Eclampsia

What is Eclampsia?

Eclampsia- is a serious condition related to high blood pressure caused by pregnancy.

It is also characterized by the presence of seizures. Unlike convulsions you may think of
as occurring with certain disorders, these seizures are not related to the presence of a
brain condition.

 Eclampsia- (Greek, "shining forth"), an acute and life-threatening complication of

pregnancy, is characterized by the appearance of tonic-clonic seizures, usually in
a patient who had developed
Preeclampsia, excludes coma that happen during pregnancy but are due to
preexisting or organic brain disorders.

 Eclampsia, like other serious medical conditions, can cause death if not properly
treated. While the risk of death from complications of eclampsia is relatively high
in the developing world –- ranging from about 14 to 22% -- the risk is much lower
in developed nations. Overall, about 70% of women with true eclampsia will
suffer some type of complication.

 Maternal complications are, unfortunately, relatively common in cases of

eclampsia, though the medical literature varies widely on exact numbers. Because
all of the major review studies examining the complication risks in eclampsia
have considered patients from around the world, the numbers may be artificially
high with respect to those living in developed nations such as the United States,
Canada, and the UK.

Causes
 The cause of the seizures is not clear, although several processes have been
implicated in their development.
 Areas of cerebral vasospasm may be severe enough to cause focal ischemia,
which may in turn lead to seizures.
 Pathologic alterations in cerebral blood flow and tissue edema induced by
vasospasm may result in headaches, visual disturbances, and hypertensive
encephalopathy, resulting in a seizure.
The eclamptic seizure
Four stages of an eclamptic event:
1. The stage of invasion- facial twitching can be observed around the mouth.

2. The stage of contraction- tonic contractions render the body rigid; this stage may last
about 15 to 20 seconds.

3. The stage of convulsion- when involuntary and forceful muscular movements occur,
the tongue may be bitten, foam appears at the mouth. The patient stops breathing and
becomes cyanotic; this stage lasts about one minute.
4. The stage is a more or less prolonged coma- when the patient awakens, she is unlikely
to remember the event. In some rare cases there are no convulsions and the patient falls
directly into a coma. Some patients when they awake from the coma may have temporary
blindness.
 During a seizure, the fetus may experience bradycardia.

How does this affect mom and baby?

 Can kill or harm the baby because of the placenta receiving too little blood flow
and oxygen.
 Can cause low birth weight.
 Ideally, you can induce labor if late enough in the pregnancy.
 Otherwise, bed rest and constant observation.

Mortality/Morbidity
Eclampsia accounts for approximately 50,000 maternal deaths worldwide annually. In
developed countries, the maternal death rate has been reported as 0-1.8%. A CDC study
found an overall preeclampsia-eclampsia case-fatality rate of 6.4 per 10,000 cases at
delivery with a rate twice as high for black women compared with white women.
 increased risk of death among women older than 30 years and those with no
prenatal care. The highest risk for maternal death was found in pregnancies at 28
weeks’ gestation or less.
 Causes of neonatal death include prematurity, placental infarcts, intrauterine
growth retardation, abruptio placentae, and fetal hypoxia

Pathophysiology
Many investigators have proposed factors relating to genetics, immunology,
endocrinology, nutrition, and infection as possible etiologies leading to the
development of preeclampsia/eclampsia. Despite extensive research, no definitive
cause for preeclampsia has been identified .The pathogenesis of eclamptic seizures
may include mechanisms of cerebral vasoconstriction, hypertensive encephalopathy,
cerebral edema, hemorrhage, and infarction. Whether these findings are causes or
results of seizure activity is unclear.
Signs & Symptoms
Signs
 Right upper quadrant pain or epigastric pain
 Proteinuria
 Eclamptic convulsion.
 Nausea
 Vomiting
 Headaches
 Cortical blindness

Symptoms
 Abdominal pain
 Liver failure
 Signs of HELLP Syndrome
 Pulmonary edema
 Oliguria

Antihypertensive management
 Antihypertensive management at this stage in pregnancy may consist of
hydralazine (5–10 mg IV every 15-20 min until desired response is achieved) or
labetalol (20 mg bolus iv followed by 40 mg if necessary in 10 minutes; then
80 mg every 10 up to maximum of 220 mg).

Magnesium Sulfate Injections

 Pre-eclampsia can lead to eclampsia (uncontrolled convulsions & dangerous).
 The control of convulsions is the most important aspect in the management of
eclampsia, and MgSO4 is a very effective anticonvulsant.
 This drug works by inhibiting Ach release at the neuromuscular junction, thereby
reducing striated muscular contraction.
Prevention of Convulsions
Prevention of convulsion is usually done using magnesium sulfate (4-6 g loading dose
in 100 ml iv fluid given over 15–20 minutes, then 2g per hour as a continuous
infusion) Evidence for the use of magnesium sulfate came from the international
MAGPIE study.

Invasive hemodynamic monitoring

Invasive hemodynamic monitoring may be useful in eclamptic patients with severe
cardiac disease, renal disease, refractory hypertension, pulmonary edema, and
oliguria.
Risk factors
 Patient have already pre-eclampsia
 First pregnancies and young mothers
 Women with preexisting vascular diseases (hypertension, diabetes, and
nephropathy)
 Conditions with a large placenta (multiple gestation, hydatidiform mole)
 Patients whose mother or sister had the condition are at higher risk

Treatment
Eclampsia is a treatable condition, and appropriate treatment is essential to avoid
dangerous complications for both mother and baby. Treating eclampsia follows a
well-defined set of guidelines.
 Preventing low oxygen levels (hypoxia) in the mother
 Controlling maternal blood pressure
 Preventing ongoing seizures
 Preparing to deliver the baby by the safest method possible

Prevention
Detection and management of preeclampsia is critical to reduce the risk of eclampsia.
Appropriate management of patients with preeclampsia generally involves the use of
magnesium sulfate as an agent to prevent convulsions, and thus preventing eclampsia.

References:
 Frayling, Frayling (2004). The Magpie Trial follow up study: outcome after
discharge from hospital for women and children recruited to a trial comparing
magnesium sulphate with placebo for pre-eclampsia
 Chesley LC. Hypertensive Disorders in Pregnancy, in Williams Obstetrics, 14th
Edition.
 Richards A, Graham D, Bullock R.. "Clinicopathological study of neurological
complications due to hypertensive disorders of pregnancy.