edema
• Acute renal failure
• Cerebral hemorrhage or edema
• Disseminated intravascular coagulation (DIC)
• Cardiac arrest
• Death

Fetal Complications

The fetus is also at risk for adverse outcomes due to eclampsia:

• Preterm birth
• Intrauterine growth restriction
• Hypoxic-ischemic encephalopathy
• Stillbirth

Long-Term Health Implications

Women who have experienced eclampsia may face increased risks of future health problems:

• Chronic hypertension
• Cardiovascular disease
• Stroke
• Kidney disease
• Cognitive impairment

Regular follow-up and lifestyle modifications are essential for managing these long-term risks.

Prevention Strategies and Future Directions in Eclampsia Research

While not all cases of eclampsia can be prevented, certain strategies may help reduce the risk or severity of the condition. Ongoing research continues to explore new approaches to prediction, prevention, and treatment.

Preventive Measures

Several strategies may help reduce the risk of preeclampsia and eclampsia:

• Low-dose aspirin therapy for high-risk women
• Calcium supplementation in populations with low dietary calcium intake
• Regular prenatal care and monitoring
• Management of pre-existing medical conditions
• Healthy lifestyle choices (e.g., maintaining a healthy weight, regular exercise)

Emerging Research Areas

Ongoing research in eclampsia focuses on several promising areas:

1. Biomarker discovery for early prediction of preeclampsia and eclampsia
2. Novel therapeutic targets based on the pathophysiology of the disease
3. Personalized medicine approaches to tailor prevention and treatment strategies
4. Long-term follow-up studies to better understand the health implications for affected women and their children

Improving Global Health Outcomes

Addressing eclampsia on a global scale requires a multifaceted approach:

• Improving access to prenatal care in underserved populations
• Enhancing education and training for healthcare providers in low-resource settings
• Implementing standardized protocols for the management of hypertensive disorders of pregnancy
• Addressing health disparities and socioeconomic factors that contribute to increased risk

As research progresses and our understanding of eclampsia deepens, the hope is that improved prevention strategies and treatments will lead to better outcomes for mothers and babies worldwide.

Eclampsia – StatPearls – NCBI Bookshelf

Continuing Education Activity

This article discusses preeclampsia and eclampsia, one of the four categories of hypertensive disorders of pregnancy. Eclampsia is a severe complication of preeclampsia and poses both a risk to the mother and fetus. Eclampsia is a disease process that needs to be emergently identified and treated promptly. This activity reviews the topic of eclampsia and specifically focuses on etiology, epidemiology, pathophysiology, history and physical, evaluation, and management of eclampsia by an interprofessional team.

Objectives:

• Review the etiology of eclampsia.

• Identify physical exam findings associated with the diagnosis of eclampsia.

• Outline the management of eclampsia.

• Describe the interprofessional team strategies for improving healthcare coordination and communication to treat eclampsia and improve outcomes.

Access free multiple choice questions on this topic.

Introduction

Eclampsia is a known complication of preeclampsia during pregnancy and is associated with morbidity and mortality of both the mother and fetus if not properly diagnosed. Preeclampsia and eclampsia are one of the four categories associated with hypertensive disorders of pregnancy.[1] The other three categories include chronic hypertension, gestational hypertension, and preeclampsia superimposed on chronic hypertension. Preeclampsia, the precursor to eclampsia, has had an evolving definition over recent years. The definition for preeclampsia initially included proteinuria as a diagnostic requirement, but this is no longer the case as some patients had the advanced disease before proteinuria detection. Preeclampsia is defined as a new-onset of hypertension with systolic blood pressure greater than or equal to 140 mmHg and/or diastolic blood pressure greater than or equal to 90 mmHg after 20 weeks of gestation with proteinuria and/or end-organ dysfunction (renal dysfunction, liver dysfunction, central nervous system disturbances, pulmonary edema, and thrombocytopenia). [1][2] Eclampsia is defined as the new onset of generalized tonic-clonic seizures in a woman with preeclampsia. Eclamptic seizures can occur antepartum, 20 weeks after gestation, intrapartum, and postpartum. Seizures before 20 weeks are rare but have been documented in gestational trophoblastic disease.[3]

Etiology

The exact etiology of eclampsia is still unclear despite the advances in the understanding of preeclampsia. It is proposed that there is increased permeability of the blood-brain barrier during preeclampsia, which causes an alteration to cerebral blood flow due to impaired autoregulation.[4]

Epidemiology

Hypertensive disorders, including chronic hypertension, gestational hypertension, preeclampsia, eclampsia, and chronic hypertension superimposed on preeclampsia, affect as many as 10% of all pregnancies worldwide are responsible for approximately 10% of all maternal deaths in the United States. The incidence of preeclampsia has increased over the last couple of decades, increasing the morbidity and mortality among mothers and neonates. [2] In the United States, African American women have a higher incidence of preeclampsia with a 3-fold higher rate of maternal mortality compared to their white counterparts. Additional risk factors associated with preeclampsia include increasing maternal age above 40, a prior history of preeclampsia, multifetal gestation, obesity, chronic hypertension, pregestational diabetes, renal disease, antiphospholipid syndrome, thrombophilia, lupus, and in vitro fertilization.[1][2]

Pathophysiology

There are two proposed pathophysiologic mechanisms for eclampsia, both of which stem from the initial disease process, preeclampsia. The pathogenesis of preeclampsia is linked to abnormal placentation. In a normal pregnancy, fetal cytotrophoblasts migrate into the maternal uterus and cause remodeling of the endometrial vasculature for the blood supply of the placenta. In preeclampsia, there is an inadequate invasion of the cytotrophoblasts, thus leading to poor remodeling of the spiral arteries, which reduces the blood supply to the placenta. Abnormal blood supply leads to increased uterine arterial resistance and vasoconstriction, which ultimately produces placental ischemia and oxidative stress. Free radicals and cytokines, such as vascular endothelial growth factor 1 or VEGF, are released as a direct result of oxidative stress, which leads to endothelial damage.[5] In addition, angiogenic or pro-inflammatory proteins negatively contribute to maternal endothelial function.[1][6] Endothelial disruption occurs not only at the site of the uterus but also at the cerebral endothelium, which leads to neurological disorders, including eclampsia.[5] Another proposed mechanism is that elevated blood pressure from preeclampsia causes dysfunction of autoregulation of the cerebral vasculature, which causes hypoperfusion, endothelial damage, or edema.[1]

History and Physical

Eclampsia is a disease process primarily related to the diagnosis of preeclampsia and can occur antepartum, during delivery, and up to 6 weeks post-partum. Women with eclampsia generally present after 20 weeks of gestation, with a majority of cases occurring after 28 weeks of gestation. The hallmark physical exam finding for eclampsia is generalized tonic-clonic seizures, which typically last 60 to 90 seconds in duration. A postictal state is often present after seizure activity. Patients can have warning symptoms such as headaches, visual changes, abdominal pain, and increased blood pressure before the onset of seizure activity.[1][3]

Evaluation

Patients with eclampsia present with generalized tonic-clonic seizures. The evaluation for eclampsia is centered around the diagnosis of preeclampsia as it is a known life-threatening complication of this disease process. The diagnosis of preeclampsia is primarily centered on blood pressure as the patient develops new-onset hypertension after 20 weeks of gestation. Patients with a systolic blood pressure of greater than or equal to 140 mmHg and/or diastolic blood pressure greater than or equal to 90 mmHg meet the criteria for new-onset hypertension. In addition to elevated blood pressure, patients also have one of the following: proteinuria, renal dysfunction, liver dysfunction, central nervous system symptoms, pulmonary edema, and thrombocytopenia.[2] Proteinuria is no longer essential for the diagnosis of preeclampsia; however, this criterion is often still included in the current diagnosis. Proteinuria is defined as at least 300 mg of protein in a 24-hour urine sample or a urinary protein/creatinine ratio of 0.3 or greater.[2] Other essential labs include a hepatic panel to assess liver function, a CBC to assess platelet function, and a basic metabolic profile to assess GFR and kidney function. Transaminase levels greater than two times the upper limit of normal with or without right upper quadrant or epigastric pain are consistent with preeclampsia. Platelet levels greater than 100,000 also are included in the diagnosis of preeclampsia. The presence of pulmonary edema on chest x-ray or exam in conjunction with elevated blood pressure is concerning for the development of preeclampsia. Central nervous symptoms associated with preeclampsia diagnosis include headache and visual disturbances.[2]

Obstetric ultrasound imaging with Doppler ultrasonography is useful to assess the effects of preeclampsia on the fetus, such as intrauterine growth restriction. Ultrasound is also useful to monitor for further complications such as placental abruption. Fetal nonstress tests should be performed to assess the fetus antepartum.[2]

Treatment / Management

Eclamptic seizures are a medical emergency and require immediate treatment to prevent mortality in both the mother and fetus. Actively seizing patients should have their airways secured to prevent aspiration. The patient should be placed on her left side, and suction should be applied to help with oral secretions. Other airway adjuncts should also be readily available if the patient deteriorates and requires intubation. Magnesium sulfate should be given to control convulsions and is the first-line treatment for eclamptic seizures. A loading dose of 4 to 6 grams should be given intravenously over 15 to 20 minutes. A maintenance dose of 2 g per hour should subsequently be administered. Magnesium treatment should be continued for at least 24 hours after a patient’s last seizure.[2][3] Special attention must be made when giving this medication as it can lead to toxicity and cause respiratory paralysis, central nervous system depression, and cardiac arrest. It is essential to monitor reflexes, creatinine function, and urine output with magnesium administration.[3] Other antiepileptic medications include diazepam or phenytoin. Benzodiazepines and barbiturates are used for refractory seizures that are unresponsive to magnesium.[2] Levetiracetam or valproic acid are alternatives for patients with myasthenia gravis with eclampsia as magnesium and phenytoin cause increased muscle weakness, which could lead to a myasthenia crisis.[7] Ultimately, immediate obstetrics consultation is required. Women with severe preeclampsia, who are greater than 34 weeks gestation and are unstable either from a maternal or fetal perspective, should undergo delivery as soon as the mother is stabilized. [8] Corticosteroids should be given to women with fetal gestation less than 34 weeks if time and circumstances permit to help aid in lung maturation. Delivery should not be delayed for steroid administration. Ultimately, the definitive treatment for preeclampsia/eclampsia is the delivery of the fetus. The route of delivery, as well as timing, is based on maternal and fetal factors.

Patients with severe preeclampsia should be given magnesium sulfate prophylactically to prevent eclamptic seizures. In addition, it is important to control blood pressure in pregnant women with preeclampsia. The American College of Obstetrics and Gynecology recommends that outpatient antihypertensive treatment be started in women with systolic blood pressure greater than 160 mmHg or diastolic blood pressure greater than 110 mmHg. First-line pharmacological treatment of hypertension in pregnant women includes labetalol, nifedipine, and hydralazine.[3] The initial dose of labetalol is 20 mg IV. This dose can be doubled to 40 mg and then 80 mg at ten-minute intervals until target blood pressure is reached. IV hydralazine is dosed at 5 to 10 mg over two minutes. An additional 10 mg IV can be administered after twenty minutes if the systolic blood pressure is greater than 160 mmHg or the diastolic blood is greater than 110 mmHg. Nifedipine is given orally at an initial dose of 10 mg. If the systolic blood pressure is greater than 160 mmHg or diastolic greater than 110 after thirty minutes, give an additional 20 mg of nifedipine. A second dose of 20 mg of nifedipine can be given after an additional 30 minutes.[4]

Blood pressure control is also crucial postpartum as the risk for eclampsia is highest during the 48 hours after birth. Systolic blood pressure should be less than 150 mmHg, and diastolic pressure should be less than 100 mmHg on two readings at least four hours apart. Treatment should also be initiated if the systolic blood pressure is greater than 160 mmHg or diastolic blood pressure is greater than 110 mmHg after one hour. Magnesium sulfate should be continued for 12 to 24 hours post-delivery. [4]

Differential Diagnosis

A list of differential diagnoses should be based on the patient’s history and physical exam findings. Differential diagnoses to consider include electrolyte abnormalities, toxins, infection, head trauma, ruptured aneurysm, and brain malignancy. If the patient is having persistent neurological symptoms, one should also consider stroke and intracranial hemorrhage.

• Chronic hypertension

• Chronic renal disease

• Primary seizure disorders

• Gallbladder disease

• Antiphospholipid syndrome

• Hemolytic-uremic syndrome.

• Pancreatic disease

• Immune thrombocytopenic purpura

• Thrombotic thrombocytopenic purpura

• Toxins

• Ruptured aneurysm

• Brain tumor

• Stroke

• Intracranial hemorrhage

Prognosis

Hypertensive disorders, including preeclampsia and eclampsia, affect 10% of pregnancies in the United States and worldwide. Despite advancements in medical management, it remains the leading cause of maternal and perinatal morbidity and mortality worldwide.[9] While rates of eclampsia specifically have decreased, it is still a very serious complication in pregnancy.

Complications

Several complications may result from eclampsia. The patient may require intubation after a seizure due to a decreased level of consciousness. When the patient does require intubation, blood pressure management is crucial as laryngoscopy causes a hypertensive response and may result in intracranial hemorrhage. Patients with preeclampsia are also at risk for respiratory failure in the form of acute respiratory distress syndrome, as well as pulmonary edema. In addition, women may experience renal failure and liver failure with severe forms of preeclampsia.[9] Posterior reversible encephalopathy syndrome (PRES), a neurological condition, is another complication that can result in patients with eclampsia. Patients with PRES can have a variety of symptoms, including headaches, seizures, changes in mental status, cortical blindness, and other visual abnormalities. [10] Most cases of PRES will resolve in a couple of weeks if blood pressure and other inciting factors are controlled; however, there is always a risk that the patient will develop cerebral edema and other fatal complications. Patients with preeclampsia and eclampsia also have an increased risk of developing cardiovascular disease later in life.[11]

Deterrence and Patient Education

Patients diagnosed with hypertension or preeclampsia during pregnancy, as well as their family members, need to be educated on the signs and symptoms of eclampsia. They need to be instructed to call emergency services immediately and should bring the patient to the hospital as soon as possible. Patients should be counseled about the importance of their hypertensive medication and should regularly follow up with their obstetrician.

Enhancing Healthcare Team Outcomes

Eclampsia is a medical condition that requires prompt diagnosis and treatment to prevent morbidity and mortality in pregnant women. The interprofessional health care team must work efficiently to provide optimal care to both the mother and the unborn child. Nurses or providers triaging patients in the emergency department need to be cognizant of signs and symptoms of eclampsia. They must notify the attending physicians treating the patient as quickly as possible, especially if they are actively seizing and require medication to abort the seizure. Communication between nurses and physicians is vital to ensure that the patients are getting proper intervention. Communication is also important between emergency physicians and obstetricians as the delivery of the fetus may be emergent. Pharmacists review the dosage of medications and check for drug-drug interactions and should report any pharmacological concerns to the clinicians immediately. Ultimately, all members of the interprofessional team care must communicate and be patient-centered to optimize outcomes in eclampsia cases. [Level 5].

References

1.

Wilkerson RG, Ogunbodede AC. Hypertensive Disorders of Pregnancy. Emerg Med Clin North Am. 2019 May;37(2):301-316. [PubMed: 30940374]

2.

Sutton ALM, Harper LM, Tita ATN. Hypertensive Disorders in Pregnancy. Obstet Gynecol Clin North Am. 2018 Jun;45(2):333-347. [PubMed: 29747734]

3.

Leeman L, Dresang LT, Fontaine P. Hypertensive Disorders of Pregnancy. Am Fam Physician. 2016 Jan 15;93(2):121-7. [PubMed: 26926408]

4.

Bergman L, Torres-Vergara P, Penny J, Wikström J, Nelander M, Leon J, Tolcher M, Roberts JM, Wikström AK, Escudero C. Investigating Maternal Brain Alterations in Preeclampsia: the Need for a Multidisciplinary Effort. Curr Hypertens Rep. 2019 Aug 02;21(9):72. [PubMed: 31375930]

5.

Uzan J, Carbonnel M, Piconne O, Asmar R, Ayoubi JM. Pre-eclampsia: pathophysiology, diagnosis, and management. Vasc Health Risk Manag. 2011;7:467-74. [PMC free article: PMC3148420] [PubMed: 21822394]

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Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. BMJ. 2019 Jul 15;366:l2381. [PubMed: 31307997]

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Waters J. Management of Myasthenia Gravis in Pregnancy. Neurol Clin. 2019 Feb;37(1):113-120. [PubMed: 30470270]

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Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013 Nov;122(5):1122-1131. [PubMed: 24150027]

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Arulkumaran N, Lightstone L. Severe pre-eclampsia and hypertensive crises. Best Pract Res Clin Obstet Gynaecol. 2013 Dec;27(6):877-84. [PubMed: 23962474]

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Sesar A, Cavar I, Sesar AP, Sesar I. Transient cortical blindness in posterior reversible encephalopathy syndrome after postpartum eclampsia. Taiwan J Ophthalmol. 2018 Apr-Jun;8(2):111-114. [PMC free article: PMC6055316] [PubMed: 30038892]

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Amaral LM, Cunningham MW, Cornelius DC, LaMarca B. Preeclampsia: long-term consequences for vascular health. Vasc Health Risk Manag. 2015;11:403-15. [PMC free article: PMC4508084] [PubMed: 26203257]

What is Eclampsia?

Eclampsia is a seizure that can occur as a complication of pregnancy, following pre-eclampsia. Pre-eclampsia describes the high blood pressure and rapid weight gain that can occur in pregnancy. Eclampsia seizures are tonic-clonic in nature and can become life-threatening unless quickly and properly treated. Together, pre-eclampsia and eclampsia are referred to as hypertensive disorder of pregnancy.

Features and causes of eclampsia

The main feature of eclampsia is a seizure that is not linked to any pre-existing disorder. Women who already have an underlying vascular disorder such as diabetes, high blood pressure or kidney disease are at a greater risk of developing eclampsia and pre-eclampsia than women without these conditions. Other conditions that increase the risk include thrombophilic diseases such as antiphospholipid syndrome. In addition, women who are over 40 years of age or women with twin or multiple pregnancies are also at a greater risk of eclampsia. A family history of the condition can also increase the risk.

Pathology of eclampsia

Pre-eclampsia (and therefore eclampsia) is thought to be caused by the abnormal development of the placenta due to problems with the vasculature that supplies it. In cases of severe pre-eclampsia, the only way to prevent eclampsia is for the baby to be delivered. Continuing the pregnancy in cases of sever pre-eclampsia is dangerous to both the mother and the baby.

Biological markers have been associated with eclampsia. For example, a blood vessel dilator called adrenomedullin has been shown to be reduced in women with pre-eclampsia and eclampsia. Other agents that act on the blood vessels in hypertensive disorders of pregnancy include nitric oxide, prostacyclin, thromboxane A2 and endothelins.

Eclampsia is a form of hypertensive encephalopathy, a cerebral condition caused by a sustained and severe elevation in blood pressure. The blood flow to the brain is increased and abnormal endothelial function can lead to the development of cerebral edema and intracranial bleeding or hemorrhage.

Detection and management

Pregnant women are regularly monitored for pre-eclampsia, which can be detected by checking blood pressure and urinary protein markers throughout the pregnancy. Women who develop pre-eclampsia are closely monitored until their baby can be delivered. The mother may be given antihypertensive medications until it is possible for the baby to be delivered, which is usually at a round 37 to 38 weeks, but can be earlier in severe cases.

Further Reading

Eclampsia – an overview | ScienceDirect Topics

Central Nervous System

Eclampsia, the convulsive phase of preeclampsia, remains a leading cause of maternal death, the proximate causes including disseminated intravascular coagulation-like syndromes, pulmonary edema, aspiration and sepsis, and especially cerebral hemorrhage and edema.^1,150,466 Knowledge of its etiology, however, remains incomplete. Some, noting fibrin deposition in brain at autopsy, relate its cause to the coagulation changes associated with preeclampsia. To others⁵¹¹ the disease is merely a form of hypertensive encephalopathy, a concept difficult to accept as the convulsion can occur suddenly in women whose systolic levels are consistently below 140 mm Hg. However, vasoconstriction in preeclamptic women can be selective. For example, investigators have demonstrated ultrasonographically the presence of severe cerebral vasospasm in patients with minimal evidence of peripheral vasoconstriction.⁵¹² They have also suggested that the cause of eclampsia may be heterogeneous, as some patients manifest normal cerebral vascular indices, while others (especially those with mean arterial pressures that exceed the brain’s autoregulatory capacity) demonstrate high pressure indexes, and/or perfusion, akin to hypertensive encephalopathy.^513,514 On the other hand, phase contrast velocity imaging techniques combined with MRI consistently fail to demonstrate any changes in cerebral perfusion in severe preeclampsia or eclampsia. ⁵¹⁵

Reports based on cranial axial tomography and MRI (the latter, the preferred diagnostic test) vary but often describe transient abnormalities consistent with localized hemorrhage or edema.^515,516 The edema is said to be vasogenic, and fully reversible, though a recent study has noted “cytotoxic” edema and infarction in up to one forth of the patients.⁵¹⁷ These data, as well as those in the perfusion studies described above are not always easy to interpret; however, as many of the patients had been treated with antihypertensive drugs, magnesium infusions, and especially with considerable fluid administration, raising the possibility that many of these findings may be iatrogenic. Of interest is a disorder termed “reversible posterior leukoencephalopathy syndrome,” observed in patients with a variety of medical disorders and in three women with postpartum eclampsia.⁵¹⁸ The disease is life threatening and characterized by accelerated hypertension, severe headaches, altered mental status, cortical blindness, and convulsions, but appears to be reversible with aggressive diuresis and rapid reduction of blood pressure. Review of this article suggests the eclamptic women had been grossly volume overloaded.

The best descriptions of gross and microscopic pathology are in autopsy series of Sheehan and Lynch,¹ as most of these necropsies were performed within two hours of death, thus eliminating most of the postpartum changes that might confound interpretation. Of interest, there was little evidence of brain edema, which led the authors to conclude that cerebral edema was a late, perhaps postseizure event, and not a cause of the convulsion. The major finding was gross evidence of cerebral hemorrhage, not surprisingly present in 60% of the subjects expiring within 48 h of the convulsion. There were also varying degrees of smaller hemorrhages and petechiae observed with the naked eye, and more numerous on histological sections. The petechiae were cited as evidence of vascular disturbances produced by local ischemia. Sheehan & Lynch¹ have produced a series of photomicrographs that we highly recommend to the reader).

Preeclampsia

What is preeclampsia?

Preeclampsia is a serious blood pressure condition that can happen after the 20th week of pregnancy or after giving birth (called postpartum preeclampsia). It’s when a woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working normally. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy.

Preeclampsia is a serious health problem for pregnant women around the world. It affects 2 to 8 percent of pregnancies worldwide (2 to 8 in 100). In the United States, it’s the cause of 15 percent (about 3 in 20) of premature births. Premature birth is birth that happens too early, before 37 weeks of pregnancy.  

Most women with preeclampsia have healthy babies. But if it’s not treated, it can cause severe health problems for you and your baby.

Can taking low-dose aspirin help reduce your risk for preeclampsia and premature birth?

For some women, yes. If your provider thinks you’re at risk for preeclampsia, he may want you to take low-dose aspirin to help prevent it. Low-dose aspirin also is called baby aspirin or 81 mg (milligrams) aspirin. Talk to your provider to see if treatment with low-dose aspirin is right for you.

You can buy low-dose aspirin over-the-counter, or your provider can give you a prescription for it. A prescription is an order for medicine from your provider. If your provider wants you to take low-dose aspirin to help prevent preeclampsia, take it exactly as she tells you to. Don’t take more or take it more often than your provider says.

If you’re at high risk for preeclampsia, your provider may want you to start taking low-dose aspirin after 12 weeks of pregnancy.  Or your provider may ask you to take low-dose aspirin if you have diabetes or high blood pressure. If your provider asks you to take low-dose aspirin, take it as recommended. 

According to the American College of Obstetricians and Gynecologists (also called ACOG), daily low-dose aspirin use in pregnancy has a low risk of serious complications and its use is considered safe.

Are you at risk for preeclampsia?

We don’t know for sure what causes preeclampsia, but there are some things that may make you more likely than other women to have it. These are called risk factors. If you have even one risk factor for preeclampsia, tell your provider.

You’re at high risk for preeclampsia if:

• You’ve had preeclampsia in a previous pregnancy. The earlier in pregnancy you had preeclampsia, the higher your risk is to have it again in another pregnancy. You’re also at higher risk if you had preeclampsia along with other pregnancy complications.
• You’re pregnant with multiples (twins, triplets or more).
• You have high blood pressure, diabetes, kidney disease or an autoimmune disease like lupus or antiphospholipid syndrome. Diabetes is when you have too much sugar in the blood. This can damage organs, like blood vessels, nerves, eyes and kidneys. An autoimmune disease is a health condition that happens when antibodies (cells in the body that fight off infections) attack healthy tissue by mistake.

Other risk factors for preeclampsia include:

• You’ve never had a baby before, or it’s been more than 10 years since you had a baby.
• You’re obese. Obese means being very overweight with a body mass index (also called BMI) of 30 or higher. To find out your BMI, go to www.cdc.gov/bmi.
• You have a family history of preeclampsia. This means that other people in your family, like your sister or mother, have had it.
• You had complications in a previous pregnancy, like having a baby with low birthweight. Low birthweight is when your baby is born weighing less than 5 pounds, 8 ounces.
• You had a fertility treatment called in vitro fertilization (also called IVF) to help you get pregnant.
• You’re older than 35.
• You’re African-American. African-American women are at higher risk for preeclampsia than other women.
• You have low socioeconomic status (also called SES). SES is a combination of things, like a person’s education level, job and income (how much money you make). A person with low SES may have little education, may not have a job that pays well and may have little income or savings.

If your provider thinks you’re at risk of having preeclampsia, he may want to treat you with low-dose aspirin to help prevent it. Talk to your provider to see if treatment with low-dose aspirin is right for you.

What are the signs and symptoms of preeclampsia?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy.

Signs and symptoms of preeclampsia include:

• Changes in vision, like blurriness, flashing lights, seeing spots or being sensitive to light
• Headache that doesn’t go away
• Nausea (feeling sick to your stomach), vomiting or dizziness
• Pain in the upper right belly area or in the shoulder
• Sudden weight gain (2 to 5 pounds in a week)
• Swelling in the legs, hands or face 
• Trouble breathing

Many of these signs and symptoms are common discomforts of pregnancy. If you have even one sign or symptom, call your health care provider right away.

How can preeclampsia affect you and your baby? 

Without treatment, preeclampsia can cause serious health problems for you and your baby, even death. You may have preeclampsia and not know it, so be sure to go to all your prenatal care checkups, even if you’re feeling fine. If you have any sign or symptom of preeclampsia, tell your provider.

Health problems for women who have preeclampsia include:

• Kidney, liver and brain damage
• Problems with how your blood clots. A blood clot is a mass or clump of blood that forms when blood changes from a liquid to a solid. Your body normally makes blood clots to stop bleeding after a scrape or cut. Problems with blood clots can cause serious bleeding problems.
• Eclampsia. This is a rare and life-threatening condition. It’s when a pregnant woman has seizures or a coma after preeclampsia. A coma is when you’re unconscious for a long period of time and can’t respond to voices, sounds or activity.
• Stroke. This is when the blood supply to the brain is interrupted or reduced. Stroke can happen when a blood clot blocks a blood vessel that brings blood to the brain, or when a blood vessel in the brain bursts open.

Pregnancy complications from preeclampsia include:

• Premature birth. Even with treatment, you may need to give birth early to help prevent serious health problems for you and your baby.
• Placental abruption. This is when the placenta separates from the wall of the uterus (womb) before birth. It can separate partially or completely. If you have placental abruption, your baby may not get enough oxygen and nutrients. Vaginal bleeding is the most common symptom of placental abruption after 20 weeks of pregnancy. If you have vaginal bleeding during pregnancy, tell your health care provider right away.
• Intrauterine growth restriction (also called IUGR). This is when a baby has poor growth in the womb. It can happen when mom has high blood pressure that narrows the blood vessels in the uterus and placenta. The placenta grows in the uterus and supplies your baby with food and oxygen through the umbilical cord. If your baby doesn’t get enough oxygen and nutrients in the womb, he may have IUGR.
• Low birthweight

Having preeclampsia increases your risk for postpartum hemorrhage (also called PPH). PPH is heavy bleeding after giving birth. It’s a rare condition, but if not treated, it can lead to shock and death. Shock is when your body’s organs don’t get enough blood flow.

Having preeclampsia increases your risk for heart disease, diabetes and kidney disease later in life.

How is preeclampsia diagnosed? 

To diagnose preeclampsia, your provider measures your blood pressure and tests your urine for protein at every prenatal visit.

Your provider may check your baby’s health with:

• Ultrasound. This is a prenatal test that uses sound waves and a computer screen to make a picture of your baby in the womb. Ultrasound checks that your baby is growing at a normal rate. It also lets your provider look at the placenta and the amount of fluid around your baby to make sure your pregnancy is healthy.
• Nonstress test. This test checks your baby’s heart rate.
• Biophysical profile. This test combines the nonstress test with an ultrasound.

Treatment depends on how severe your preeclampsia is and how far along you are in your pregnancy. Even if you have mild preeclampsia, you need treatment to make sure it doesn’t get worse.

How is mild preeclampsia treated? 

Most women with mild preeclampsia after 37 weeks of pregnancy don’t have serious health problems. If you have mild preeclampsia before 37 weeks:

• Your provider checks your blood pressure and urine regularly. She may want you to stay in the hospital to monitor you closely. If you’re not in the hospital, your provider may want you to have checkups once or twice a week. She also may ask you to take your blood pressure at home.
• Your provider may ask you to do kick counts to track how often your baby moves. There are two ways to do kick counts: Every day, time how long it takes for your baby to move ten times. If it takes longer than 2 hours, tell your provider. Or three times a week, track the number of times your baby moves in 1 hour. If the number changes, tell your provider.
• If you’re at least 37 weeks pregnant and your condition is stable, your provider may recommend that you have your baby early. This may be safer for you and your baby than staying pregnant. Your provider may give you medicine or break your water (amniotic sac) to make labor start. This is called inducing labor.

How is severe preeclampsia treated? 

If you have severe preeclampsia, you most likely stay in the hospital so your provider can closely monitor you and your baby. Your provider may treat you with medicines called antenatal corticosteroids (also called ACS). These medicines help speed up your baby’s lung development. You also may get medicine to control your blood pressure and medicine to prevent seizures (called magnesium sulfate).

If your condition gets worse, it may be safer for you and your baby to give birth early. Most babies of moms with severe preeclampsia before 34 weeks of pregnancy do better in the hospital than by staying in the womb. If you’re at least 34 weeks pregnant, your provider may recommend that you have your baby as soon as your condition is stable. Your provider may induce your labor, or you may have a c-section. If you’re not yet 34 weeks pregnant but you and your baby are stable, you may be able to wait to have your baby.

If you have severe preeclampsia and HELLP syndrome, you almost always need to give birth early. HELLP syndrome is a rare but life-threatening liver disorder. About 2 in 10 women (20 percent) with severe preeclampsia develop HELLP syndrome. You may need medicine to control your blood pressure and prevent seizures. Some women may need blood transfusions. A blood transfusion means you have new blood put into your body.

If you have preeclampsia, can you have a vaginal birth? 

Yes. If you have preeclampsia, a vaginal birth may be better than a cesarean birth (also called c-section). A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. With vaginal birth, there’s no stress from surgery. For most women with preeclampsia, it’s safe have an epidural to  manage labor pain as long as your blood clots normally. An epidural is pain medicine you get through a tube in your lower back that helps numb your lower body during labor. It’s the most common kind of pain relief during labor.

What is postpartum preeclampsia?

Postpartum preeclampsia is a rare condition. It’s when you have preeclampsia after you’ve given birth. It most often happens within 48 hours (2 days) of having a baby, but it can develop up to 6 weeks after a baby’s birth. It’s just as dangerous as preeclampsia during pregnancy and needs immediate treatment. If not treated, it can cause life-threatening problems, including death.

Signs and symptoms of postpartum preeclampsia are like those of preeclampsia. It can be hard for you to know if you have signs and symptoms after pregnancy because you’re focused on caring for your baby. If you do have signs or symptoms, tell your provider right away.

We don’t know exactly what causes postpartum preeclampsia, but these may be possible risk factors:

• You had gestational hypertension or preeclampsia during pregnancy. Gestational hypertension is high blood pressure that starts after 20 weeks of pregnancy and goes away after you give birth.
• You’re obese.
• You had a c-section.

Complications from postpartum preeclampsia include these life-threatening conditions:

• HELLP syndrome
• Postpartum eclampsia (seizures). This can cause permanent damage to our brain, liver and kidneys. It also can cause coma.
• Pulmonary edema. This is when fluid fills the lungs.
• Stroke
• Thromboembolism. This is when a blood clot travels from another part of the body and blocks a blood vessel.

Your provider uses blood and urine tests to diagnose postpartum preeclampsia. Treatment can include magnesium sulfate to prevent seizures and medicine to help lower your blood pressure. Medicine to prevent seizures also is called anticonvulsive medicine. If you’re breastfeeding, talk to your provider to make sure these medicines are safe for your baby.

Last reviewed: October 2020

Pre-eclampsia – NHS

Pre-eclampsia is a condition that affects some pregnant women, usually during the second half of pregnancy (from around 20 weeks) or soon after their baby is delivered.

Important:
Coronavirus (COVID-19) update

If you’re well, it’s really important you go to all your appointments and scans for the health of you and your baby.

If you’re pregnant, hospitals and clinics are making sure it’s safe for you to go to appointments.

If you get symptoms of COVID-19, or you’re unwell with something other than COVID-19, speak to your midwife or maternity team. They will advise you what to do.

Find out more about pregnancy and COVID-19

Symptoms of pre-eclampsia

Early signs of pre-eclampsia include having high blood pressure (hypertension) and protein in your urine (proteinuria).  

It’s unlikely that you’ll notice these signs, but they should be picked up during your routine antenatal appointments.

In some cases, further symptoms can develop, including:

• swelling of the feet, ankles, face and hands caused by fluid retention (oedema)
• severe headache
• vision problems
• pain just below the ribs

If you notice any symptoms of pre-eclampsia, seek medical advice immediately by calling your midwife, GP surgery or NHS 111.

Although many cases are mild, the condition can lead to serious complications for both mother and baby if it’s not monitored and treated. 

The earlier pre-eclampsia is diagnosed and monitored, the better the outlook for mother and baby.

Video: what is pre-eclampsia and what are the warning signs?

In this video, a midwife explains the warning signs of pre-eclampsia.

Media last reviewed: 1 September 2020
Media review due: 1 September 2023

Who’s affected?

Mild pre-eclampsia affects up to 6% of pregnancies, and severe cases develop in about 1 to 2% of pregnancies.

There are a number of things that can increase your chances of developing pre-eclampsia, such as:

Other things that can slightly increase your chances of developing pre-eclampsia include:

• having a family history of the condition
• being over 40 years old
• it having been at least 10 years since your last pregnancy
• expecting multiple babies (twins or triplets)
• having a body mass index (BMI) of 35 or over

If you have 2 or more of these together, your chances are higher.

If you’re thought to be at a high risk of developing pre-eclampsia, you may be advised to take a daily dose of low-dose aspirin from the 12th week of pregnancy until your baby is delivered.

What causes pre-eclampsia?

Although the exact cause of pre-eclampsia is not known, it’s thought to occur when there’s a problem with the placenta, the organ that links the baby’s blood supply to the mother’s.

Treating pre-eclampsia

If you’re diagnosed with pre-eclampsia, you should be referred for an assessment by a specialist, usually in hospital.

While in hospital, you’ll be monitored closely to determine how severe the condition is and whether a hospital stay is needed.

The only way to cure pre-eclampsia is to deliver the baby, so you’ll usually be monitored regularly until it’s possible for your baby to be delivered.

This will normally be at around 37 to 38 weeks of pregnancy, but it may be earlier in more severe cases.

At this point, labour may be started artificially (induced) or you may have a caesarean section.

Medication may be recommended to lower your blood pressure while you wait for your baby to be delivered.

Complications

Although most cases of pre-eclampsia cause no problems and improve soon after the baby is delivered, there’s a risk of serious complications that can affect both the mother and her baby.

There’s a risk that the mother will develop fits called “eclampsia”. These fits can be life threatening for the mother and baby, but they’re rare.

Page last reviewed: 07 June 2018
Next review due: 07 June 2021

What Is Eclampsia? – Definition, Symptoms & Treatment – Video & Lesson Transcript

What Causes It?

The exact cause of preeclampsia and eclampsia is unknown. It’s believed to be the result of a placenta that does not function properly. Researchers also suspect that poor nutrition, high body fat or insufficient blood flow to the uterus may all be possible causes. It’s also possible that genetics may play a role. Preeclampsia is most often seen in women who are experiencing their first pregnancy, in pregnant teenagers, or in pregnancy in women over age 40. Risk factors for developing preeclampsia include:

• History of high blood pressure, diabetes, kidney disease, lupus or rheumatoid arthritis prior to pregnancy
• History of preeclampsia in a previous pregnancy
• Having a mother/sister who had preeclampsia/eclampsia
• History of obesity
• Multiple gestation pregnancy (carrying more than one baby)

Symptoms of Preeclampsia and Eclampsia

Fortunately, not all women who have preeclampsia will go on to develop eclampsia. It’s very difficult to determine which women will have seizures. There are some signs and symptoms seen in preeclampsia that are associated with a greater risk of seizures. These include:

• Abnormal blood test (specifically elevated liver enzymes and low platelet count)
• Headaches
• Very high blood pressure (anything over 140/90 is considered a hypertensive condition)
• Vision changes, such as spots or blurry vision

Other symptoms of preeclampsia include:

• Gaining more than 2 pounds in one week
• Nausea and vomiting
• Stomach pain (especially in the upper right quadrant)
• Swelling of hands, feet and face

As stated earlier, not every woman with preeclampsia will develop eclampsia. When preeclampsia turns into eclampsia, the following symptoms are typically present:

• Seizures
• Muscle aches and pains
• Severe agitation
• Unconsciousness

Treatment

There is no cure to treat preeclampsia or eclampsia. The only cure is to deliver the baby. The doctor will determine when this should be done based on the severity of symptoms and the gestation of the baby. If the preeclampsia is mild, the doctor may prescribe:

• Bed rest, either at home or in the hospital
• Careful observation of the baby with a fetal heart rate monitor and frequent ultrasounds
• Blood and urine tests to assess severity of preeclampsia
• Medications to help lower blood pressure and reduce likelihood of seizures
• Possible steroid injections to help the baby’s lungs develop more quickly

In women who are requiring closer observation in a hospital, treatment may include the addition of:

• Magnesium sulfate to prevent seizures
• Hydralazine or other antihypertensive medications to lower blood pressure
• Monitoring of fluid intake and output

If preeclampsia is severe, the doctor may deliver the baby right away, even if the baby is not close to term.

Intravenous magnesium sulfate is the treatment of choice for women with severe preeclampsia to prevent seizures or for women who have seized, to prevent recurrence. It’s important to note that magnesium sulfate is used to prevent seizures, not to lower blood pressure. Many physicians will treat every preeclamptic patient with magnesium sulfate during labor, even if preeclampsia is mild. Treatment will generally continue 24 to 48 hours after delivery or the last seizure. Close observation is very important during magnesium sulfate treatment, as overdosing is possible.

Lesson Summary

Again, eclampsia is a rare but very serious complication of pregnancy involving seizures and convulsing. This condition usually occurs after preeclampsia. Preeclampsia is also a complication of pregnancy marked by hypertension and proteinuria. Hypertension is a condition of high blood pressure, usually 140/90 and higher. Proteinuria is a condition in which the urine contains abnormally high levels of protein.

The exact cause of either condition is unknown. Researchers suspect that poor nutrition, high body fat, insufficient blood flow to the uterus and genetics can all be possible causes. There is no cure for preeclampsia or eclampsia other than delivery of the baby.

Symptoms of eclampsia include one or more seizures, muscle aches and pains, severe agitation and unconsciousness. The treatment of choice for eclampsia is intravenous magnesium sulfate to prevent seizures or recurrence of seizures.

Medical Disclaimer: The information on this site is for your information only and is not a substitute for professional medical advice.

Preeclampsia and Eclampsia | Cedars-Sinai

Overview

Preeclampsia is development of high blood pressure, swelling or high levels of albumin in the urine between the 20th week of pregnancy and the end of the first week after delivery. Eclampsia is development of convulsive seizures or coma without other causes during that same time frame.

Symptoms

Signs of preeclampsia in a pregnant woman include:

• Blood pressure of 140/90
• Systolic blood pressure that rises by 30 mm Hg or more even it if is less than 140. (This is the highest level of blood pressure during the heart’s pumping cycle.)
• Diastolic blood pressure that rises by 15 mm Hg or more even if it is less than 90. (This is the lowest level of blood pressure during the heart’s pumping cycle.)
• Swelling in the face or hands
• High levels of albumin in the urine

In its milder forms, it may appear as borderline high blood pressure, swelling or water retention that doesn’t respond to treatment or albumin in the urine.

Pregnant women who have blood pressure of 150/110, marked swelling or water retention and high levels of albumin in their urine may also experience disturbances in their sight or have pain in the abdomen. Their reflexes may be hypersensitive.

Causes and Risk Factors

It is not known what causes these conditions. Preeclampsia develops in about 5% of pregnant women. These women are usually having their first baby or had high blood pressure or vascular disease before they became pregnant.

If preeclampsia isn’t treated it may suddenly turn into eclampsia. Eclampsia can be fatal without treatment. One complication of preeclampsia is a condition where the placenta detaches too early from the wall of the uterus (abruptio placentae).

Diagnosis

In addition to the symptoms, a doctor may order blood tests, an analysis of the urine and tests of liver function. He or she will also try to rule out unsuspected kidney disease.

Treatment

The goal of treatment is to protect the life and health of the mother. This usually assures that the baby survives, too.

When a woman has early, mild preeclampsia, she will need strict bed rest. She should be seen by her doctor every two days. She needs to keep her salt intake at normal levels but drink more water. Staying in bed and lying on her left side will increase her need to urinate. This keeps her from becoming dehydrated and her blood from getting concentrated.

If she doesn’t immediately improve, she may need to go into the hospital. Once she has been admitted, she will be given a balanced salt solution intravenously.

She may be given magnesium sulfate intravenously until her reflexes return to normal. This reduces the risk of seizures. At the same time, blood pressure usually goes down. Swelling should begin to go down, too. If the high blood pressure doesn’t respond to the magnesium sulfate, other drugs may be tried to lower blood pressure.

Both the mother and baby need constant monitoring. The patient should be observed for complications such as headaches, blurred vision, confusion, abdominal pain, vaginal bleeding or loss of fetal heart sounds. Some doctors may admit the patient directly to the intensive care unit for continuous monitoring of the mother and baby. An obstetrician should be involved in the management of the condition.

At this point the goal of treatment becomes delivery of the baby. Any woman who has preeclampsia that doesn’t respond to treatment should be stabilized and delivery accomplished, no matter how long the pregnancy has been. Mild preeclampsia may take six to eight hours to stabilize.

About four to six weeks after the baby is delivered, the signs of preeclampsia should begin to go away.

The patient will need to be watched as closely and as often after delivery as she was during labor. About one out of four cases of eclampsia happen during the first two to four days after delivery.

Although she may need to stay in the hospital longer than a normal delivery would require, a woman usually recovers after delivery quickly. She should be seen by her doctor one to two weeks after the delivery. It may be necessary for her to take drugs to manage high blood pressure.

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

90,000 causes, symptoms and treatment in the article of the gynecologist S.V. Simanin

Date of publication December 1, 2020 Updated June 17, 2021

Definition of the disease. Causes of the disease

Eclampsia – an attack of seizures or a series of seizures during pregnancy and in the first days after childbirth, which is based on a disorder of the general circulation. Eclampsia occurs against the background of preeclampsia and is characterized by multiple organ failure (dysfunction of several organs) ^[5] .

Currently, eclampsia in pregnant women rarely develops in a hospital setting. This is due to the fact that modern methods of therapy can prevent the development of the convulsive stage. However, patients can be admitted to the hospital with an attack of eclampsia. In this case, eclampsia is often the cause of maternal death as a result of multiple organ failure and cerebral edema.

The frequency of occurrence of eclampsia – from 1: 1700 to 1: 2000 births ^[5] .

Causes of eclampsia

Eclampsia is a multifactorial disease that is triggered by endothelial dysfunction. In this pathology, the endothelial cells lining the vessels from the inside secrete substances that lead to vasospasm and the formation of blood clots. As a result, the vascular tone increases and the blood supply is disrupted in all organs, and most dangerous of all – in the brain, which ultimately leads to seizures.

Risk groups for the development of eclampsia:

As a rule, eclampsia is preceded by preeclampsia – a complication of pregnancy with a profound disorder of the functions of all body systems.However, in 30% of cases, eclampsia occurs without preeclampsia ^[7] . According to recent studies, a genetic predisposition to hypertension is the main risk factor for preeclampsia ^[14] .

Preeclampsia is characterized by arterial hypertension after 20 weeks of gestation and the presence of protein in the urine.

Moderate preeclampsia – increased blood pressure (BP) from 140/90 to 160/110, as well as more than 0.3 g of protein in the urine per day.

Severe preeclampsia – blood pressure above 160/110, more than 5 g of protein in urine per day.

Additional criteria for severe preeclampsia:

• sudden onset or growth of massive edema;
• headache;
• visual disturbances in the form of “flashing flies” before the eyes;
• pain in the upper abdomen;
• nausea and vomiting;
• decrease in the amount of urine.

Severe preeclampsia is accompanied by changes in the biochemical blood test:

• decreases in the number of platelets;
• the level of liver enzymes AlAt, AsAt and creatinine increases.

If you experience similar symptoms, consult your doctor. Do not self-medicate – it is dangerous for your health!

Symptoms of eclampsia

Eclampsia is manifested by seizures, which can be single, or there is a series of seizures following each other at short intervals. A series of seizures is called eclampsic status.

The seizure lasts 1-2 minutes.

Preconvulsive period

During the preconvulsive (introductory) period, small twitching of the facial muscles is noted, the gaze becomes motionless, the pupils dilate, and then go under the upper eyelid, and the protein becomes visible.The corners of the mouth drop down. Rapid twitching of the muscles of the face, including the eyelids, spreads from top to bottom – from the face to the upper limbs. The hands are clenched into fists. Breathing is saved. The preconvulsive period lasts 30 seconds.

Period of tonic convulsions

Then comes the period of tonic convulsions, during which the muscles of the whole body contract tetanically. Tetanic muscle contraction is the continuous tension of a muscle without relaxation between successive single contractions.Following the twitching of the upper limbs, the patient’s head is tilted back. The whole torso tenses, the spine bends, the jaws clench, breathing stops, the skin of the face turns blue. The period lasts 30 seconds.

Period of clonic seizures

This is followed by a period of clonic seizures – the patient, who had been lying motionless before, begins to beat in continuous convulsions. Convulsions spread down the body from top to bottom. As a result, the patient jumps up and down on the bed, sharply moving her arms and legs.The whole body shakes with violent convulsions, seizing the muscles of the face, arms, legs, trunk. The patient is not breathing, the pulse is not felt. Gradually, the cramps subside, hoarse breathing appears, foam flows out of the mouth, stained with blood due to the bite of the tongue. The duration of clonic seizures ranges from 30 seconds to 1.5 minutes, sometimes longer.

Resolution of convulsive seizure

The patient makes a noisy breath with snoring, which turns into deep, rare breathing. Blood-stained foam comes out of the mouth.The face turns pink, a pulse appears, the pupils gradually narrow. Then consciousness returns, but the woman does not remember anything about what happened.

Prolonged loss of consciousness after a seizure is called “eclampsic coma”. Its duration is indicative of severe eclampsia. An eclampsic coma can last more than 4-6 hours.

During an attack of eclampsia, there is a spasm of the respiratory muscles, a retraction of the tongue, and breathing is disturbed. The secretion of saliva and bronchial secretions increases, which closes the respiratory lumen.There is no cough reflex during an attack. Hypoxia begins – a lack of oxygen. Considering that an attack of eclampsia occurs against a background of high blood pressure, the load on the heart increases. This explains the violation of the heart rhythm and changes in the ECG. Blood circulation is impaired and pulmonary edema develops, which leads to even greater heart failure ^[2] .

An increase in blood pressure and impaired blood circulation provoke an increase in intracranial pressure and, as a result, an increase in seizures.If the vicious circle is not broken, then there is a cerebral hemorrhage, respiratory arrest, cardiac arrest and death of the patient.

Atypical course of eclampsia

In an atypical course, or “non-convulsive eclampsia,” the patient suddenly loses consciousness without a seizure. For the atypical form, the following clinical picture is characteristic: at first there is a severe headache, it darkens in the eyes, the muscles of the face begin to twitch. Suddenly, complete blindness can occur, and the patient falls into a coma with high blood pressure.Very often this form of eclampsia is associated with cerebral hemorrhage.

Eclampsia is based on dysfunction of the central nervous system, so its excitability increases sharply, and irritants such as noise, light, pain can cause a new seizure.

Before the onset of eclampsia, headache intensifies, anxiety arises, blood pressure rises and sleep worsens ^{[1] [6]} .

It should be remembered that eclampsia can occur not only in the second half of pregnancy, but also in the first days after childbirth.Therefore, follow-up is important both during pregnancy and after childbirth (from 48 hours to 4 weeks after childbirth) ^{[2] [7] [8]} .

Pathogenesis of eclampsia

Endothelial dysfunction is a key link in the pathogenesis of eclampsia. The endothelium is a layer of cells that lines the inner surface of blood and lymph vessels. It provides vascular wall integrity and selective permeability to various substances. Also, the endothelium produces many biologically active substances and affects all body systems.

According to the theory of placental ischemia, during the invasion of the trophoblast (the outer layer of the cells of the human embryo), incomplete “ingrowth” of the trophoblast occurs. The violation affects the structure of the arteries of the uterus and leads to insufficient blood supply to the forming placenta ^[13] .

Hypoxia, which develops in this case, leads to damage to the vascular endothelium, first locally, then generalized. In this case, the endothelium begins to secrete many biologically active substances.The permeability of the vascular wall increases, the sensitivity to vasoconstrictor substances increases, the mechanisms of thrombus formation are activated.

Against the background of vasospasm, there is a lack of oxygen and the functions of all organs are impaired. There is an increase in the total vascular resistance of blood vessels, arterial hypertension, impaired vascular permeability, hypovolemia – a decrease in the volume of circulating blood, centralization of blood circulation due to narrowing of peripheral vessels, and a decrease in cardiac output.

Also increases the viscosity of the blood, the tendency to thrombus formation and suppression of fibrinolysis – the dissolution of blood clots. The number of platelets decreases, as they are involved in the formation of blood clots. As a result, disseminated intravascular coagulation (DIC) develops – the formation of blood clots in combination with incoagulability of the blood, leading to massive hemorrhages.

Vascular spasm also leads to a decrease in cerebral blood flow. The excitability of the central nervous system increases, and convulsions appear.In severe cases, subarachnoid hemorrhages develop (hemorrhage in the cavity between the meninges), hemorrhagic and ischemic stroke.

In the cerebral form of eclampsia, the dominant lesions in the form of edema, hemorrhage and necrosis occur in the brain; in the hepatic and renal form, liver and kidney damage predominates, respectively.

Classification and stages of development of eclampsia

The classification adopted in 2005 at the All-Russian Scientific and Educational Forum “Mother and Child” is based on the severity of certain pathogenetic and clinical symptoms.

Allocate:

1. Convulsive form of eclampsia, which is divided into:
2. renal eclampsia – the leading symptom is kidney damage and lack of urine;
3. hepatic (hepatopathy) – liver damage;
4. cerebral (encephalopathy) – damage to the central nervous system.
5. Non-convulsive (eclampsic coma) ^[5] .

Complications of eclampsia

Eclampsia is a life-threatening condition for women and the fetus.A complication of eclampsia can be cerebral coma , resulting from a cerebral hemorrhage.

A cerebral hemorrhage can cause paralysis of the respiratory center and respiratory arrest, cardiac arrest, shock, heart failure, leading to pulmonary edema. All this can end in death.

If death did not occur immediately after the attack, but after a few days, then the cause is, as a rule:

• hepatic coma – damage to the liver tissue by massive hemorrhages and foci of necrosis;
• acute renal failure – necrosis, that is, the death of the cortex of the kidneys and renal tubules against the background of a sharp violation of blood circulation;
• DIC syndrome – successive episodes of bleeding and thrombosis, which lead to damage to all tissues and organs.

After suffering eclampsia, the patient may face complications from the central nervous system :

• paralysis;
• psychosis;
• epilepsy;
• headache;
• Memory violation.

As well as pathologies from other organs and systems – retinal detachment and blindness.

From the side of the fetus, the most formidable complications in eclampsia are placental abruption and antenatal death ^{[3] [8]} .

Diagnostics of eclampsia

When taking anamnesis it is important for the doctor to pay attention to the following complaints:

• headache;
• “flashing flies” before the eyes;
• pain in the upper abdomen;
• rapidly increasing edema;
• Difficulty nasal breathing.

On examination – for edema on the woman’s body.

Blood pressure with eclampsia increased:

• systolic blood pressure – 160 mm Hg.art and above;
• diastolic blood pressure – 110 mm Hg. Art. and higher.

Increased pressure in eclampsia is combined with laboratory indicators:

• proteinuria – the appearance of protein in the urine 3 g / day and above;
• oliguria – a small amount of urine, the volume per day is less than 400 ml;
• thrombocytopenia – a decrease in platelets less than 100 * 10 ⁹ ;
• hypocoagulation – deviations in the indicators of the blood coagulation system;
• high levels of liver enzymes in the biochemical blood test;
• an increase in the level of bilirubin in a biochemical blood test;
• an increase in creatinine levels of more than 90 μmol / l.

On the part of the fetus – intrauterine growth retardation, placental abruption, hypoxia, intrauterine death. These conditions are diagnosed using ultrasound (ultrasound), Doppler ultrasound (USDG) and fetal cardiotocography (CTG) ^[11] .

Differential diagnosis

Eclampsia should be distinguished from epilepsy, stroke, intracranial aneurysm and cerebral hemorrhage, brain tumors and abscesses, infections, acute intoxications ^{[2] [7]} .

According to the autopsy data of patients who died from eclampsia, the liver is most often damaged. In it, foci of hemorrhage and necrosis are noted (cell death as a result of a sharp violation of blood supply due to vascular spasm and closure of the lumen by a thrombus). Thrombosis and hemorrhages also lead to kidney damage – urine flow is impaired, up to its complete absence.

Treatment of eclampsia

First aid for the development of seizures:

1. The patient is placed on a flat surface, her head is taken to the side.
2. Holding the woman, quickly release the airways, carefully opening the mouth with a spatula or spoon, pull the tongue forward. If possible, aspirate the contents of the mouth and upper respiratory tract. Aspiration is a procedure in which a vacuum is used to take biological material or liquid using a special device – an aspirator.
3. While maintaining and quickly recovering spontaneous breathing after a convulsive seizure, oxygen is given.In case of prolonged absence of breathing, auxiliary ventilation is immediately started (with the help of an Ambu bag, a breathing apparatus mask) or the patient is transferred to artificial lung ventilation (ALV).
4. In case of cardiac arrest, in parallel with artificial ventilation of the lungs, a closed heart massage is performed and all methods of cardiovascular resuscitation are performed.
5. Anticonvulsants and sedatives are given intravenously to stop seizures.

Eclampsia is an indication for emergency delivery by caesarean section .

Treatment and recovery from an attack of eclampsia is carried out in the intensive care unit. All manipulations are carried out under anesthesia against the background of artificial lung ventilation. In this case, it is necessary to constantly monitor the functions of vital organs.

Complex treatment is also carried out using:

• magnesia therapy – which has an anticonvulsant, hypotensive, anti-edema effect;
• infusion therapy – in order to replenish the circulating blood volume and improve blood circulation in vital organs;
• antihypertensive therapy – to lower blood pressure;
• antiplatelet therapy – aimed at preventing the formation of blood clots in the vascular bed;
• antioxidant therapy – rehabilitation treatment aimed at weakening the effect of damaging substances;
• diuretic therapy – anti-edema.

Mechanical ventilation is stopped only with a stable improvement in the patient’s condition and restoration of spontaneous breathing ^{[1] [12]} .

Forecast. Prevention

Eclampsia does not come on suddenly, it starts gradually and can be prevented by an experienced clinician. If a pregnant woman is at risk of developing eclampsia, this does not yet give a complete prognosis, but should alert the doctor.

In this case, it is necessary to pay especially close attention to clinical criteria :

• rapid increase in body weight, not corresponding to the gestational age;
• high blood pressure;
• the appearance of protein in the urine;
• subjective symptoms – headache, “flashing of flies” before the eyes, edema;
• changes in biochemical blood tests in the form of a decrease in protein, an increase in liver function tests, bilirubin, nitrogenous compounds;
• decrease in the number of platelets;
• disorders in the blood coagulation system.

The above data is sufficient to transfer a pregnant woman from the “norm” group to the “pathological state” group ^[6] .

Preventive measures

• Reduce weight.
• Give up bad habits.
• Sleep at least 8 hours at night and rest 1-2 hours during the day. Some authors note that dosed bed rest improves uteroplacental blood flow and decreases peripheral vascular resistance. The method consists in staying pregnant women in a position on the left side from 10 to 13 and from 14 to 17 hours, i.e.that is, the time that corresponds to the increased peaks in blood pressure ^{[1] [5]} .
• Walking in the fresh air.
• Eliminate the source of negative emotions.
• Eat rationally with a sufficient amount of protein (up to 120 g / day), carbohydrates (up to 350 g / day) and fat (up to 80 g / day) and a total energy value of up to 2800 kcal.
• Take prophylactically folates and vitamins contained in nutrient complexes such as Femibion, Vitazhinal, Berlamin-Modular and others ^[2] .
• Get at least 1 g of calcium per day ^[2] .

All pregnant women at risk of developing preeclampsia, from 12 weeks of gestation, need prophylactic aspirin. The drug improves blood flow in the arteries of the uterus. The dosage should be checked with the doctor ^{[1] [4] [7]} .

What is preeclampsia and how can it be prevented?

Preeclampsia is a serious complication of pregnancy that must be prevented, especially if you have one of the risk factors for preeclampsia.In Russia, the incidence of preeclampsia in pregnant women on average ranges from 7% to 20%. The existing risk factors can be very scary for a pregnant woman, but knowing what preeclampsia is can give a sense of control over the situation and help to cope with it.

What is preeclampsia?

Preeclampsia is a pregnancy complication that usually occurs after the 20th week of pregnancy in the second or third trimester.

With preeclampsia, blood pressure indicators are disturbed.It can rise sharply, or slowly, but evenly. The severity of the condition ranges from moderate to severe:

• Moderate preeclampsia. Even a slight increase in blood pressure in combination with the appearance of protein in the urinalysis may be a sign of preeclampsia. However, since the symptoms are not severe, you may not even notice them. Even mild preeclampsia requires close medical supervision, and you may be shown stimulation of labor at the time when the pregnancy is considered full-term.

• Severe preeclampsia. At this level of complication, your blood pressure readings will be very high and you are likely to notice severe symptoms of preeclampsia (more on this below). Hospitalization is indicated for severe preeclampsia. Doctors will prescribe treatment based on symptoms, and in some cases, urgent delivery may be required.

Your doctor will monitor for any risk of preeclampsia symptoms during regular visits and will prescribe treatment if necessary.In most cases, women with preeclampsia have a favorable prognosis for the outcome of labor.

Eclampsia. Preeclampsia should not be confused with eclampsia. Eclampsia is a more severe and serious condition that causes seizures caused by high blood pressure. Usually, in this case, emergency delivery is required, regardless of the gestational age.

Postpartum eclampsia. Postpartum eclampsia occurs after childbirth and may occur even if signs of mild preeclampsia were observed during pregnancy.Symptoms of postpartum eclampsia may appear in the first 48 hours after delivery or within 28 days after delivery. Childbirth saves the mother from eclampsia if she has it, and treatment for postpartum eclampsia usually consists of taking medications to lower blood pressure and prevent seizures.

What are the causes of preeclampsia?

Although it is not always clear what causes preeclampsia during pregnancy, risk factors are known, including:

• First pregnancy

• More than ten years have passed between two pregnancies

• Pregnancy in a woman over 35 years old

• Preeclampsia was observed in a previous pregnancy.

• History of pre-eclampsia in maternal relatives (mothers, sisters, grandmothers)

• High blood pressure or kidney disease

• Multiple pregnancy

• Metabolic diseases

(obesity, diabetes)

IVF pregnancy

What is the prevention of preeclampsia?

It is not always possible to avoid preeclampsia, but if you have one of the risk factors, you need to identify them and strive to minimize them – take some precautions in advance:

• Bring blood pressure back to normal, if necessary, lose weight.If you have diabetes, you need to make sure your condition is under control before pregnancy. If you are already pregnant and have one of the risk factors, your doctor will advise you on the steps you need to take.

• Some doctors may prescribe low-dose aspirin during pregnancy if you are in a high-risk group.

Signs of preeclampsia

Symptoms of preeclampsia include:

• Persistent headache

• Points in front of the eyes or other visual impairments

• Pain in the epigastric region (stomach area)

  9005 (in the second half of pregnancy)

• A sharp increase in weight

• A sharp swelling of the face and hands

• Difficulty breathing

• Decreased amount of urine when urinating

Some of these symptoms (edema, nausea or headaches) are also normal signs of pregnancy, and it can sometimes be difficult to tell when something is really wrong.Therefore, if you notice signs such as severe headache, great blurred vision, severe abdominal pain or suffocation, you should immediately consult a doctor or call an ambulance.

How can a doctor diagnose preeclampsia?

A pre-eclampsia test is usually a measurement of your blood pressure during prenatal screenings or at your doctor’s appointment. Blood pressure above 140/90, which persists when measured again after four hours, is considered abnormal.Be sure to tell your doctor if you notice any signs of preeclampsia, as this will help to establish a diagnosis in time. Your doctor will likely order a detailed examination to accurately diagnose and determine the severity of the condition:

• Blood tests to measure liver, kidney function and platelet count.

• Urinalysis for determination of protein content in urine.

• Ultrasound of the fetus, which allows you to monitor its growth and weight, check the volume of amniotic fluid.

• Non-stress test during which the baby’s heartbeat is monitored when he is at rest and when he is moving.

• Fetal biophysical profile, which evaluates several parameters, including fetal breathing, muscle tone and movement.

Complications of preeclampsia

Complications of preeclampsia may include:

• The placenta separates from the wall of the uterus, causing severe bleeding).

• Long-term: Increased risk of cardiovascular disease, kidney disease, heart attack, stroke, brain damage and high blood pressure in the future.

Preeclampsia can also affect the baby, namely his birth weight. In the case of severe preeclampsia, emergency delivery is indicated – the possible risks for the child depend on how premature the delivery is. Preeclampsia is an extremely serious condition that can be fatal if the necessary measures are not taken in time.Your doctor will recommend a treatment that suits your individual needs.

Many women are concerned about whether normal childbirth is possible with preeclampsia. In some cases, vaginal delivery may be safer than caesarean section. Your doctor will choose the best solution for you based on your condition and the condition of your baby.

Treatment of preeclampsia

Childbirth is one of the main treatments for severe preeclampsia. However, premature birth can be dangerous for the baby.Your doctor should discuss with you the best course of events depending on the severity of preeclampsia and how long you are pregnant:

• Moderate preeclampsia. You may be put on storage, and if your condition improves, you may be prescribed outpatient treatment. At the same time, more regular visits to the gynecologist are needed. Your doctor may also recommend stimulating labor at week 37.

• Severe preeclampsia. Usually in this case, the expectant mother is in the hospital. If the condition worsens after the 34th week, labor can be stimulated. You may be prescribed drugs to lower blood pressure and prevent seizures, and corticosteroids to improve liver function, platelet dynamics, and help your baby’s lungs develop.

Preeclampsia is a rare condition for which there is treatment. Doctors are sure to detect the symptoms of preeclampsia and take immediate action.Treat this knowledge as useful information, not a reason for worrying, and be attentive to yourself. Most women with preeclampsia have healthy babies.

ECLAMPSIA is … What is ECLAMPSIA?

90,000 Eclampsia is … What is Eclampsia?

90,000 Preeclampsia. Eclampsia. – Family Clinic

There is such a formidable obstetric complication – eclampsia. Every obstetrician-gynecologist can dream of the development of this complication in his patient only in a nightmare. But, alas, eclampsia annually takes away the lives of mothers all over the world, and goes on a par with such obstetric syndromes as intrauterine fetal death, placental insufficiency and premature birth.

Interesting fact: A documentary description of such a formidable syndrome as preeclampsia was recorded already 2,400 years ago, and until recently it was hidden under the term toxicosis of the second half of pregnancy.

What is preeclampsia and eclampsia?

Preeclampsia is a severe toxemia of pregnancy, a syndrome that most often combines high blood pressure in a woman, proteinuria, increased swelling and impaired nervous activity.With the development of eclampsia, convulsions, impaired consciousness to a coma are added to everything else.

Interesting fact: Eclampsia translated from Greek means “flash like lightning.” This indicates how rapidly the symptoms of eclampsia develop.

For the mother, this syndrome is dangerous by disruption of the kidneys and nervous system up to acute renal failure and hemorrhage in the brain of the pregnant woman.For a child in utero, this is accompanied by placental insufficiency, oxygen starvation and, accordingly, possible intrauterine fetal death.

The method of treating preeclampsia is the only one – it is delivery, no matter how long it happens, otherwise both the mother and the baby may die from the above complications. Therefore, if preeclampsia happened, for example, at 25 weeks, then the condition of the pregnant woman is stabilized and an emergency caesarean section is performed, despite the fact that the baby is still very small and is not ready for life outside the mother.Any delay can cost both lives.

Since we do not know the reasons for the development of preeclampsia and eclampsia, it is difficult to find methods for their prevention. One thing is known: preeclampsia can develop if something goes wrong in the short term of pregnancy. Incorrectly placed placenta in short periods of pregnancy gives complications in the later stages. This process is influenced by high blood pressure, excess weight, inflammation in the body, impaired immunity and hormone imbalance. There is only one way out: to properly prepare for pregnancy in order to prevent those risk factors that we can influence.

If in a previous pregnancy you faced such a formidable complication, then you need to get to an obstetrician-gynecologist before pregnancy in order to identify and prevent risk factors. If you are already pregnant, then it is imperative to consult an obstetrician-gynecologist: do you have a high risk of developing preeclampsia. The prenatal diagnostics room is in charge of identifying and preventing preeclampsia, where an obstetrician-gynecologist should send you during pregnancy, and there you can calculate the chances of meeting this enemy and take appropriate action.

In the circulation of information from the Internet and other sources, it is important for mommy to get reliable and most understandable information. FAMILY CLINIC obstetricians-gynecologists will be able to advise you on all issues of interest related to pregnancy, diagnose and prescribe the prevention of complications.

Preeclampsia. Eclampsia »Lakhta Clinic

General

Preeclampsia is a severe complication of gestation (gestation), characterized by high blood pressure, impaired fluid withdrawal (which, in turn, leads to swelling), proteinuria (the appearance of protein in the urine), symptoms of damage to the central nervous system and internal organs; in general, there is a tendency to the rapid development of life-threatening multiple organ failure.In the absence of urgent response measures to stop preeclampsia symptoms, eclampsia develops – an epileptiform convulsive syndrome, which, however, has nothing to do with true epilepsy.

Epidemiological data naturally differ depending on where, by whom and in what formulation of the question the research was carried out. Various sources agree that preeclampsia and eclampsia are among the leading factors of maternal and perinatal mortality (according to other sources, they occupy the first place in such lists), are one of the leading causes of pregnancy loss and the development of severe persistent health disorders in the postpartum period.Globally, the incidence of preeclampsia is estimated to be in the order of 2-8%; There are reports that up to 16% of maternal mortality is due to this particular condition and that the mortality rate in preeclampsia today varies within the range of 0.05-0.09 per 1000 (perinatal mortality of newborns with preeclampsia is much higher and is 50-150 per 1000). In a number of cases, unexplained seizures – eclampsia – occur against the background of unrecognized preeclampsia, and the risk of death in this case increases sharply.

It is known that such syndromes can develop in the prenatal (usually between 20 and 30 weeks of gestation), perinatal and postpartum periods.

The problem of preeclampsia and eclampsia for obstetrics and gynecology is very serious; The WHO documents reflect the growing concern about the situation in developing countries, where, against the background of insufficient or absent management of pregnancy, these medical and statistical indicators are several times or even orders of magnitude worse than in developed countries.

Historical and terminological information

Translated from the ancient Greek “eclampsia” means “lightning”; in a broader sense, it is a flash of light, in a figurative sense, a sudden, lightning-fast appearance of something. Note that lightning-fast processes in medicine are generally called in Latin: fulminant, but this is, so to speak, a household term, while the Greek “eclampsia” is a proper name, since it indicates a special, considered separately, quite definite pathological status.

The prefix “pre-” means precedence in time. Thus, preeclampsia (pre-eclampsia) and eclampsia are consistently developing conditions, two phases of a rapidly progressive and not yet fully understood pathological process. Eclampsia is the most probable (up to 60%) and most formidable complication of preeclampsia syndrome, its natural outcome in the absence of urgent or emergency medical care.

The first surviving description of preeclampsia belongs to Hippocrates and dates back to the 5th century BC.NS. However, the very term “(pre-) eclampsia” appeared, apparently, much later; It is generally accepted that it was first used in the treatise by Johann Varandeus (1620, Italy) on the pathology of internal organs during pregnancy. Until recent decades, the term “toxemia of pregnancy” (toxemia, literally = poison in the blood) was used to denote (pre-) eclampsia of various severity, which is now internationally recognized as obsolete: the leading role of placental toxins in the development of eclampsia has not been confirmed.Until the 1980s, “early / late toxicosis of pregnancy” was diagnosed, then a less categorical and less definite “gestosis” was introduced (meaning, in principle, the same thing), but during the period of validity of the International Classification of Diseases of the Tenth Revision (which at the time of this writing loses its force, replaced by ICD-11) The Russian Association of Obstetricians and Gynecologists practiced its own classification approach, which does not coincide with the ICD. This kind of divergence between national and international paradigms is by no means unique; they are not limited to the problem of preeclampsia, they are observed not only in gynecology and not only in Russia.This situation is normal, inevitable and, moreover, necessary for the further development of medicine in general. As new reliable facts emerge, the differences between national and international perceptions are leveled; the more we know and understand, the faster we will speak the same language. But so far we do not know everything, therefore we continue to argue: toxemia, toxicosis, gestosis, preeclampsia …

Reasons

The problem of (pre-) eclampsia is significantly complicated by the fact that the etiopathogenesis of this condition remains essentially unknown.To date, dozens of theories and hypotheses are discussed in the literature (immunopathological, hereditary, neuroendocrine, psychosomatic, infectious, hematological, etc.), each of which receives certain confirmation and therefore has the right to exist. There are also many more or less significant risk factors:

• first / early childbirth (in a pregnant woman under 17 years of age), or late pregnancy after a long break;
• multiple pregnancies;
• diabetes mellitus;
• excess volume of amniotic fluid;
• hypertension, hypertension during pregnancy;
• diseases of the kidneys, liver, heart;
• Autoimmune diseases, in particular collagenoses and antiphospholipid syndrome;

90,051 smoking;

90,051 preeclampsia during previous pregnancies;

90,051 overweight;

• hereditary predisposition.

Several attempts have been made to develop a reliable system of predictors (prognostically significant factors) or sufficiently informative laboratory tests that would allow taking preventive measures to prevent the development of preeclampsia or eclampsic convulsive syndrome. However, at the moment, the diagnosis at the subclinical stage – and, accordingly, prevention – of preeclampsia also remains an unresolved problem. It is all the more important for a pregnant woman to follow all medical prescriptions regarding routine follow-up examinations during gestation: in almost any work on this issue, the direct connection between the quality of pregnancy management, the woman’s motivation and level of responsibility, adherence to the regimen, and the general obstetric and gynecological prognosis is confirmed and emphasized.

Symptoms

As mentioned above, the main clinical manifestations of preeclampsia include high or very high blood pressure, proteinuria, general edema (when pressure is applied, traces remain), visual impairment (up to retinal detachment and ischemic degeneration of the visual cortex), nausea and vomiting, abdominal pain, neurological symptom complexes and mental disorders, insufficient blood clotting and persistent bleeding, edema of the brain, lungs, joints.An intense and rapidly growing headache against the background of twitching of certain muscle groups (usually mimic) is a harbinger of eclampsia, a convulsive syndrome with an outcome in a coma and severe, often incompatible with life, complications.

Even if it is possible to eliminate the immediate threat to the mother and / or the fetus, the patients who survived the preeclampsia state are several times higher than in the general population, the risk of developing serious chronic cardiovascular, nephrological, neurological, pulmonological pathology.

It should be emphasized that in some cases, preeclampsia can be of low-symptom nature – and immediately manifest as eclampsic convulsive syndrome. On the other hand, what has been said does not mean that with the onset of any pregnancy, you need to bring yourself to panic or anxiety-hypochondriacal disorder of the psyche as soon as possible: gynecologists tirelessly remind that pregnancy for a woman is a completely normal, physiological state, and not a pathological a priori.And yet, a modern woman should be well informed about the possible significance of unusual or unusual phenomena, disorders of general well-being, such as, for example, insomnia and headaches, swelling of the fingers, unexplained too fast weight gain, etc. For this, there is a strategy for managing pregnancy, so that planned measures are combined with the opportunity to contact the observing doctor at any time – and here, of course, it is better to play it safe once again than to miss the really formidable lightning symptoms.

Diagnostics

Unlike long-term prediction, the diagnosis of pre-eclampsia is not difficult for an experienced specialist. Reasonable suspicions and the results of physical examination are confirmed by high blood pressure (140/90 and higher), detection of protein in urine, decreased platelet count and increased uric acid content in the blood (hyperuricemia), a significant increase in the level of aminotransferases (ALT / AST) in biochemical analysis blood, Doppler studies of the vascular system (including uteroplacental blood supply), echocardiography of the mother and fetus.For the purpose of confirming and differential diagnosis, urgent consultations of specialized specialists (neuropsychiatrist, ophthalmologist, nephrologist, cardiologist, etc.) are appointed.

Treatment

Any suspicion of preeclampsia implies urgent hospitalization, special protective regime, diet and constant monitoring of the condition. The therapeutic regimen is selected based on the diagnostic results, the characteristics of the anamnesis and other nuances of a particular case.As a rule, the primary measures include the prevention of the development of convulsive syndrome and multiple organ failure associated with hemodynamic and vascular disorders of internal organs. Magnesium sulfate, adrenergic blockers, vasodilators and antihypertensive drugs are widely used, if necessary, sedatives, circulatory stimulants, anticoagulants, etc. A separate task is the normalization of water-salt balance, blood composition, higher and peripheral nervous activity.All available measures are being taken to ensure the survival of the fetus.

However, there is always the possibility that the most competent and timely measures will not be effective enough – and then, in cases of therapeutic resistance and a rapid deterioration in the patient’s condition, it is necessary to urgently perform a cesarean section.

If it is possible to reliably stabilize the vital signs of the fetus and the mother, various options are considered in search of the optimal time and method of delivery for a given case.It is advisable to hold a multidisciplinary consultation, since literally hundreds of significant factors have to be taken into account. In particular, it is known that preeclampsia and eclampsia, being the most severe variant of gestosis, are associated precisely with pregnancy, i.e. after a successful delivery, the risk should be dramatically reduced. But on the other hand, up to 25% of cases of preeclampsia develop in the postpartum period, which makes it necessary to continue monitoring, adherence to the prescribed regimen of fluid intake, ensure complete psycho-emotional comfort of the mother and child, and prevent complications from the kidneys, liver, and cardiovascular system.

What is ECLAMPSIA, definition of the term in the Dictionary of Foreign Words

In addition, with the introduction of bicarbonate, water retention occurs in the body, therefore it is contraindicated in heart failure, the threat of pulmonary edema, eclampsia and some other conditions.

A.I. Levshankov, Respiratory support during anesthesia, resuscitation and intensive care, 2005

Contraindications: eclampsia , arterial hypertension, cerebrovascular accident.

V. N. Malevannaya, Pharmacology

With exacerbation of acute nephritis, acute encephalopathy or eclampsia caused by arterial hypertension and cerebral edema may occur.

E. N. Belyanskaya, Nutritional therapy for kidney disease, 2013

Renal Eclampsia occurs without precursors or after a pre-eclamptic period.

E. N. Belyanskaya, Nutritional therapy for kidney disease, 2013

In the presence of arterial hypertension and especially when eclampsia occurs , complex antihypertensive therapy with peripheral vasodilators (verapamil, hydralazine, sodium nitroprusside, diazoxide) or sympatholytics (reserpine, clonidine) in combination with saluretics (furosemide) and ethacrynic acid is indicated …).

E. N. Belyanskaya, Nutritional therapy for kidney disease, 2013

Leukocytosis will be recorded in various inflammatory conditions, with injuries and burns, with rheumatic attack or intoxication, including endogenous (diabetic acidosis, eclampsia , uremia, gout).

Yu. S. Popova, Anemia. The most effective treatments, 2008

With a severe course of nephritis, complications are possible: acute renal failure, eclampsia (convulsions due to brain damage), acute heart failure.

Irina Vecherskaya, 100 recipes for kidney disease.Tasty, healthy, mentally, healthy, 2013

A complication of acute glomerulonephritis is angiospastic encephalopathy, or renal eclampsia .

Julia Popova, Diseases of the kidneys and urinary bladder, 2008

Renal eclampsia is dangerous because it can end in cerebral hemorrhage, which, even with emergency resuscitation, can cause irreversible consequences or even death of the patient.

Julia Popova, Diseases of the kidneys and urinary bladder, 2008

With uremic coma, renal eclampsia and nephropathy of pregnant women (toxicosis of the second half of pregnancy, in which the kidneys are affected), convulsions are observed.

A.A. Poghosyan, Kidney Disease, 2013

Arterial hypertension in acute nephritis may be accompanied by the development of eclampsia .

A. A. Pogosyan, Kidney disease, 2013

Death in the acute period of the disease is rare, it is more often associated with cerebral hemorrhages against the background of eclampsia , less often with heart failure, pneumonia or acute uremia.

A. A. Pogosyan, Kidney disease, 2013

Leukocytosis will be recorded in various inflammatory conditions, trauma, burns, rheumatic attack, intoxication, including endogenous – diabetic acidosis, eclampsia , uremia, gout.

Yu.S. Popova, What the analyzes say, 2008

Well eclampsia , well, premature was born, just think.

Dr. Nonna, Do not renounce, loving (collection), 2015

In fact, a new disease has joined the seizures – eclampsia .

E. V. Sergeeva, Blessed Xenia of Petersburg: Life, Miracles, Shrines, 2011

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