Eclampsia

What is Eclampsia?

Eclampsia is a serious complication that can happen during pregnancy when a woman has preeclampsia, a condition related to high blood pressure. If not identified and treated correctly, eclampsia can harm both the mother and baby. Preeclampsia and eclampsia are two out of four categories associated with blood pressure problems during pregnancy. The other two categories are chronic high blood pressure and gestational high blood pressure, as well as preeclampsia that occurs with chronic high blood pressure.

The way we define preeclampsia, which can lead to eclampsia, has changed over the years. The original definition required the presence of protein in the woman’s urine, but this criterion has been discarded because some patients showed severe symptoms before protein could be detected. Now, preeclampsia is defined as new high blood pressure, with a systolic (upper) blood pressure of 140 or more, or a diastolic (lower) blood pressure of 90 or more, developing after 20 weeks of pregnancy, accompanied by protein in the urine and/or effects on certain organs.

The organ effects can include kidney malfunction, liver problems, disturbances in the central nervous system, fluid in the lungs, or a low platelet count. Eclampsia, on the other hand, is defined as the occurrence of general seizures in a woman who has preeclampsia. The seizures can happen before giving birth, 20 weeks after becoming pregnant, during childbirth, or after childbirth. Seizures before 20 weeks are rare but have been recorded in a disease called gestational trophoblastic disease.

What Causes Eclampsia?

Despite advancements in understanding preeclampsia, we still don’t know the exact cause of eclampsia. However, it’s believed that during preeclampsia, the blood-brain barrier becomes more permeable. This can change blood flow to the brain because it disrupts the body’s natural regulation of blood flow.

Risk Factors and Frequency for Eclampsia

Hypertensive disorders, such as chronic high blood pressure, gestational hypertension, preeclampsia, eclampsia, and chronic high blood pressure combined with preeclampsia, impact up to 10% of all pregnancies globally and are responsible for around 10% of all maternal deaths in the United States. Over the recent years, the incidence of preeclampsia has been on the rise, which has led to increased health risks and death rates among mothers and newborns. African American women in the United States are more prone to preeclampsia, leading to a maternal death rate that is three times higher than that of their white counterparts. Several other risk factors have been associated with preeclampsia.

• Maternal age over 40
• Previous history of preeclampsia
• Pregnancy with multiple fetuses
• Obesity
• Chronic hypertension
• Pregestational diabetes
• Kidney disease
• Antiphospholipid syndrome
• Thrombophilia
• Lupus
• In vitro fertilization

Signs and Symptoms of Eclampsia

Eclampsia is a condition that is primarily associated with another condition called preeclampsia. It can occur before, during, or up to six weeks after delivery. Typically, women with eclampsia start showing symptoms after 20 weeks of pregnancy, but most cases happen after the 28th week of pregnancy. The main sign of eclampsia are seizures that shake the whole body, and these usually last from one to one and a half minute. After the seizure, the person frequently feels confused or drowsy. Before having a seizure, patients might experience warning signs like headaches, changes in their vision, stomach pain, and high blood pressure.

Testing for Eclampsia

Eclampsia is a severe condition that can occur in pregnancy, marked by sudden, often severe seizures. Doctor’s tests to diagnose eclampsia largely focus on identifying preeclampsia, a related condition known to potentially lead to eclampsia.

Preeclampsia is often identified by high blood pressure that appears for the first time after 20 weeks into a pregnancy. You could be diagnosed with preeclampsia if your systolic (top number) blood pressure is 140 mmHg or higher or if your diastolic (bottom number) blood pressure is 90 mmHg or higher. Alongside high blood pressure, preeclampsia diagnosis requires that you also show one of these other signs: excessive protein in the urine, improperly functioning kidneys, liver problems, symptoms related to the central nervous system like headache and visual disturbances, water in the lungs, or a reduced number of platelets in the blood.

While it’s no longer considered essential for the diagnosis, higher levels of protein in the urine (proteinuria) often form part of the criteria used in diagnosing preeclampsia. For proteinuria to be confirmed, there needs to be at least 300mg of protein found in a 24-hour urine sample, or a protein-to-creatinine ratio of 0.3 or higher.

Other tests often done include a hepatic panel examining liver function, a Complete Blood Count (CBC) to check platelet function, and a basic metabolic profile to assess kidney function. Elevated levels of transaminase in the blood, more than two times the normal limit, coupled with pain in the upper right stomach area, suggest the presence of preeclampsia. Platelet levels higher than 100,000 can also indicate preeclampsia. The development of fluid in the lungs, as detected by a chest x-ray or physical examination, along with high blood pressure, can be a sign of preeclampsia.

In addition to these tests, ultrasounds can be performed during pregnancy to identify any effects of preeclampsia on the developing baby, such as slowed growth in the womb. An ultrasound can also help doctors monitor other potential complications such as placental abruption, where the placenta separates from the womb’s inner wall before birth. Similarly, a nonstress test can be done to ensure the baby’s health before birth.

Treatment Options for Eclampsia

Eclamptic seizures, which are a dangerous medical condition that can occur during pregnancy, necessitate immediate treatment to save the lives of both the mother and baby. If a patient is experiencing these seizures, the first steps involve safeguarding her airways to avoid chocking and positioning her on her left side to help handle oral secretions. These crucial measures prevent further worsening of the patient’s condition and allow for effective intervention.

The preferred treatment for eclamptic seizures is a medication called magnesium sulfate, which helps control the convulsions. Doctors normally administer a dose of 4 to 6 grams through an IV over a span of 15 to 20 minutes. After that, a maintenance dosage of 2 grams per hour is given. This treatment should continue for at least a day following the last seizure.

However, it’s important to use this medication with caution because improper dosages can be toxic, leading to serious issues like respiratory failure, depression of the central nervous system, and even cardiac arrest. Therefore, while administering this treatment, doctors need to closely monitor reflexes, kidney function, and urine levels.

If the seizures do not respond to magnesium, benzodiazepines and barbiturates are used. For patients with a specific condition called myasthenia gravis, Levetiracetam or Valproic acid are recommended, as magnesium and phenytoin could increase muscle weakness leading to a health crisis. In all cases, immediate consultation with a maternity specialist is needed.

In particular, if the mother is more than 34 weeks pregnant and her condition is severe, delivery should be the next step, provided the mother’s condition can be stabilized. For those with a gestational age of less than 34 weeks, corticosteroids can be administered to aid in the development of the baby’s lungs if time permits, although delivery should not be delayed for this treatment.

It’s also crucial to prevent eclamptic seizures in pregnant women with severe preeclampsia by providing them with magnesium sulfate prophylactically (preventatively). Controlling blood pressure is also imperative. Doctors often recommend starting antihypertensive treatment in pregnant women with high blood pressure levels. Suitable medications for managing high blood pressure during pregnancy include labetalol, nifedipine, and hydralazine. Blood pressure management is also essential after delivery as the risk of eclamptic seizures is particularly high during the first 48 hours post-birth.

What else can Eclampsia be?

Making a correct diagnosis is based on the patient’s medical history and the findings from a physical exam. Various conditions could be the cause of the patient’s symptoms, ranging from electrolyte imbalances in the body, exposure to toxins, infections, or injuries to the head. Extreme medical conditions such as a ruptured aneurysm or brain cancer should also be considered. If the patient is suffering from continuous neurological symptoms, the possibilities of a stroke or bleeding within the brain cannot be ruled out.

Here’s a list of some other potential conditions that might be considered:

• Long-term high blood pressure
• Long-term kidney disease
• Primary seizure disorders
• Gallbladder disease
• Antiphospholipid syndrome – a blood clotting disorder
• Hemolytic-uremic syndrome – a condition affecting blood and kidney
• Pancreatic disease
• Immune thrombocytopenic purpura – a disorder causing excessive bleeding or bruising
• Thrombotic thrombocytopenic purpura – a disorder causing blood clots formation in small blood vessels
• Toxins
• Ruptured aneurysm – a burst blood vessel
• Brain tumor
• Stroke
• Intracranial hemorrhage – bleeding within the brain

What to expect with Eclampsia

Hypertensive disorders, such as preeclampsia and eclampsia, impact 10% of pregnancies in the United States and across the world. Despite improvements in medical treatment, these disorders continue to be the top cause of severe health issues and fatalities among pregnant women and newborns globally. Eclampsia, in particular, is a critical pregnancy complication. Despite its rates have decreased, it remains a serious concern.

Possible Complications When Diagnosed with Eclampsia

Eclampsia, a severe form of high blood pressure during pregnancy, can cause various complications. After a seizure, the patient might need help to breathe due to a lower level of awareness, this process called intubation. During intubation, managing the blood pressure is important because the procedure can cause a sudden spike in blood pressure, leading to bleeding in the brain. Women with eclampsia also risk lung failure, presenting as ‘acute respiratory distress syndrome’ and fluid build-up in the lungs. As well, they can experience kidney and liver failure.

One neurological complication of eclampsia is ‘Posterior Reversible Encephalopathy Syndrome’ (PRES), which can cause various symptoms such as headaches, seizures, changes in mental status, temporary blindness, and other vision issues. While most PRES cases can improve in a few weeks if blood pressure and other triggers are managed, there’s always a risk of developing brain swelling and other serious complications.

Additionally, women with eclampsia are at a higher risk of developing heart disease later in life.

Possible Complications from Eclampsia:

• Need for intubation after a seizure
• Sudden spike in blood pressure leading to brain bleeding
• Acute respiratory distress syndrome and lung fluid build-up (Respiratory failure)
• Kidney failure
• Liver failure
• ‘Posterior Reversible Encephalopathy Syndrome’ (PRES) with symptoms including headaches, seizures, mental changes, and visual issues.
• Increased risk of heart disease later in life

Preventing Eclampsia

For women who have been diagnosed with high blood pressure or preeclampsia while they’re pregnant, it is crucial to be aware of the potential symptoms of a related condition called eclampsia. It’s important for both the women themselves and their family members to recognize these signs. If any symptoms are noticed, immediate medical help should be sought and the patient should be taken to the hospital as soon as possible. These women should also understand the importance of taking their high-blood pressure medication as prescribed, and maintain regular appointments with their pregnancy doctor or obstetrician.