Eclampsia is seizures (convulsions) in a pregnant woman that are not related to brain conditions.

Symptoms
y y y y

Muscle aches and pains Seizures Severe agitation Unconsciousness

Symptoms of preeclampsia include:

y y y y y

Gaining more than 2 pounds per week Headache Stomach pain Swelling of the hands and face Vision problems

Causes & Risk Factors

The cause of eclampsia is not well understood. Researchers believe the following may play a role:
y y y y

Blood vessels Brain and nervous system (neurological) factors Diet Genes

However, no theories have yet been proven. Eclampsia follows preeclampsia, a serious complication of pregnancy that includes high blood pressure and excess and rapid weight gain. It is difficult to predict which women with preeclampsia will go on to have seizures. Women at high risk for seizures have severe preeclampsia and:
y y y y

Abnormal blood tests Headaches Very high blood pressure Vision changes

Eclampsia occurs in about 1 out of every 2,000 to 3,000 pregnancies. The following increase a woman's chance for getting preeclampsia:
y y y y y y

Being 35 or older Being African American First pregnancy History of diabetes, high blood pressure, or kidney (renal) disease Multiple pregnancies (twins, triplets, etc.) Teenage pregnancy

Tests & Diagnostics

The health care provider will do a physical exam and rule out other possible causes of seizures. Blood pressure and breathing rate will be checked and monitored. Blood tests may be done to check:
y y y y

Creatinine Uric acid Liver function Platelet count

Treatments

If you have eclampsia your health care provider should carefully monitor you. Delivery is the treatment of choice for severe eclampsia. Delivering the baby relieves the condition. Prolonging the pregnancy can be dangerous to both you and your infant. With careful monitoring, the goal is to manage severe cases until 32 - 34 weeks into the pregnancy, and mild cases until 36 - 37 weeks have passed. This helps reduce complications from premature delivery. You may be given medicine to prevent seizures (anticonvulsant). Magnesium sulfate is a safe drug for both you and your baby. Your doctor may prescribe medication to lower high blood pressure, but you may have to deliver if your blood pressure stays high, even with medication.

Preeclampsia is a pregnancy condition in which high blood pressure and protein in the urine develop after the 20th week (late 2nd or 3rd trimester) of pregnancy.
Alternative Names

Toxemia; Pregnancy-induced hypertension (PIH)

Causes, incidence, and risk factors

The exact cause of preeclampsia is not known. Possible causes include:

y y y y

Autoimmune disorders Blood vessel problems Diet Genes

Preeclampsia occurs in a small percentage of pregnancies. Risk factors include:

y y y y y

First pregnancy Multiple pregnancy (twins or more) Obesity Older than age 35 Past history of diabetes, high blood pressure, or kidney disease

Symptoms

Often, women who are diagnosed with preeclampsia do not feel sick. Symptoms of preeclampsia can include:
y y

Swelling of the hands and face/eyes (edema) Weight gain o More than 2 pounds per week o Sudden weight gain over 1 - 2 days

Note: Some swelling of the feet and ankles is considered normal with pregnancy. Symptoms of more severe preeclampsia:
y y

Headaches that are dull or throbbing and will not go away Abdominal pain, mostly felt on the right side, underneath the ribs. Pain may also be felt in the right shoulder, and can be confused with heartburn, gallbladder pain, a stomach virus, or the baby kicking Agitation

y y y

Decreased urine output, not urinating very often Nausea and vomiting (worrisome sign) Vision changes -- temporary loss of vision, sensations of flashing lights, auras, light sensitivity, spots, and blurry vision

Prevention

Although there is no known way to prevent preeclampsia, it is important for all pregnant women to start prenatal care early and continue it through the pregnancy. This allows the health care provider to find and treat conditions such as preeclampsia early. Proper prenatal care is essential. At each pregnancy checkup, yor health care provider will check your weight, blood pressure, and urine (through a urine dipstick test) to screen you for preeclampsia. As with any pregnancy, a good prenatal diet full of vitamins, antioxidants, minerals, and the basic food groups is important. Cutting back on processed foods, refined sugars, and cutting out caffeine, alcohol, and any medication not prescribed by a doctor is essential. Talk to your health care provider before taking any supplements, including herbal preparations.

Magnesium Sulfate Magnesium sulfate is most commonly used for the treatment of preeclampsia during pregnancy. Use of magnesium for the treatment of preterm labor or preeclampsia is an unlabeled use of the medicine. Magnesium sulfate is sometimes used as a tocolytic medicine to slow uterine contractions during preterm labor. But studies show it does not stop preterm labor and it may cause complications for both mother and baby.1 Magnesium sulfate is usually given through a vein (intravenously) until contractions have slowed and the mother's cervix has stopped thinning (effacing) or opening (dilating). How It Works This medicine is thought to affect the action of calcium in the body, and calcium must be present for the muscles of the uterus to contract. Why It Is Used Magnesium sulfate may be used to stop preterm labor when:
y

y y y y y

Labor needs to be delayed for 24 to 48 hours to: o Let corticosteroids given to the mother help fetal lungs mature. o Provide time to move a mother to a hospital that offers neonatal intensive care, if her local hospital does not. Regular contractions of the uterus have thinned (effaced) the cervix and opened (dilated) it less than 4 cm, and the mother's amniotic sac has not broken. The mother is healthy. The fetus is alive and not in distress. Another tocolytic medicine has not slowed uterine contractions. Treatment with other tocolytic medicines has been stopped because of side effects.

If preterm labor is likely to lead to preterm delivery, magnesium sulfate may be used to reduce the risk of cerebral palsy in the premature newborn.2More research is needed to find out how well this works.3 Side Effects Common side effects of this medicine include:
y y y y y y

Muscle weakness and lack of energy. Blurry vision. Slurred speech. Headache. Nausea and vomiting. Flushing.

Stuffy nose.

What To Think About In rare cases, symptoms of magnesium toxicity (nausea, muscle weakness, loss of reflexes) occur during magnesium sulfate treatment. The medicine calcium gluconate is given to treat the problem. Magnesium sulfate:
y

Affects the central nervous system (brain and spinal cord) of the mother. Part of normal care when intravenous magnesium sulfate is given includes checking the mother's reflexes. If too much magnesium sulfate is given, the mother's reflexes will be slowed. Reflexes are usually checked about every 2 to 4 hours while the mother is on this medicine. Affects the fetus's central nervous system. If this medicine has been given to the mother in large doses and the baby is born before the drug has had time to clear the mother's body, the baby may have temporary problems with breathing right after birth. These problems are quickly reversed with medicine. Leaves the mother's body in her urine. The amount of urine she produces is closely monitored to ensure that this medicine does not build up in her bloodstream.

Mothers on magnesium sulfate are closely monitored. Blood pressure and pulse are checked about every 30 minutes for at least the first few hours of treatment. METHERGINE (methylergonovine maleate) DESCRIPTION Methergine (methylergonovine maleate) is a semi-synthetic ergot alkaloid used for the prevention and control of postpartum hemorrhage. Methergine is available in sterile ampuls of 1 mL, containing 0.2 mg methylergonovine maleate for intramuscular or intravenous injection and in tablets for oral ingestion containing 0.2 mg methylergonovine maleate. CLINICAL PHARMACOLOGY Methergine (methylergonovine maleate) acts directly on the smooth muscle of the uterus and increases the tone, rate, and amplitude of rhythmic contractions. Thus, it induces a rapid and sustained tetanic uterotonic effect which shortens the third stage of labor and reduces blood loss. The onset of action after I.V. administration is immediate; after I.M. administration, 2-5 minutes, and after oral administration, 5-10 minutes. Pharmacokinetic studies following an I.V. injection have shown that methylergonovine is rapidly distributed from plasma to peripheral tissues within 2-3 minutes or less. The bioavailability after oral administration was reported to be about 60% with no accumulation after repeated doses. During delivery, with intramuscular injection, bioavailability increased to 78%. Ergot alkaloids are mostly eliminated by

hepatic metabolism and excretion, and the decrease in bioavailability following oral administration is probably a result of first-pass metabolism in the liver. Bioavailability studies conducted in fasting healthy female volunteers have shown that oral absorption of a 0.2 mg methylergonovine tablet was fairly rapid with a mean peak plasma concentration of 3243 1308 pg/mL observed at 1.12 0.82 hours. For a 0.2 mg intramuscular injection, a mean peak plasma concentration of 5918 1952 pg/mL was observed at 0.41 0.21 hours. The extent of absorption of the tablet, based upon methylergonovine plasma concentrations, was found to be equivalent to that of the I.M. solution given orally, and the extent of oral absorption of the I.M. solution was proportional to the dose following administration of 0.1, 0.2, and 0.4 mg. When given intramuscularly, the extent of absorption of Methergine solution was about 25% greater than the tablet. The volume of distribution (Vdss/F) of methylergonovine was calculated to be 56.1 17.0 liters, and the plasma clearance (CLp/F) was calculated to be 14.4 4.5 liters per hour. The plasma level decline was biphasic with a mean elimination half-life of 3.39 hours (range 1.5 to 12.7 hours). A delayed gastrointestinal absorption (Tmax about 3 hours) of Methergine tablet might be observed in postpartum women during continuous treatment with this oxytocic agent. INDICATIONS AND USAGE For routine management after delivery of the placenta; postpartum atony and hemorrhage; subinvolution. Under full obstetric supervision, it may be given in the second stage of labor following delivery of the anterior shoulder. CONTRAINDICATIONS Hypertension; toxemia; pregnancy; and hypersensitivity. WARNINGS This drug should not be administered I.V. routinely because of the possibility of inducing sudden hypertensive and cerebrovascular accidents. If I.V. administration is considered essential as a lifesaving measure, Methergine (methylergonovine maleate) should be given slowly over a period of no less than 60 seconds with careful monitoring of blood pressure. Intra-arterial or periarterial injection should be strictly avoided. PRECAUTIONS General Caution should be exercised in the presence of sepsis, obliterative vascular disease, hepatic or renal involvement. Also use with caution during the second stage of labor. The necessity for manual removal of a retained placenta should occur only rarely with proper technique and adequate allowance of time for its spontaneous separation.