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]

  gain Diagnosis: ( ACOG 2013 ) Necessary lab work: CBC, Basic metabolic panel, LFTs, Urinalysis (24 hour urine collection ideal but impractical in ED), Uric Acid, LDH Mild Preeclampsia New onset elevated blood pressure ( ≥ 140 mmHg OR ≥ 90 mmHg diastolic [coreem.net]

  For example, weight gain and swelling are pre-eclampsia symptoms that also occur during normal pregnancies. [labtestsonline.org]

• Sepsis

  Diabetes and Hyperglycemia -- Hypoglycemia -- Sodium and Water Balance -- Potassium -- Calcium, Magnesium, and Phosphorus -- Thyroid Disorders -- Adrenal Crisis -- Rhabdomyolysis -- Pituitary Apoplexy -- Meningitis, Encephalitis, and Brain Abscess -- Sepsis [worldcat.org]

  […] in NICU, need for blood transfusion, need for pressor agents, need for mechanical ventilation, neonatal cardiac dysrhythmias, [ Time Frame: Discharge from hospital ] neonatal cardiac failure, necrotizing enterocolitis, sudden infant death, neonatal sepsis [clinicaltrials.gov]

• 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]

  Disease 358 362 Rheumatoid Arthritis 359 363 Riley-Day Syndrome (Familial Dysautonomia; Hereditary and Sensory Autonomic Neuropathy Type III) 360 364 Rocky Mountain Spotted Fever 362 365 Rubella and Congenital Rubella Syndrome 363 366 Saethre-Chotzen [worldcat.org]

  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]

  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]

• Collapse

  The intraoperative course was complicated by seizures and hemodynamic collapse. [ncbi.nlm.nih.gov]

  Without this wall support, arteries would collapse in diastole (between each heart beat). [medicinenet.com]

  These include flushing, sweating, hypotension, depressed reflexes, flaccid paralysis, hypothermia, circulatory collapse, cardiac and CNS depression proceeding to respiratory paralysis. [web.archive.org]

  The condition usually presents with severe epigastric pain, which may persist for several hours before circulatory collapse. [glowm.com]

• Fatigue

  […] 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]

  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]

  […] 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]

• Dyspnea

  While percutaneous pericardiocentesis temporarily improved her condition, pericardial effusion, dyspnea and tachycardia reappeared 5 days after delivery. [ncbi.nlm.nih.gov]

  Patients with abnormally high magnesium levels (eg, with magnesium levels > 10 mEq/L or a sudden decrease in reflex reactivity), cardiac dysfunction (eg, with dyspnea or chest pain), or hypoventilation after treatment with magnesium sulfate can be treated [msdmanuals.com]

  […] concurrent HELLP syndrome. [31] A report of an international study demonstrated that serious complications among patients with eclampsia (including maternal mortality) may be predicted by the use of a model that incorporates gestational age, chest pain or dyspnea [emedicine.com]

• Vomiting

  Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological complication associated with several medical conditions and it has been described in clinical findings of seizures, headache, vomiting, altered mental status, and visual changes and [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]

• 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]

• Right Upper Quadrant Pain

  We describe the case of a first twin pregnancy in a 27 year old patient, who experienced acute onset epigastric and right upper quadrant pain at a gestational age of 32 weeks and 2 days. [ncbi.nlm.nih.gov]

  The syndrome comprises haemolysis, increased liver enzymes, and low platelets with epigastric or right upper quadrant pain.12 This represents a life threatening complication and requires prompt delivery. [emj.bmj.com]

  These include persistent occipital headache, blurred vision, photo phobia, and epigastric and/or right upper quadrant pain. [glowm.com]

  Features of eclampsia include the following: Seizure or postictal state (100%) Headache (80%), usually frontal Generalized edema (50%) Vision disturbance (40%), such as blurred vision and photophobia Right upper quadrant abdominal pain with nausea (20% [emedicine.com]

• Liver Tenderness

  […] disease – epigastric pain, liver tenderness, elevated transaminases neurological problems – seizures, visual disturbance, papilloedema, clonus haematological disturbance – thrombocytopaenia, haemolysis, DIC fetal growth restriction – non reassuring CTG [lifeinthefastlane.com]

  Liver tenderness. Visual disturbance (eg, blurring or flashing lights in front of the eyes). Epigastric pain and/or vomiting. [patient.info]

  tenderness Ø HELLP syndrome Ø Decrease in platelet count to less than 100 x 109 per litre Ø Abnormal liver enzymes (ALT or ASTrising to above 70 iu/litre). [bjmp.org]

• Hypertension

  Hypertensive disease in pregnancy is associated with a spectrum of severity, ranging from mild pregnancy-induced hypertension to eclampsia. [ncbi.nlm.nih.gov]

  Alcohol and hypertension Hypertensive retinopathy and retinal vascular disease Blood pressure lowering in patients with prior stroke Atrial fibrillatioin and hypertension Hemorrhagic stroke Hypertension and lacunar infarcts Hypertensive Patients with [worldcat.org]

• 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, blurred 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]

  The symptoms of impending seizure often include body temperature of up to 104° F, anxiety, epigastric pain, severe headache, and blurred vision. [medical-dictionary.thefreedictionary.com]

• 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]

  failure, liver failure, HELLP syndrome (haemolysis, elevated liver enzymes and low platelets), disseminated intravascular coagulation, pulmonary oedema.For the baby, these were: death: stillbirths (death in utero at or after 20 weeks' gestation), perinatal [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]

  However, some pregnant women may experience serious complications such as seizures, a stroke, kidney failure, liver failure or bleeding due to clotting problem. [pregnancybirthbaby.org.au]

• 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]

  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]

  Atrial fibrillatioin and hypertension Hemorrhagic stroke Hypertension and lacunar infarcts Hypertensive Patients with Coronary Artery Disease Hypertension with Congestive Heart Failure Peripheral Arterial Disease and Hypertension Thoracic aorta dissection [worldcat.org]

• 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]

  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]

  Central nervous system (CNS) effects include headache and blurred vision with hyperreflexia. Seizures indicate a progression to eclampsia and require immediate delivery of the fetus. [renalandurologynews.com]

  […] 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]

• Agitation

  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]

  FACTORS PET during another pregnancy advanced maternal age multiple pregnancy high BMI conception before age 20 connective tissue disorders protein C and S deficiencies factor V leiden mutation hyperhomocysteinemia EXAMINATION BP >140/90 hyperreflexic agitated [lifeinthefastlane.com]

  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. [study.com]

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.

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.

This article highlights the occurrence of neurological complications due to pre-eclampsia/eclampsia that require particular neurosurgical attention, its treatment and prognosis. We also review the literature regarding this pathology. [ncbi.nlm.nih.gov]

Prognosis for pre-eclampsia complicated by 5 g or more of proteinuria in 24 hours. [dictionary.cambridge.org]

[…] 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]

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.

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.

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.

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.

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.

1. Mattar F, Sibai BM. Eclampsia. VIII. Risk factors for maternal morbidity. American journal of obstetrics and gynecology. Feb 2000;182(2):307-312.
2. Horrobin DF. Pathophysiology of pre-eclampsia and of eclampsia. East African medical journal. Apr 1971;48(4):165-175.
3. Zunker P, Hohenstein C, Deuschl G. Pathophysiology of pre-eclampsia/eclampsia syndrome. Journal of neurology. May 2001;248(5):437-438.
4. Reddy A, Suri S, Sargent IL, Redman CW, Muttukrishna S. Maternal circulating levels of activin A, inhibin A, sFlt-1 and endoglin at parturition in normal pregnancy and pre-eclampsia. PloS one. 2009;4(2):e4453.
5. MacKay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstetrics and gynecology. Apr 2001;97(4):533-538.
6. Cooray SD, Edmonds SM, Tong S, Samarasekera SP, Whitehead CL. Characterization of symptoms immediately preceding eclampsia. Obstetrics and gynecology. Nov 2011;118(5):995-999.
7. Douglas KA, Redman CW. Eclampsia in the United Kingdom. Bmj. Nov 26 1994;309(6966):1395-1400.
8. Baweja S, Kent A, Masterson R, Roberts S, McMahon LP. Prediction of pre-eclampsia in early pregnancy by estimating the spot urinary albumin: creatinine ratio using high-performance liquid chromatography. BJOG : an international journal of obstetrics and gynaecology. Aug 2011;118(9):1126-1132.
9. Lucas MJ, Leveno KJ, Cunningham FG. A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. The New England journal of medicine. Jul 27 1995;333(4):201-205.
10. Milne F, Redman C, Walker J, et al. The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community. Bmj. Mar 12 2005;330(7491):576-580.