Definition of "Eclampsia"
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It's where you get seizures. In pre-eclampsia, you don't yet have seizures. You just have high blood pressure in protein in your urine, at that point. So it's a step down from eclampsia.
So there's the seizure, it's usually a full scale shake, lasting for about 1 minute. And you can also get things which indicate that the seizure is about to happen, which we call preictal symptoms. And there can be things that sustain following the seizure, which we call postictal symptoms.
Low heart rate. And fetal distress, which means things like decreased fetal movement, mecnoium in the amniotic fluid, problems with the CTG, and pH issues with the baby's blood.
Not really. High blood pressure means that there's going to be reduced resistance, to blood pushing through the blood system. Therefore, there's going to be increased blood flow to the brain. This can cause fluid to be pushed out of the blood vessels, into the brain itself. This is what causes the seizures.
First baby. New mom. If you already have heart system, or blood disease. A big placenta, which can be because of twins/triplets. Having previously had pre-eclampsia or eclampsia. And a family history of someone having seizure in pregnancy, like a lot in medicine.
Blood tests, indicating platelets being used up due to blood clotting. Testing coagulation itself. And checking end organ damage, testing kidney, as well as liver function. You can also do an ultrasound to check for how well the placenta is working.
You can try bringing blood pressure down with medication. Magnesium sulfate can both used to treat, as well as prevent seizure. Aspirin can be given to thin the blood, in those with high risk.
The seizure itself can cause bleeding in the brain. The end organ damage however, can also damage the lungs, causing water in the lungs, or a lung infection due to aspiration. The kidneys, heart, or placenta can also be damaged.
Eclampsia (from Greek "eclampsia" meaning "lightning"
is the onset of seizures in a woman with pre-eclampsia (i.e. HTN+proteinuria, or other organ dysfunction). Onset may be before, during, or after delivery. Most often, it is during the 2nd half of the pregnancy.
Patient information
What is eclampsia, and how's it different from pre-eclampsia?It's where you get seizures. In pre-eclampsia, you don't yet have seizures. You just have high blood pressure in protein in your urine, at that point. So it's a step down from eclampsia.
Sx
- Preictal Sx, including:
- Nausea
- Vomiting
- Headaches
- Cortical blindness
- Tonic-clonic seizure, typically for about 1 min
- Postictal Sx, including:
- Confusion
- Coma
- Amaurosis fugax (dark and fleeting unilateral temporary blindness)
- Multi-organ failure eventually, causing:
- Abdominal pain
- Jaundice
- SOB
- Diminished urine output
Patient information
What happens in eclampsia?So there's the seizure, it's usually a full scale shake, lasting for about 1 minute. And you can also get things which indicate that the seizure is about to happen, which we call preictal symptoms. And there can be things that sustain following the seizure, which we call postictal symptoms.
Anything else apart from the seizure?
Yep. Remember that pre-eclampsia also involved end organ problems starting. So eventually, you'll get end organ failure.
Whilst the mother has convulsions, the baby may experience:
- Bradycardia
- Fetal distress
Patient information
Anything happen with bub?Low heart rate. And fetal distress, which means things like decreased fetal movement, mecnoium in the amniotic fluid, problems with the CTG, and pH issues with the baby's blood.
Pathophysiology
- Pre-eclampsia results in prolonged HTN
- Eclampsia is a form of hypertensive encephalopathy. Cerebral vascular resistance is reduced, leading to increase blood flow to the brain, causing cerebral edema, and resulting in convulsions
- Eclamptic convulsions usually does not cause chronic brain damage unless ICH occurs
Patient information
Why does seizure happen in pregnancy, particularly due to high blood pressure? It seems a strange link?Not really. High blood pressure means that there's going to be reduced resistance, to blood pushing through the blood system. Therefore, there's going to be increased blood flow to the brain. This can cause fluid to be pushed out of the blood vessels, into the brain itself. This is what causes the seizures.
Risk factors
- Primi's → novel exposure to paternal antigens
- Young mothers → novel exposure to paternal antigens
- Pre-existing vascular disease:
- HTN
- Diabetes
- Nephropathy
- Pre-existing thrombophilic diseases:
- Antiphospholipid syndrome
- Large placenta:
- Multiple gestation
- Molar pregnancy/hydatidiform mole
- Genetic component, w/ a woman's mother/sister having the condition at highest risk than otherwise
- PMH of preeclampsia/eclampsia
Patient information
What makes it more likely that you have seizures in pregnancy?First baby. New mom. If you already have heart system, or blood disease. A big placenta, which can be because of twins/triplets. Having previously had pre-eclampsia or eclampsia. And a family history of someone having seizure in pregnancy, like a lot in medicine.
DDx
- Convulsions unrelated to pre-eclampsia, including: → usually won't be preceded by signs of severe pre-eclampsia
- Seizure disorder
- Brain tumor
- Brain aneurysms
- Drug-related seizures
Ix
- FBC, showing depleted platelets, due to blood clotting → thrombocytopenia
- Renal function test → kidney damage
- 24 hour urine creatinine and protein → kidney damage. Note that 20% of Pt's Dx w/ eclampsia, show no evidence of proteinuria
- Liver function test → liver damage
- Coagulation screen → thrombocytopenia
- Fetal/placenta U/S → check placental function
Patient information
How can you look deeper into seizures during pregnancy?Blood tests, indicating platelets being used up due to blood clotting. Testing coagulation itself. And checking end organ damage, testing kidney, as well as liver function. You can also do an ultrasound to check for how well the placenta is working.
Tx
- Prevention:
- Tx of prior HTN with antihypertensives, including hydralazine and/or labetalol, due to their effectiveness, and lack of negative effects on fetus
- Mx of pre-eclampsia, w/ magnesium sulfate to reduce risk of eclampsia
- Aspirin, in those at high risk
- Calcium supplementation, in areas with low intake
- Exercise during pregnancy may also be useful
- ABC's, including intubation, mechanical ventilation
- IV or IM magnesium sulfate, can be used to Tx convulsions. Following IV administration the onset of anticonvulsant action is fast and lasts about 30 minutes. Following IM administration the onset is about 1 hour and lasts for 3-4 hours. Even w/ therapeutic serum magnesium concentrations, and additional magnesium may be required, but w/ close monitoring for respiratory, cardiac, and neurological depression
- Addition of other IV anticonvulsants can be used, although MgSO4 has better outcomes. Other anticonvulsants include diazepam, phenytoin, or a combination of chlorpromazine, promethazine, pethidine
- Emergency delivery of baby either vaginally or by C-section. This needs to occur even if the fetus is premature, because the eclamptic condition is unsafe for both the baby and mother
- Monitor closely for the onset of multi-organ failure, including liver, kidneys, lungs, cardiovascular system, and coagulation system. Regional anesthesia for C section is contraindicated when coagulopathy has developed
Patient information
Anything you can do to prevent seizure in pregnancy?You can try bringing blood pressure down with medication. Magnesium sulfate can both used to treat, as well as prevent seizure. Aspirin can be given to thin the blood, in those with high risk.
OK, if it's already happening, what do you do?
Resuscitation, what we call ABC's, is the most important thing. Ensure the patient has a clear airway, and can breathe. Magnesium sulfate should be immediately given. Other anticonvulsants can also be given, but magnesium sulfate is preferred. We also need to very carefully monitor end organ damage, to essentially every system in th ebody... the liver, kidneys, lungs, heart system, and blood system.
How about bub? What do we do for them?
Deliver. They need to pop out, because Houston... we have a problem . So this is either emergency delivery by vaginally, or if this is not possible, by C section.
Complications
- Maternal:
- Pulmonary edema (common complication, affecting 3%) → too much intravenous fluid
- Aspiration pneumonia
- Cerebral hemorrhage
- Kidney failure
- Cardiac arrest
- Placental bleeding
- Placental abruption
- Fetal:
- IUGR
Patient information
What bad things can happen due to seizure in pregnancy?The seizure itself can cause bleeding in the brain. The end organ damage however, can also damage the lungs, causing water in the lungs, or a lung infection due to aspiration. The kidneys, heart, or placenta can also be damaged.
How about bub?
Remember that they're protected by the amniotic sac, which cushions them. But they do need to come out immediately. Therefore, they might be small, particularly due to medical problems, which we call IUGR.
Epidemiology
- Whilst pre-eclampsia affects about 5% of deliveries, eclampsia affects 1.4% of deliveries
- Around 1% of women with eclampsia die
See also
- Pre-eclampsia (-seizure)
- Gestational HTN (-seizure, -proteinuria)
- Maternal HTN (category)
Synonyms:
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