Eclampsia

 What is eclampsia?

Eclampsia is a severe complication of preeclampsia. It’s a rare but serious condition where high blood pressure results in seizures during pregnancy.

Seizures are periods of disturbed brain activity that can cause episodes of staring, decreased alertness, and convulsions (violent shaking). Eclampsia affects about 1 in every 200 women with preeclampsia. You can develop eclampsia even if you don’t have a history of seizures.

What are the symptoms of eclampsia?

Because preeclampsia can lead to eclampsia, you may have symptoms of both conditions. However, some of your symptoms may be due to other conditions, such as kidney disease or diabetes. It’s important to tell your doctor about any conditions you have so they may rule out other possible causes.

The following are common symptoms of preeclampsia:

• elevated blood pressure
• swelling in your face or hands
• headaches
• excessive weight gain
• nausea and vomiting
• vision problems, including episodes with loss of vision or blurry vision
• difficulty urinating
• abdominal pain, especially in the right upper abdomen

Patients with eclampsia can have the same symptoms as those noted above, or may even present with no symptoms prior to the onset of eclampsia. The following are common symptoms of eclampsia:

• seizures
• loss of consciousness
• agitation

What causes eclampsia?

Eclampsia often follows preeclampsia, which is characterized by high blood pressure occurring in pregnancy and, rarely, postpartum. Other findings may also be present such as protein in the urine. If your preeclampsia worsens and affects your brain, causing seizures, you have developed eclampsia.

Doctors don’t know for sure what causes preeclampsia, but it’s thought to result from abnormal formation and function of the placenta. They can explain how the symptoms of preeclampsia may lead to eclampsia.

High blood pressure

Preeclampsia is when your blood pressure, or the force of blood against the walls of your arteries, becomes high enough to damage your arteries and other blood vessels. Damage to your arteries may restrict blood flow. It can produce swelling in the blood vessels in your brain and to your growing baby. If this abnormal blood flow through vessels interferes with your brain’s ability to function, seizures may occur.

Proteinuria

Preeclampsia commonly affects kidney function. Protein in your urine, also known as proteinuria, is a common sign of the condition. Each time you have a doctor’s appointment, your urine may be tested for protein.

Typically, your kidneys filter waste from your blood and create urine from these wastes. However, the kidneys try to retain nutrients in the blood, such as protein, for redistribution to your body. If the kidneys’ filters, called glomeruli, are damaged, protein can leak through them and excrete into your urine.

Who is at risk for eclampsia?

If you have or have had preeclampsia, you may be at risk for eclampsia.

Other risk factors for developing eclampsia during pregnancy include:

• gestational or chronic hypertension (high blood pressure)
• being older than 35 years or younger than 20 years
• pregnancy with twins or triplets
• first-time pregnancy
• diabetes or another condition that affects your blood vessels
• kidney disease

Eclampsia and your baby

Preeclampsia and eclampsia affect the placenta, which is the organ that delivers oxygen and nutrients from the mother’s blood to the fetus. When high blood pressure reduces blood flow through the vessels, the placenta may be unable to function properly. This may result in your baby being born with a low birth weight or other health problems.

Problems with the placenta often require preterm delivery for the health and safety of the baby. In rare cases, these conditions cause stillbirth.

How is eclampsia diagnosed?

If you already have a preeclampsia diagnosis or have a history of it, your doctor will order tests to determine if your preeclampsia has happened again or gotten worse. If you don’t have preeclampsia, your doctor will order tests for preeclampsia as well as others to determine why you’re having seizures. These tests can include:

Blood tests

Your doctor may order several types of blood tests to assess your condition. These tests include a complete blood count, which measures how many red blood cells you have in your blood, and a platelet count to see how well your blood is clotting. Blood tests will also help examine your kidney and liver function.

Creatinine test

Creatinine is a waste product created by the muscles. Your kidneys should filter most of the creatinine from your blood, but if the glomeruli get damaged, excess creatinine will remain in the blood. Having too much creatinine in your blood may indicate preeclampsia, but it doesn’t always.

Urine tests

Your doctor may order urine tests to check for the presence of protein and its excretion rate.

What are the treatments for eclampsia?

Delivering your baby and placenta are the recommended treatment for preeclampsia and eclampsia. Your doctor will consider the severity of the disease and how mature your baby is when recommending timing of delivery.

If your doctor diagnoses you with mild preeclampsia, they may monitor your condition and treat you with medication to prevent it from turning into eclampsia. Medications and monitoring will help keep your blood pressure within a safer range until the baby is mature enough to deliver.

If you do develop severe preeclampsia or eclampsia, your doctor may deliver your baby early. Your care plan will depend on how far along you are in your pregnancy and the severity of your disease. You will need to be hospitalized for monitoring until you deliver your baby.

Medications

Medications to prevent seizures, called anticonvulsants drugs, may be necessary. You may need medication to lower blood pressure if you have high blood pressure. You may also receive steroids, which can help your baby’s lungs mature prior to delivery.

What is the long-term outlook?

Your symptoms should resolve within days to weeks after you have your baby. That said, you will still have a greater chance of blood pressure issues in your next pregnancy and possibly later in lifeTrusted Source. It’s important to follow up for postpartum blood pressure checks and exams after delivering your baby to ensure the disease is resolving.

If complications occur during the pregnancy, you may have a medical emergency such as placental abruption. Placental abruption is a condition that causes the placenta to detach from the uterus. This requires immediate emergency cesarean delivery to save the baby.

The baby may be very ill or may even die. Complications to the mother can be quite severe, including risk of deathTrusted Source from stroke or cardiac arrest.

However, getting the proper medical care for preeclampsia may prevent progression of the disease into a more severe form such as eclampsia. Go to your prenatal visits as recommended by your doctor to have your blood pressure, blood, and urine monitored. Make sure to talk to your doctor about any symptoms you have, as well.

What are the possible complications?

You’re more likely to have complications if you develop preeclampsia early in pregnancy. In some cases, doctors must perform induced labor or a caesarean delivery to remove the baby. This will stop preeclampsia from progressing and should lead to resolution of the condition.

If left untreated, complications may develop. Some complications of preeclampsia include:

• a lack of oxygen to the placenta which can cause slow growth, low birth weight, or preterm birth of the baby or even stillbirth
• placental abruption, or the separation of the placenta from the uterus wall, which can cause severe bleeding and damage to the placenta
• HELLP syndrome, which causes loss of red blood cells, elevated liver enzymes, and low blood platelet count, resulting in organ damage
• eclampsia, which is preeclampsia with seizures
• stroke, which can lead to permanent brain damage or even death

Women who develop preeclampsia face an increased risk for heart and blood vessel disease. Their risk of preeclampsia in future pregnancies also increases. Women who’ve had preeclampsia have a 16 percentTrusted Source chance of developing it again in a future pregnancy.

How does magnesium sulfate therapy treat preeclampsia?

The only treatment to stop progression and lead to resolution of preeclampsia is delivery of the baby and placenta. Waiting to deliver can increase risk of complications but delivering too early in the pregnancy increases the risk for preterm birth.

If it’s too early in your pregnancy, you may be told to wait until the baby is mature enough to be born to minimize those risks.

Depending on the severity of the disease and gestational age, doctors may recommend women with preeclampsia come in more often for outpatient prenatal visits, or possibly be admitted to the hospital. They’ll likely perform more frequent blood and urine tests. They may also prescribe:

• medications to lower blood pressure
• corticosteroids to help mature the baby’s lungs and improve the mother’s health

In severe cases of preeclampsia, doctors often recommend antiseizure medications, such as magnesium sulfate. Magnesium sulfate is a mineral that reduces seizure risks in women with preeclampsia. A healthcare provider will give the medication intravenously.

Sometimes, it’s also used to prolong pregnancy for up to two days. This allows time for corticosteroid drugs to improve the baby’s lung function.

Magnesium sulfate usually takes effect immediately. It’s normally given until about 24 hours after delivery of the baby. Women receiving magnesium sulfate are hospitalized for close monitoring of the treatment.

Are there any side effects?

Magnesium sulfate can be beneficial to some with preeclampsia. But there’s a risk of magnesium overdose, called magnesium toxicity. Taking too much magnesium can be life-threatening to both mother and child. In women, the most common symptoms include:

• nausea, diarrhea, or vomiting
• large drops in blood pressure
• slow or irregular heart rate
• breathing problems
• deficiencies in minerals other than magnesium, especially calcium
• confusion or fogginess
• coma
• heart attack
• kidney damage

In a baby, magnesium toxicity can cause low muscle tone. This is caused by poor muscle control and low bone density. These conditions can put a baby at greater risk for injuries, such as bone fractures, and even death.

Doctors treat magnesium toxicity with:

• giving an antidote
• fluids
• breathing support
• dialysis

To prevent magnesium toxicity from happening in the first place, your doctor should closely monitor your intake. They may also ask how you’re feeling, monitor your breathing, and check your reflexes often.

The risk of toxicity from magnesium sulfate is low if you’re dosed appropriately and have normal kidney function.

What is the outlook?

If you have preeclampsia, your doctor may continue to give you magnesium sulfate throughout your delivery. Your blood pressure should return to a normal level within days to weeks of delivery. Because the condition may not resolve immediately, close follow up after delivery and for some time after is important.

The best way to prevent complications from preeclampsia is an early diagnosis. When you go to your prenatal care visits, always tell your doctor about any new symptoms.