Eclampsia: Causes, Symptoms & Treatment
Eclampsia is a life-threatening complication of pregnancy characterized by seizures. It usually develops from pre-eclampsia and requires immediate medical treatment.
Things worth knowing about "Eclampsia"
Eclampsia is a life-threatening complication of pregnancy characterized by seizures. It usually develops from pre-eclampsia and requires immediate medical treatment.
What is Eclampsia?
Eclampsia is a severe condition that can occur during pregnancy, labor, or shortly after delivery. It is characterized by sudden seizures that are not attributable to a pre-existing neurological condition. Eclampsia is considered the most severe form of pre-eclampsia – a pregnancy disorder associated with high blood pressure and elevated protein levels in the urine. It is a medical emergency and can be life-threatening for both mother and child.
Causes and Risk Factors
The exact cause of eclampsia is not yet fully understood. The primary trigger is thought to be abnormal development of the placenta in early pregnancy, leading to reduced blood supply to the placenta. This sets off a cascade of reactions in the mother's body, including high blood pressure, vascular damage, and neurological disturbances.
Risk factors for developing eclampsia include:
- Pre-existing pre-eclampsia
- First pregnancy (first-time mothers have a higher risk)
- Multiple pregnancy (twins, triplets)
- Pre-existing conditions such as high blood pressure, diabetes, or kidney disease
- Family history of pre-eclampsia or eclampsia
- Obesity
- Age under 18 or over 35 years
- History of pre-eclampsia in a previous pregnancy
Symptoms
Eclampsia is often preceded by signs of severe pre-eclampsia. Typical warning signs include:
- Severe headaches that do not respond to painkillers
- Visual disturbances (flickering, flashing lights, blurred vision)
- Upper abdominal pain (especially under the right rib margin)
- Sudden weight gain and severe swelling (fluid retention)
- High blood pressure (above 140/90 mmHg)
- Elevated protein in the urine (proteinuria)
The eclamptic seizure itself typically progresses through several phases:
- Prodromal phase: Twitching around the mouth and hands, reduced consciousness
- Tonic phase: Stiffening of the body (approximately 30 seconds)
- Clonic phase: Rhythmic jerking of all body muscles (approximately 1–2 minutes)
- Recovery phase: Coma or loss of consciousness following the seizure
Diagnosis
Eclampsia is diagnosed clinically, based on observed seizures in combination with the typical signs of pre-eclampsia. The following investigations support the diagnosis:
- Blood pressure measurement: Values of 140/90 mmHg or higher
- Urine test: Detection of elevated protein in the urine
- Blood tests: Assessment of liver and kidney function, blood count, and coagulation parameters
- CTG (cardiotocography): Monitoring of the baby's heartbeat
- Ultrasound: Assessment of the placenta and fetal growth
- Brain imaging (MRI/CT): To exclude other causes of seizures
Treatment
Eclampsia is a medical emergency and must be treated in hospital immediately. The primary goal is to stabilize the mother and prevent further seizures.
Medical Treatment
- Magnesium sulfate: The treatment of choice for seizure prevention and management. It is administered intravenously and protects the mother's brain from further seizures.
- Antihypertensive medications: Drugs to lower blood pressure (e.g., labetalol, nifedipine, hydralazine) to prevent severe complications such as stroke.
- Corticosteroids: Given in cases of preterm birth risk to support the development of the baby's lungs.
Delivery
The only definitive treatment for eclampsia is delivery of the baby. The timing and method of delivery (vaginal or cesarean section) depend on the gestational age and the condition of both mother and baby. After the 34th week of pregnancy, immediate delivery is generally recommended.
Intensive Monitoring
Both mother and baby require close monitoring after delivery. Complications such as HELLP syndrome (a particularly severe form involving liver damage and low platelet count), kidney failure, or brain hemorrhage must be identified and treated promptly.
Prognosis and Long-Term Effects
With timely treatment, most women make a full recovery from eclampsia. In the long term, women who have experienced eclampsia have an increased risk of high blood pressure, heart disease, and stroke later in life. In future pregnancies, there is an increased risk of recurrence of pre-eclampsia. Early preventive measures, including low-dose aspirin from the first trimester, can help reduce this risk.
References
- World Health Organization (WHO): WHO Recommendations for Prevention and Treatment of Pre-eclampsia and Eclampsia. Geneva, 2011. Available at: https://www.who.int
- Magee LA, Nicolaides KH, von Dadelszen P: Preeclampsia. New England Journal of Medicine, 2022;386(19):1817–1832.
- American College of Obstetricians and Gynecologists (ACOG): Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin No. 222. Obstetrics & Gynecology, 2020;135(6):e237–e260.
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