Eclampsia
Eclampsia is a highly life-threatening pregnancy complication that involves the development of convulsions or seizures in a woman with preeclampsia (proteinuria and high blood pressure). It is an urgent condition that needs medical attention.
Causes of Eclampsia:
Eclampsia is a consequence of improperly treated preeclampsia, leading to high blood pressure and organ failure. Common factors are
placental defects may result in decreased blood flow.
significant cerebral edema and hypertension.
Damage to blood vessels is caused by endothelial dysfunction.
Inflammatory and immune responses to maternal circulation.
Family history of pre-eclampsia/eclampsia.
Symptoms of Eclampsia
Acute & severe headache
Nausea and emesis
Confusion and mental restlessness
Blurred vision or transient blindness
Convulsions/ Seizures
Severe epigastric pain (upper abdominal pain)
Acute edema of the extremities, face, or lips
Dyspnea as a result of pulmonary edema.
Unconsciousness (in serious cases)
Precautions & Prevention:
Risk-bearing pregnant women must take the following precautions:
Regular prenatal visits to check blood pressure and proteinuria.
Maintenance of blood pressure control by lifestyle modification and medication if needed.
Proper calcium supplementation (particularly in high-risk women).
Healthy nutrition with high levels of vitamins and minerals, and low sodium content.
ensure monitoring of fetal growth by ultrasound & doppler if required.
Management and medication of Eclampsia
Seizures & Convulsions Management
Magnesium sulfate (MgSO₄) is the first-line of treatment of seizures. It can be administered IV intravenously or IM intramuscularly.
Dose; 6g IV (30ml of 20%) in 100ml of 5% Dextrose water over 10-15 minutes as loading dose & then 1-2g per hour. 20g added in 1000ml of dextrose water at the rate of 100ml/hour as maitenance dose.
Second line of treatment; Diazepam or Lorazepam
Management of severe hypertension
Labetolol (first beta-blocker): initially 20mg IV bolus, check blood pressure & repeat the dose after 10-15 minutes if required . Maximum dose 300mg
or Hydralazine (vasodilator): initially 5mg IV bolus, check blood pressure & repeat the dose after 20 minutes if required or Nifedipine (calcium Channel blocker) may be administered orally to manage blood pressure.
Corticosteroids (if premature delivery is indicated) Betamethasone or Dexamethasone (to promote fetal lung maturity)
The treatment of choice for eclampsia is delivery of the infant, usually by induced labor or cesarean delivery following stabilization of the mother.
To prevent further seizures , Magnesium sulfate is usually continued for 24 hours postpartum, close monitoring of urine output ( atleast100ml in 4 hours), respiratory rate, Oxygen saturation and Mg levels need to be monitored. In case of any toxicity delay the next dose.
MgSO₄ dose should continue 24 hours after delivery or last convulsions which one is occured last.
Conclusion:
Eclampsia is a state of emergency requiring early treatment to prevent maternal and fetal complications. Prompt diagnosis and management of convulsions & hypertension will significantly decrease the risks of disease.
Frequently Asked Questions
What is the difference between preeclampsia and eclampsia?
Eclampsia is a serious pregnancy complication in which a woman with preeclampsia, characterized by elevated blood pressure andindications of harm to other organ systems, begins to experience seizures. Eclampsia is the term used to describe the occurrence of seizures in conjunction with preeclampsia, however preeclampsia can also occur without seizures.
What are the signs & symptoms of eclampsia?
The basic symptom of eclampsia, seizures, may be preceded by warning signs such strong headaches, stomach pain, fast swelling, or impaired vision. If a pregnant woman experiences any of these symptoms, particularly seizures, it is imperative that she seek medical attention immediately.
What is the treatment for eclampsia?
Stabilizing the pregnant woman and managing the seizures are the usual treatments for eclampsia. Magnesium sulfate is frequently used to stop seizures from happening again. The treatment of choice for eclampsia is delivery of the infant, usually by induced labor or cesarean delivery following stabilization of the mother.