Eclampsia Overview

Eclampsia, a life-threatening complicatio of pregnancy, results when a pregnantwoman previously diagnosed with preeclampsia (high blood pressure and protein in the urine) develops seizures or coma. In some cases, seizures or coma may be the first recognizable sign that a pregnant woman has preeclampsia. Key warning signs of eclampsia in a woman diagnosed with preeclampsia may be severe headaches, blurred or double vision, or seeing spots. Toxemia is a common name used to describe preeclampsia and eclampsia. There has never been any evidence suggesting an orderly progression of disease beginning with mild preeclampsia progressing to severe preeclampsia and then on to eclampsia. The disease process can begin mild and stay mild, or can be initially diagnosed as eclampsia without prior warning.

Approximately 5-7% of all pregnancies are complicated by preeclampsia.

Preeclampsia usually occurs in a woman's first pregnancy but may occur for the first time in a subsequent pregnancy.

Less than one in 100 women with preeclampsia will develop eclampsia or (convulsions or seizures) or coma.

Up to 20% of all pregnancies are complicated by high blood pressure. Complications resulting from high blood pressure, preeclampsia, and eclampsia may account for up to 20% of all deaths that occur in pregnant women.

Eclampsia Causes

No one knows what exactly causes preeclampsia or eclampsia.

Since we don't know what causes preeclampsia or eclampsia, we don't have any effective tests to predict when preeclampsia or eclampsia will occur, or treatments to prevent preeclampsia or eclampsia from occurring (or recurring).

Preeclampsia usually occurs with first pregnancies. However, preeclampsia may be seen with twins (or multiple pregnancies), in women older than 35 years, in women with high blood pressure before pregnancy, in women with diabetes, and in women with other medical problems (such as connective tissue disease andkidney disease).

For unknown reasons, African American women are more likely to develop eclampsia and preeclampsia than white women.

Preeclampsia may run in families, although the reason for this is unknown.

Preeclampsia is also associated with problems with the placenta, such as too much placenta, too little placenta, or how the placenta attaches to the wall of the uterus. Preeclampsia is also associated with hydatidiform molepregnancies, in which no normal placenta and no normal baby are present.

There is nothing that any woman can do to prevent preeclampsia or eclampsia from occurring. Therefore, it is both unhealthy and not helpful to assign blame and to review and rehash events that occurred either just prior to pregnancy or during early pregnancy that may have contributed to the development of preeclampsia.

Eclampsia Symptoms
The hallmark of eclampsia is seizures. Similar to preeclampsia, other changes and symptoms may be present and vary according to the organ system or systems that are affected. These changes can affect the mother only, baby only, or more commonly affect both mother and baby. Some of these symptoms give the woman warning signs, but most do not.

The most common symptom and hallmark of preeclampsia is high blood pressure. This may be the first or only symptom. Blood pressure may be only minimally elevated initially or can be dangerously high; symptoms may or may not be present. However, the degree of blood pressure elevation varies from woman to woman, and also varies during the development and resolution of the disease process. There are also some women who never have significant blood pressure elevation (including approximately 20% of women with eclampsia).

A common belief is that the risk of eclampsia rises as blood pressure increases above 160/110 mm Hg.

The kidneys are unable to efficiently filter the blood (as they normally do). This may cause an increase in protein to be present in the urine. The first sign of excess protein is commonly seen on a urine sample obtained in your provider's office. Rarely does a woman note any changes or symptoms associated with excess protein in the urine. In extreme cases affecting the kidneys, the amount of urine produced decreases greatly.

Nervous system changes can include blurred vision, seeing spots, severe headaches, convulsions, and even occasionally blindness. Any of these symptoms require immediate medical attention.

Changes that affect the liver can cause pain in the upper part of the abdomen and may be confused with indigestion or gallbladder disease. Other more subtle changes that affect the liver can affect the ability of the platelets to cause blood to clot; these changes may be seen as excessive bruising.

Changes that can affect your baby can result from problems with blood flow to the placenta and therefore result in your baby not getting proper nutrients. As a result, the baby may not grow properly and may be smaller than expected, or worse the baby will appear sluggish or seem to decrease the frequency and intensity of its movements. You should call your doctor immediately if you notice your baby's movements slow down.

When to Seek Medical Care

If you have any question about either your health or your baby's health

If you have severe or persistent headacheor any visual disturbance, such as double vision or seeing spots (This may be a warning sign that preeclampsia could progress to eclampsia.)

If you take your own blood pressure and it is greater than or equal to 160/110 mm Hg,call your doctor immediately!

If you have severe pain in the middle of your belly or on the right side of your belly under your ribs (This may be a warning sign that preeclampsia is worsening.)

If you notice any unusual bruising or bleeding If you notice excessive swelling or weight gain If your baby has slowed down its movements If you have any vaginal bleeding or cramping

Exams and Tests

If you experience any of the above symptoms call your provider immediately and expect to come to the office or hospital. If you have your own blood pressure device at home, report this reading to your physician. However, do not substitute your home blood pressure reading for a physician visit.

Be sure to review all of your signs, symptoms, and concerns with your provider. Your provider should check your blood pressure, weight, and urine at every office visit.

If your provider suspects that you have preeclampsia, he or she will order blood tests to check your platelet count, liver function, and kidney function. They will also check a urine sample in the office or possibly order a 24-hour urine collection to check for protein in the urine. The results of these blood tests should be available within 24 hours (if sent out), or within several hours if performed at a hospital.

The well-being of your baby should be checked by placing you on a fetal monitor. Further tests may include nonstress testing, biophysical profile (ultrasound), and an ultrasound to measure the growth of the baby (if it has not been done within the previous 2-3 weeks).

Eclampsia Treatment
Once eclampsia develops, the only treatment is delivery of your baby (if eclampsia occurs prior to delivery). Eclampsia can also occur after delivery (up to 24 hours postpartum, typically). Rarely, eclampsia can be delayed and occur up to one week following delivery. There is no cure for eclampsia. Magnesium sulfate (given intravenously) is the treatment of choice once eclampsia develops. This treatment decreases the chances of having recurrent seizures. Magnesiumtreatment is continued for a total of 24-48 hours after your last seizure. You may receive magnesium in an intensive care unit or a labor and delivery unit. While magnesium is given you will be observed closely, receiveintravenous fluids, and have a Foley catheterplaced in your bladder (to measure your urine output). Occasionally, recurrent seizures require additional treatment with a short-acting barbiturate such as sodium amobarbital. Other medications including diazepam (Valium) or phenytoin (Dilantin) have been used to treat eclampsia; however, they are not as effective as magnesium sulfate. You may also receive treatment for elevated blood pressure while being treated for eclampsia. Common blood pressure medications (for women with eclampsia) include hydralazine (Apresoline) or labetalol (Normodyne, Trandate). Once the mother's condition is stabilized following a seizure, your doctor will prepare to deliver your baby. This can occur either by cesarean delivery or induction of labor and vaginal delivery. If you are already in labor, labor can be allowed to progress provided there is no evidence that your baby has become "distressed" or compromised by the seizure. The closer you are to your due date, the more likely your cervix will be ripe (ready for delivery), and that induction of labor will be successful. Sometimes medications, such as oxytocin (Pitocin), are given to help induce labor.

The earlier in pregnancy (24-34 weeks), the less chance of a successful induction (although induction is still possible). It is more common to have a cesarean delivery when eclampsia necessitates delivery early in pregnancy.

If the baby shows signs of compromise, such as decreased fetal heart rate, an immediate cesarean delivery will be performed.

Medications

You may require medication to treat your high blood pressure during labor or after delivery. It is unusual to require medication for high blood pressure after six weeks following delivery (unless you have a problem with high blood pressure that is unrelated to pregnancy).

During labor (and for 24-48 hours after delivery) you will be given a medication called magnesium sulfate. This is to decrease your chances of having a recurrent seizure.

Medications such as oxytocin (Pitocin) or prostaglandins are given to induce labor and/or ripen your cervix. A Foley catheter is sometimes placed in the cervix to mechanically "speed" the dilation process. .