Overview

Eclampsia, considered as a complication of severe preeclampsia, is commonly defined as new onset of grand mal seizure activity and/or unexplained coma during pregnancy or postpartum in a woman with signs or symptoms of preeclampsia. It typically occurs during or after the 20th week of gestation or in the postpartum period.

Preeclampsia is a condition that occurs only during pregnancy, and usually only after the 20th week. A woman with preeclampsia develops high blood pressure and protein in her urine, and she often has swelling (edema) of the legs, hands, face, or entire body.

Title
Eclampsia

Types

- Antepartum eclampsia

- Intrapartum eclampsia 

Postpartum eclapmsia

Symptoms

Eclampsia should always be considered in a pregnant patient with a seizure episode. Ninety percent of eclampsia cases occur after 28 weeks' gestation. Preeclampsia can quickly develop into eclampsia. Features of eclampsia include seizure or postictal state (100%); headache (80%), usually frontal; generalized edema (50%); vision disturbance (40%), such as blurred vision and photophobia; right upper quadrant abdominal pain with nausea (20%); amnesia and other mental status changes.

Causes

The mechanism(s) responsible for the development eclampsia remain(s) unclear. Genetic predisposition, immunology, endocrinology, nutrition, abnormal trophoblastic invasion, coagulation abnormalities, vascular endothelial damage, cardiovascular maladaptation, dietary deficiencies or excess, and infection have been proposed as etiologic factors for preeclampsia/eclampsia.

Treatment

Eclamptic convulsions are life-threatening emergencies and require the proper treatment to decrease maternal morbidity and mortality. Delivery is the only definitive treatment for eclampsia. The patient should be advised and educated on the course of the disease and any residual problems. She should also be educated on the importance of adequate prenatal care in subsequent pregnancies. An experienced obstetrician or maternal-fetal medicine specialist should be consulted. Patients with eclampsia require immediate obstetric consultation and admission to a labor and delivery unit capable of providing intensive care until delivery of the neonate. In the event of premature delivery or fetal compromise, a pediatrician or neonatologist should be

Prevention

Preventing the development of preeclampsia in high-risk patients could theoretically decrease the risk of eclampsia and its complications later in pregnancy. Aspirin blocks platelet aggregation and vasospasm in preeclampsia, and it may be effective in preventing preeclampsia. Studies have shown that low-dose aspirin in women at high risk for preeclampsia can contribute to a decreased risk of preeclampsia, a reduction in preterm delivery rates, and a reduction in fetal death rates, without increasing the risk of placental abruption. An obstetrician should directly supervise low-dose aspirin therapy in high-risk patients.

If the patient has preexisting hypertension, she should have good control before conception and throughout her pregnancy. Her case should be followed for recognition and treatment of preeclampsia.

Complications

As many as 56% of patients with eclampsia may have transient deficits, including cortical blindness. However, there is no evidence of persisting neurologic deficits after uncomplicated eclamptic seizures during the follow-up period. Studies suggest that there is an increased risk for cerebrovascular accidents (CVAs) and coronary artery disease (CAD) in eclamptic mothers later in life. Other potential complications of eclampsia include permanent neurologic damage from recurrent seizures or intracranial bleeding, renal insufficiency and acute renal failure, oligohydramnios, increased risk of recurrent preeclampsia/eclampsia with subsequent pregnancy, and maternal or fetal death.

Risks

Risk factors for eclampsia include nulliparity, family history of preeclampsia, previous preeclampsia and eclampsia, poor outcome of previous pregnancy (including intrauterine growth retardation, abruptio placentae, or fetal death), multifetal gestations, teen pregnancy etc.

Preexisting medical conditions are also considered risk factors such obesity, chronic hypertension, renal disease, and gestational diabetes