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Eclampsia

Eclampsia is a complication of pregnancy characterized by seizures in a woman diagnosed with preeclampsia.


Presentation

Preeclampsia occurs insidiously in the 24th to 25th week of gestation, with the development of edema, proteinuria, and rising blood pressure. The classical symptoms of preeclampsia include frontal headache, visual disturbance and epigastric pain. However, the majority of women with preeclampsia are asymptomatic or merely complain of general, vague ‘flu-like’ symptoms.

Should the condition evolve into eclampsia, renal function is impaired, the blood pressure mounts, and convulsions may occur. Neurological examination may reveal hyperreflexia and clonus in severe cases.

Other symptoms and signs include general malaise, nausea, restlessness, agitation, right upper quadrant tenderness, poor urine output and papilledema. Certain neurologic symptoms such as headache may precede the onset of eclampsia [6].

The fetus may also have complications such as restriction of growth, reduced perfusion and oligohydramnios [7].

Weight Gain
  • If you develop pre-eclampsia, the first thing you notice may be rapid weight gain, on the order of two to five pounds in a single week.[webmd.com]
  • 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.[news-medical.net]
  • For example, weight gain and swelling are pre-eclampsia symptoms that also occur during normal pregnancies.[labtestsonline.org]
Fever
  • […] p)-sē-ə, e- \ Medical Definition of eclampsia : a convulsive state : an attack of convulsions: as a : convulsions or coma late in pregnancy in an individual affected with preeclampsia — compare toxemia of pregnancy b : a condition comparable to milk fever[merriam-webster.com]
  • 659.5 embolism (pulmonary) 673.2 entanglement, umbilical cord 663.3 eversion, cervix or uterus 665.2 excessive face presentation 652.4 failure, fetal head to enter pelvic brim 652.5 female genital mutilation 660.8 fetal fetopelvic disproportion 653.4 fever[icd9data.com]
  • Sedation -- Resuscitation in Pregnancy -- Neonatal Cardiopulmonary Resuscitation -- Pediatric Resuscitation -- General Approach to the Pediatric Patient -- Emergencies in the First Weeks of Life -- Emergencies in Infants and Toddlers -- Child with a Fever[worldcat.org]
  • The role of malarial fever in this may need to be further investigated. Competing interest This paper did not receive any funding from any source.[panafrican-med-journal.com]
Fatigue
  • Their high blood pressure could be due to any number of reasons including weight gain, fatigue, genetics and even stress. While high blood pressure is part of preeclampsia, it’s a symptom, not a cause.[fitpregnancy.com]
  • […] mineral metabolism ; Sect. 5: Disorders of intermediary metabolism -- pt. 17: Neurologic disorders : Sect. 1: Diagnosis of neurologic disorders ; Sect. 2: Diseases of the central nervous system ; Sect. 3: Nerve and muscle disorders ; Sect. 4: Chronic fatigue[worldcat.org]
  • […] gravidarum) - see Pregnancy, complicated, vomiting endometritis (conditions classifiable to 615.0 - 615.9 ) 670.1 epilepsy 649.4 excessive weight gain NEC 646.1 face presentation 652.4 failure, fetal head to enter pelvic brim 652.5 false labor (pains) 644.1 fatigue[icd9data.com]
Hunting
  • A CT scan showed subarachnoid hemorrhage (Hunt and hess grade I, Fisher grade III).[ncbi.nlm.nih.gov]
  • Hunt and associates 74 reported a reduced incidence of pregnancy-induced hypertension among Mexican-American women who received zinc supplementation.[glowm.com]
Orthopnea
  • We present a case of late postpartum eclampsia, initially diagnosed as right-sided heart failure, 10 days postpartum.Two days after the delivery she developed mild swelling of both feet, progressive shortness of breath on exertion and orthopnea.[ncbi.nlm.nih.gov]
Severe Clinical Course
  • While most of the stings are harmless and tend to be milder, some stings rarely have severe clinical course, including neurological, cardiovascular and respiratory system complications.[ncbi.nlm.nih.gov]
Nausea
  • A 23-year-old healthy woman presented headache and nausea 10 weeks after delivery. Two days later, she generalized tonic-clonic seizure. Her brain MRI presented the foci which is typical of PRES.[ncbi.nlm.nih.gov]
  • Symptoms of eclampsia include: Seizures Severe agitation Unconsciousness Most women will have these symptoms of preeclampsia before the seizure: Headaches Nausea and vomiting Stomach pain Swelling of the hands and face Vision problems, such as loss of[nlm.nih.gov]
  • Pregnancy-related hypertension disorder symptoms can include high blood pressure, protein in urine, hand/face swelling, headache, vision problems, abdominal pain, seizures, & nausea/vomiting.[nichd.nih.gov]
Hypertension
  • Hypertensive disease in pregnancy is associated with a spectrum of severity, ranging from mild pregnancy-induced hypertension to eclampsia.[ncbi.nlm.nih.gov]
Blurred Vision
  • Sudden blurred vision is also a symptom. It is also possible to have pre-eclampsia without having any symptoms at all.[thewomens.org.au]
  • Retinal disease may be signaled by symptoms including: blurred vision spots in vision or areas that are black or gray flashes of light loss of color vision loss of central or side vision curtain or shadow over vision complete loss of vision All women[aao.org]
  • vision, double vision, or missing areas in the visual field The health care provider will do a physical exam to look for causes of seizures.[nlm.nih.gov]
Oliguria
  • Three patients had evidence of worsening severity of disease characterized by acute renal failure with oliguria, HELLP Syndrome, Intrauterine Growth Restriction and adverse perinatal outcome.[ncbi.nlm.nih.gov]
  • Oliguria (urine output 500 cc/day) indicates a much more severe clinical picture. Sudden onset or worsening of edema is a cause of concern in preeclamptic patients. Thrombocytopenia and liver damage are other clinical manifestations.[renalandurologynews.com]
  • Data from the present study also indicate that oliguria occurs with some high degree of frequency (4.72% of aggregate women).[doi.org]
Kidney Failure
  • If left untreated, pre-eclampsia can lead to serious problems such as: fitting or convulsions kidney failure liver failure blood clotting problems death.[betterhealth.vic.gov.au]
  • […] death during pregnancy or up to 42 days after the end of the pregnancy, or death more than 42 days after the end of the pregnancy); development of eclampsia or recurrence of seizures; stroke; any serious morbidity: defined as at least one of stroke, kidney[ncbi.nlm.nih.gov]
  • The complications of PE are: Maternal: severe increase in blood pressure requiring termination of the pregnancy, HELLP syndrome, eclampsia, retroplacentary haematoma, acute kidney failure, etc.[eurofins-biomnis.com]
  • This puts them at a much greater risk of developing life-threatening complications during pregnancy, including kidney failure, liver impairment, and seizures.[theconversation.com]
Seizure
  • Do not overlook other neurologic causes of seizure, particularly if the seizure occurs more than 24 hours after delivery.[emedicine.com]
  • CONCLUSION: Women with eclampsia should be reassured that, although the relative risk of a seizure disorder is higher than unaffected women, the absolute risk is extremely low (approximately one seizure/2,200 person-years).[ncbi.nlm.nih.gov]
  • Emergency symptoms include seizures or decreased alertness.[nlm.nih.gov]
Headache
  • KEYWORDS: antepartum; headache; pre-eclampsia; reversible cerebral vasoconstriction; reversible posterior leukoencephalopathy[ncbi.nlm.nih.gov]
  • The patient usually presents with headache, fits, visual disturbance and swelling in the legs and feet. It is more common in women above 35 years of age.[symptoma.com]
  • Women at high risk of seizures often have severe preeclampsia with findings such as: Abnormal blood tests Headaches Very high blood pressure Vision changes Abdominal pain Your chances of getting preeclampsia increase when: You are 35 or older.[nlm.nih.gov]
Stroke
  • In pregnant women with eclampsia or stroke, accurate antihypertensive and anticonvulsive treatment are necessary. Discriminating between eclampsia and stroke during labor is difficult.[ncbi.nlm.nih.gov]
Hyperreflexia
  • (NICHD) Definition (MSH) Onset of HYPERREFLEXIA; SEIZURES; or COMA in a previously diagnosed pre-eclamptic patient (PRE-ECLAMPSIA).[fpnotebook.com]
  • Increasing blood pressure will lead to increasing hyperreflexia (overactive reflexes), until eventually uncontrollable seizures result.[medbroadcast.com]
  • Neurological examination may reveal hyperreflexia and clonus in severe cases. Other symptoms and signs include general malaise, nausea, restlessness, agitation, right upper quadrant tenderness, poor urine output and papilledema.[symptoma.com]
  • Signs & Symptoms Most commonly asymptomatic, but can cause: Flu-like symptoms Vomiting pulse Hyperreflexia and Clonus ( 3 beats) Seizures – indicated eclampsia Headache Visual disturbance Bruising (Platelets Epigastric pain – HELLP – difficult to differentiate[almostadoctor.co.uk]
  • […] vasoconstrictors vasodilators Presentation Symptoms headache blurred vision abdominal pain weight gain (water retention) Physical exam hypertension mild preeclampsia 140/90 severe preeclampsia 160/110 edema of face and extremities altered mentation hyperreflexia[medbullets.com]
Frontal Headache
  • The classical symptoms of preeclampsia include frontal headache, visual disturbance and epigastric pain. However, the majority of women with preeclampsia are asymptomatic or merely complain of general, vague ‘flu-like’ symptoms.[symptoma.com]

Workup

Severe preeclampsia is identified by a blood pressure of 160/110 mmHg or more and the presence of proteinuria on ‘dipstick’ testing. A 24 hour urine collection for quantification of proteinuria may be started, but in practice there may not be time to wait for its complication before effecting delivery [8].

In addition, the fetus may appear small, with oligohydramnios and reduced fetal movements. The cardiotocograph may demonstrate signs of hypoxia with a fetal tachycardia, reduced variability and decelerations. Eclampsia is obvious as a grand mal convulsion.

However, other causes of fits such as epilepsy have to be considered. Preceding preeclampsia suggests eclampsia, but in approximately one-third of cases the eclampsia fit precedes other signs. After the convulsion, the blood pressure is frequently normal for a while, but proteinuria will usually still be present. Any convulsion in pregnancy should be considered to be eclamptic until proved otherwise.

Brain Edema
  • Hydrostatic brain edema: basic mechanisms and clinical aspect. Acta Neurochir. 2003; 86 (suppl): 17–20. Rapoport SI. Brain edema and the blood-brain barrier. In: Welch KMA, Caplan, LR, Reis DJ, Siesjo BK, Weir B, eds.[web.archive.org]
  • Hydrostatic brain edema: basic mechanisms and clinical aspect. Acta Neurochir. 2003 ; 86 (suppl): 17–20. Google Scholar 43 Rapoport SI. Brain edema and the blood-brain barrier. In: Welch KMA, Caplan, LR, Reis DJ, Siesjo BK, Weir B, eds.[hyper.ahajournals.org]

Treatment

The aim of hypertensive therapy is to lower the blood pressure and reduce the risk of maternal cerebrovascular accidents without reducing uterine blood flow and compromising the fetus. In a woman with severe preeclampsia, the airway and breathing are likely to be secure. However, if a seizure has occurred, these will need assessment and treatment.

There are a variety of hypertensives used in the management of preeclampsia. Methyldopa is centrally acting antihypertensive agent. It can only be given orally, it takes upwards of 24 hours to take effect and has a range of unpleasant side effects, including sedation and depression. Labetolol is an alpha-blocking and beta- blocking agent. Nifedipine is a calcium-channel blocker with a rapid onset of action.

The drug of choice for the treatment of eclampsia is magnesium sulphate [9] [10]. This is given intravenously and reduces the incidence of further convulsions in women with eclampsia. Moreover, iatrogenic premature delivery of the fetus is often required in severe eclampsia.

Prognosis

  • Our results suggest that by adopting a careful and correct approach and accurate neurological diagnosis, most of these patients could be treated successfully with good prognosis of the newborns.[ncbi.nlm.nih.gov]
  • It is typically asymptomatic, and occurs after 20 weeks, although it rarely presents before 32 weeks – but when it does, it is associated with a worse prognosis.[almostadoctor.co.uk]
  • […] of Three-Dimensional Sonography in Obstetrics -- Central Nervous System Imaging Cephalocele -- Imaging of the Face and Neck Cleft Lip and Palate -- Thoracic Imaging -- Fetal Cardiac Malformations and Arrhythmias: Detection, Diagnosis, Management, and Prognosis[worldcat.org]

Etiology

Eclampsia most commonly is caused due to blood vessel disorders. Brain and neurological factors play a role leading to tonic-clonic seizures in complicated cases of pregnancy. Diet and genetic factors also contribute to the condition. Eclampsia commonly follows a condition called preeclampsia. This is a serious complication of pregnancy in which a woman has high blood pressure and very rapid weight gain. The risk of preeclampsia in pregnant women increases with multiparity, preeclampsia in any previous pregnancy, ten years or more since last pregnancy, family history of preeclampsia, body mass index of 35 or more, diastolic blood pressure of 80mmHg or more, proteinuria of >1 on more than one occasion, and certain other medical disorders such as preexisting hypertension, renal disease and diabetes.

Epidemiology

Eclampsia is relatively rare in the United States, occurring in approximately 1:2000 pregnancies. It may occur antepartum 40 %, intrapartum 20 % or postpartum 40 %. Severe preeclampsia is more common than eclampsia. The syndrome occurs in 5% to 10% of pregnancies, in women older than 35 years of age.

Moreover, the condition is more common in primigravid women, and there is a three to four fold increase in the incidence of eclampsia in the first degree relatives of affected women.

Sex distribution
Age distribution

Pathophysiology

The triggering events initiating these syndromes are unknown, but a basic feature underlying all cases is inadequate maternal blood flow to the placenta secondary to inadequate development of the spiral arteries of the uteroplacental bed [2] [3]. In the third trimester of normal pregnancy, the musculoelastic walls of the spiral arteries are replaced by a fibrinous material, permitting them to dilate into wide vascular sinusoids.

In preeclampsia and eclampsia, the musculoskeletal walls are retained and the channels remain narrow. Recent studies suggest that an imbalance between proangiogenic and antiangiogenic factors predate the onset of preeclampsia. Increase in the antiangiogenic factor sFlt 1 and reduction in the level of proangiogenic factor VEGF (vascular endothelial growth factor) have been noted [4]. While the exact basis of vascular abnormalities remains unknown, several consequences ensue:

  1. Placental hypoperfusion with an increased predisposition to the development of infarcts.
  2. Reduced elaboration by the trophoblast of the vasodilators prostacyclin, prostaglandins E2, and nitric oxide, which in normal pregnancies oppose the effect of renin-angiotensin- hence the hypertension of preeclampsia and eclampsia.
  3. Production by the ischemic placenta of thromboplastic substances such as tissue factor and thromboxane, which probably account for the development of disseminated intravascular coagulation.

Prevention

Established preventive intervensions in pregnant females who presented with eclampsia include low-dose aspirin 75mg daily, which reduces the risk of preeclampsia in high-risk women, and calcium supplementation may also reduce risk, but only in women with dietary intake. The vitamins C and E do not lower the risk of preeclampsia.

The antenatal care and Doppler ultrasound studies help to identify women at high risk of preeclampsia. However, there is currently no screening tests for hypertensive disorders.

Summary

Eclampsia, a life threatening complication of pregnancy, is a condition in which a woman develops seizures [1]. The woman is usually previously diagnosed with preeclampsia as hypertension of at least 140/90 mmHg recorded on at least two separate occasion, 4 hours apart and in the presence of at least 300mg protein in a 24 hour collection of urine.

Preeclampsia and eclampsia are commonly called as “hypertensive disorders of pregnancy” or “toxemia of pregnancy”. The condition usually arises de novo after the 20th week of pregnancy in a previously normotensive women and resolving completely by the sixth postpartum week.

Eclampsia in a woman diagnosed with preeclampsia may be characterized by tonic-clonic seizures, severe headache, double vision, or seeing spots. The seizures are not related to an existing brain condition.

Patient Information

Eclampsia is a disease in which there are fits in a pregnant woman. It follows a condition called preeclampsia that is marked by high blood pressure and a high level of protein in the urine. The patient usually presents with headache, fits, visual disturbance and swelling in the legs and feet. It is more common in women above 35 years of age.

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Last updated: 2019-07-11 22:38