What is Acute Eclampsia?
Eclampsia is a condition that only happens during pregnancy and it begins with sudden, full-body seizures. This typically happens after 20 weeks of pregnancy, but could appear sooner with multiple or abnormal pregnancies, or sometimes up to six weeks after giving birth. Eclampsia is considered the most severe form of another condition called preeclampsia.
Preeclampsia involves symptoms such as severe headaches or vision changes, which originate from the central nervous system. Additionally, it might involve liver abnormalities – indicated by discomfort in the upper right abdomen and high levels of a specific liver enzyme. Other possible factors are high blood pressure, reduced platelet count (which plays a role in blood clotting), kidney abnormalities, and fluid accumulation in the lungs.
It’s important to know that eclampsia can be dangerous. In developed countries, up to 1.8% of the mothers suffering from eclampsia might die as a result, and this number can reach up to 14% in developing countries.
What Causes Acute Eclampsia?
The exact cause of this disorder is hard to pinpoint, but the placenta seems to play a major part. Certain conditions that make the placenta larger, such as having more than one baby, can increase the risk of conditions like preeclampsia and eclampsia. A condition called fetal hydrops, which causes swelling in the placenta, can also raise the risk.
Also, molar pregnancies, which affect the structure of the placenta, can likewise increase the likelihood of these complications. Overall, issues that affect the placenta’s size, shape, or condition seem to be closely tied to this disorder.
Risk Factors and Frequency for Acute Eclampsia
Preeclampsia is a condition that can occur during pregnancy. In developed countries, it happens in about 1.5 to 10 out of every 100,000 deliveries. However, it’s more common in developing countries. Certain factors increase the risk for getting preeclampsia.
- Being pregnant for the first time (nulliparity)
- Not being of white race
- Coming from a low socio-economic background
- Having multiple pregnancies at the same time (plural pregnancies)
- Being very young or old when pregnant
Some health conditions that the mother may have can also increase the risk. Some of these are:
- High blood pressure that’s been there a long time (chronic hypertension)
- Long-term kidney disease (chronic renal disease)
- Disorders where the body’s defenses attack its own cells (autoimmune disorders)
- Being obese
- Having diabetes during pregnancy (maternal diabetes)
Lastly, certain conditions in the baby, like excess fluid in the body tissues (fetal hydrops), may also contribute to preeclampsia.
Signs and Symptoms of Acute Eclampsia
Eclampsia is a serious condition in pregnancy marked by seizures. This problem can show up in women who already have preeclampsia, which involves high blood pressure. However, in some cases, eclampsia might be the first sign that a pregnant woman has preeclampsia. The signs of this condition can vary and might include severe headaches that get worse over time, changes in vision such as blurriness or seeing spots, confusion, and seizures. It’s worth noting that even if a woman doesn’t have high blood pressure or protein in her urine, she could still have eclampsia. One special finding that might point towards eclampsia is a condition called posterior reversible encephalopathy syndrome. This involves swellings, typically in the back part of the brain, and comes with symptoms like headaches, confusion, vision problems, and seizures.
Testing for Acute Eclampsia
If a woman with preexisting conditions like preeclampsia experiences generalized seizures that do not linger or leave any lasting neurological issues, there isn’t usually a need for further diagnostic testing beyond what is done for preeclampsia. To evaluate a woman with preeclampsia, doctors usually assess kidney and liver functions, take a full blood count, and perform imaging of the fetus and placenta.
This imaging, done through ultrasound, looks at how the baby is growing and the baby’s overall health, including results of a biophysical profile and, if necessary, Doppler studies of the umbilical artery. The baby’s heart rate is also closely monitored.
There is an increased focus on watching for placental abruption as well as any possible complications that can develop for the mother – such as lung waterlogging or kidney dysfunction. Further brain imaging studies are only considered in cases where:
– There are lasting neurological issues
– There is an extended loss of consciousness
– Seizures start more than 48 hours after delivering a baby
– A seizure occurs before the 20th week of pregnancy
– There are repeating seizures even after correct treatment with magnesium sulfate
Treatment Options for Acute Eclampsia
In emergency cases of seizure activity, initial attention is to ensure the patient can breathe, prevent the inhalation of fluids into the lungs, and stop any further harm to the mother. The patient should be moved onto her left side after the seizure, and additional oxygen should be provided at a rate of 8 to 10 liters per minute using a face mask.
Magnesium sulfate is the preferred treatment for preventing further seizures; though, roughly 10% of patients may experience another seizure despite this treatment. Such instances require close monitoring for potential muscle injury, metabolic imbalances, lung inflammation from inhaled food, drink or vomit, and fluid buildup in the lungs. In such cases, either more magnesium sulfate can be given, or lorazepam may be provided over 3 to 5 minutes through an IV.
The patient’s blood pressure is an important consideration, with medication such as labetalol commonly used to manage severe high blood pressure. The aim is to maintain the systolic (higher number) blood pressure between 140 and 160, and diastolic (lower number) blood pressure between 90 and 105.
After a seizure, it is typical for the baby’s heart rate to slow down for 3 to 5 minutes, but this doesn’t necessarily mean that an emergency Caesarean section is required. Initial care involves stabilizing the mother’s situation and managing her high blood pressure if present, as well as providing oxygen to alleviate low oxygen levels and high carbon dioxide levels in the blood.
However, if there is no improvement in the baby’s heart rate after 15 minutes despite these treatments, a hidden placental abruption might be suspected, where the placenta detaches from the uterus. In this case, an emergency Caesarean section might be necessary. When an eclampsia, or pregnancy-induced seizures, occur, delaying action or “wait-and-see” management is not advisable, and delivery should be carried out as soon as possible once the mother and baby’s conditions are stable, especially after the 32-week mark.
What else can Acute Eclampsia be?
When investigating certain diseases or conditions, physicians must also consider other potential causes of the symptoms. Here are some possibilities:
- Adrenal insufficiency and adrenal crisis (issues related to the adrenal glands that sit atop the kidneys)
- Cerebral hemorrhage (bleeding in the brain)
- Cerebral aneurysms (ballooning of a blood vessel in the brain)
- Cerebral venous thrombosis (a blood clot in a vein of the brain)
- Encephalopathy (general term for brain disease)
- Encephalitis (inflammation of the brain)
- Gestational trophoblastic neoplasia (a rare pregnancy-related tumour)
- Head trauma (any kind of injury to the head)
- Hypertensive emergencies (very high blood pressure that could lead to organ damage)
- Hypoglycemia (abnormally low levels of blood sugar)
A doctor will always tailor the diagnostic process to the individual patient’s symptoms and medical history to determine the most likely cause of their condition.
What to expect with Acute Eclampsia
Most women with mild preeclampsia can expect a successful pregnancy. However, eclampsia – a more severe form of the condition – carries a mortality rate of 2%, highlighting its seriousness. The likelihood of preeclampsia repeating in future pregnancies often depends on how severe the condition was initially.
It’s important to note that patients who have experienced eclampsia may face an increased risk for heart disease in later life. This risk is even higher in cases where the eclampsia was severe or started early.
Possible Complications When Diagnosed with Acute Eclampsia
- Blindness caused by brain damage (Cortical blindness)
- Problems related to brain, nerve or muscle function (Neurological deficits)
- Heart’s blood supply interruption leading to damage (Stroke)
- Unexpected heart condition or event (Coronary event)
- Kidney failure (Renal failure)
- Malfunctioning of the liver (Liver dysfunction)
- Blood clotting problems (DIC)
- Potential death
- Slowed or stopped growth of the fetus in the womb (Intrauterine growth retardation)
Preventing Acute Eclampsia
It’s important that women continue to be educated and advised about eclampsia even after having their baby. This way, they can better understand and identify the signs of eclampsia that can occur after childbirth. If a woman who has recently given birth reports symptoms of eclampsia and seeks treatment – usually in an emergency department – she should get an expert opinion from a specialist in obstetrics and gynecology, not just emergency room doctors.
