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 .
The fetus may also have complications such as restriction of growth, reduced perfusion and oligohydramnios .
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 .
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  . 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.
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.
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  . 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 . While the exact basis of vascular abnormalities remains unknown, several consequences ensue:
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 . 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.