### Date : 2024-09-03 21:10 ### Topic : Eclampsia #OBGY #medicine ---- ### **Eclampsia Overview** **Eclampsia** is a severe complication of pregnancy, characterized by the onset of seizures in a woman who has preeclampsia. Preeclampsia itself is a condition marked by high blood pressure and often proteinuria (protein in the urine) after 20 weeks of gestation. Eclampsia is a life-threatening condition that requires immediate medical attention. ### **Preeclampsia vs. Eclampsia** - **[[Preeclampsia]]**: A pregnancy complication characterized by high blood pressure (hypertension) and signs of damage to another organ system, most often the liver and kidneys. Preeclampsia is diagnosed after 20 weeks of pregnancy and can range from mild to severe. - **Eclampsia**: Eclampsia occurs when a woman with preeclampsia develops seizures that are not attributable to other causes, such as epilepsy. It can occur during pregnancy, labor, or in the postpartum period. ### **Epidemiology** - Eclampsia is less common than preeclampsia, affecting about 0.1% of pregnancies in developed countries, but the incidence is higher in developing countries. - It is a leading cause of maternal and perinatal morbidity and mortality. ### **Risk Factors** - **History of Preeclampsia or Eclampsia**: Women with a history of preeclampsia in previous pregnancies are at higher risk. - **Chronic Hypertension**: Preexisting high blood pressure increases the risk. - **First Pregnancy**: Primigravidas (first-time mothers) are at higher risk. - **Multiple Gestations**: Twins or triplets increase the likelihood of preeclampsia and eclampsia. - **Obesity**: Higher body mass index (BMI) is associated with an increased risk. - **Age Extremes**: Very young or older maternal age (above 35 years) increases risk. - **Diabetes or Kidney Disease**: Preexisting conditions like diabetes or renal disease heighten the risk. ### **Pathophysiology** - **Endothelial Dysfunction**: Preeclampsia and eclampsia are believed to result from abnormal placentation leading to widespread endothelial dysfunction, which causes vasoconstriction, increased vascular permeability, and a hypercoagulable state. - **Cerebral Edema**: In eclampsia, severe hypertension and endothelial damage can lead to cerebral edema (swelling of the brain) and vasospasm, which can result in seizures. ### **Clinical Presentation** 1. **Seizures**: The hallmark of eclampsia. These are generalized tonic-clonic seizures and are not related to any underlying neurological condition. 2. **Severe Hypertension**: Blood pressure readings typically exceed 160/110 mmHg. 3. **Headache**: Severe and persistent headaches are common. 4. **Visual Disturbances**: Blurred vision, photophobia, or even temporary blindness can occur. 5. **Epigastric Pain**: Often described as right upper quadrant pain, it can indicate liver involvement. 6. **Altered Mental Status**: Confusion, agitation, or unconsciousness can be present. 7. **Other Preeclampsia Symptoms**: Proteinuria, edema, and other signs of organ dysfunction. ### **Diagnosis** - **Clinical Diagnosis**: Eclampsia is diagnosed based on the presence of seizures in a woman with preeclampsia. Other causes of seizures (like epilepsy) should be ruled out. - **Blood Pressure Measurement**: Persistent severe hypertension is usually present. - **Urine Tests**: Proteinuria (≥300 mg/24 hours) is a common finding. - **Blood Tests**: - **Complete Blood Count (CBC)**: To check for thrombocytopenia (low platelet count). - **Liver Function Tests (LFTs)**: Elevated liver enzymes can indicate severe disease. - **Renal Function Tests**: Elevated creatinine levels can indicate kidney involvement. ### **Management** Eclampsia is a medical emergency that requires immediate treatment to prevent further complications for both mother and baby. 1. **Seizure Control**: - **Magnesium Sulfate**: The drug of choice for preventing and treating eclamptic seizures. It acts as a central nervous system depressant and is more effective than other anticonvulsants. - **Benzodiazepines**: May be used if magnesium sulfate is unavailable or if seizures persist. 2. **Blood Pressure Management**: - **Antihypertensive Therapy**: Medications like labetalol, hydralazine, or nifedipine are used to control severe hypertension and prevent complications like stroke. 3. **Delivery of the Baby**: - **Timing of Delivery**: The definitive treatment for eclampsia is delivery of the baby. The timing depends on the gestational age, severity of maternal condition, and fetal status. - **Mode of Delivery**: Vaginal delivery is often preferred, but cesarean section may be necessary if the maternal or fetal condition warrants it. 4. **Monitoring and Supportive Care**: - **Intensive Monitoring**: Continuous monitoring of maternal vital signs, fetal heart rate, urine output, and neurological status. - **Fluid Management**: Careful fluid management is important to avoid pulmonary edema or worsening hypertension. 5. **Postpartum Care**: - **Continued Monitoring**: Women with eclampsia need close monitoring even after delivery, as seizures and hypertension can persist in the postpartum period. - **Magnesium Sulfate**: Continued for 24 hours postpartum to prevent recurrent seizures. ### **Complications** - **Maternal Complications**: - **Cerebral Hemorrhage**: One of the most severe and life-threatening complications. - **Pulmonary Edema**: Due to fluid overload and heart failure. - **Acute Kidney Injury**: Due to severe hypertension and preeclampsia. - **HELLP Syndrome**: A severe form of preeclampsia characterized by Hemolysis, Elevated Liver enzymes, and Low Platelet count. - **Fetal Complications**: - **Preterm Birth**: Often necessary due to the severity of the maternal condition. - **Intrauterine Growth Restriction (IUGR)**: Due to placental insufficiency. - **Perinatal Death**: Higher risk due to preterm delivery and complications related to eclampsia. ### **Prognosis** - **Maternal Prognosis**: With prompt and appropriate treatment, maternal outcomes have improved significantly, but eclampsia still poses a significant risk of maternal morbidity and mortality, especially in resource-limited settings. - **Fetal Prognosis**: Dependent on gestational age at delivery and the severity of maternal illness. Preterm delivery can lead to complications such as respiratory distress syndrome and other prematurity-related conditions. ### **Prevention** - **Antenatal Care**: Regular prenatal visits to monitor blood pressure and screen for signs of preeclampsia. - **Low-Dose Aspirin**: May be recommended for women at high risk of preeclampsia starting in the late first trimester. - **Calcium Supplementation**: In populations with low dietary calcium intake, supplementation may reduce the risk of preeclampsia. Eclampsia is a critical condition requiring immediate medical intervention. With early detection and proper management, the risks to both mother and baby can be significantly reduced. ### Reference: - ### Connected Documents: -