Eclampsia

Evidence

https://www.ncbi.nlm.nih.gov/books/NBK554392/

Mackenzie Magley; Melissa R. Hinson.

Eclampsia is a known complication of pre-eclampsia during pregnancy. Pre-eclampsia and eclampsia are of the four categories associated with hypertensive disorders of pregnancy. The other three categories include chronic hypertension, gestational hypertension, and preeclampsia superimposed on chronic hypertension.

Pre-eclampsia, the precursor to eclampsia, has had an evolving definition over recent years. The definition for pre-eclampsia initially included proteinuria as a diagnostic requirement, but this is no longer the case as some patients had advanced disease before proteinuria detection. Pre-eclampsia is defined as a new-onset of hypertension with systolic blood pressure greater than or equal to 140 mmHg and/or diastolic blood pressure greater than or equal to 90 mmHg after 20 weeks of gestation with proteinuria and/or end-organ dysfunction (renal dysfunction, liver dysfunction, central nervous system disturbances, pulmonary oedema, and thrombocytopenia). Eclampsia is defined as the new onset of generalized tonic-clonic seizures in a woman with preeclampsia. Eclamptic seizures can occur antepartum, 20 weeks after gestation, intrapartum, and postpartum. Seizures before 20 weeks are rare but have been documented in gestational trophoblastic disease.

Education

What is Eclampsia?

Eclampsia is serious complication of pre-eclampsia. Pre-eclampsia is a disorder of pregnancy in which a person who’s pregnant has high blood pressure and protein in their urine, generally after 20 weeks of the pregnancy. Thankfully, very few women with pre-eclampsia go on to have eclampsia.

Eclampsia is when a person with pre-eclampsia develops seizures (convulsions) during pregnancy and is a medical emergency. Seizures are episodes of shaking, confusion and disorientation caused by abnormal brain activity. Eclampsia can cause complications during pregnancy and requires emergency medical care.

What is the difference between preeclampsia and eclampsia?

Eclampsia is a severe form of pre-eclampsia that causes seizures. It’s considered a complication of pre-eclampsia, but it can happen without prior signs of pre-eclampsia. These seizures can cause confusion and disorientation. In most cases, pre-eclampsia is managed before it progresses to eclampsia.

Who is at risk for eclampsia?

If you have or have had pre-eclampsia, 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

What are the warning signs of eclampsia?

Many people will have warning signs before having a seizure caused by eclampsia. Some of these signs are:

• Severe headaches.
• Difficulty breathing.
• Nausea or vomiting.
• Trouble urinating or not urinating often.
• Abdominal pain (especially on the upper right side).
• Blurred vision, seeing double or loss of vision.
• Swelling of the hands, face or ankles.

What are the symptoms of eclampsia?

The most common symptoms of eclampsia are:

•  
• Severe distress or confusion.
• Losing consciousness.

What causes eclampsia?

Eclampsia typically develops from pre-eclampsia. High blood pressure (from pre-eclampsia) puts pressure on your blood vessels. There can be swelling in your brain, which may lead to seizures.

How is eclampsia treated?

The initial management involves getting help from a resuscitation team and simple measures such as protecting the airway, making sure breathing is ok and putting drips in. Often the eclamptic seizure will stop on its own but medications will always be given through a drip. The medication is called Magnesium sulphate and it can sometimes make you feel a little flushed. The Magnesium drip will usually stay up until around 24 hours after birth of your baby.

If the blood pressure is high, medications will be given to control it.

Steroid injections to help mature the baby’s lungs to prepare for being born. These are only needed at certain gestations as they are helpful just for premature babies.

A catheter (a small tube) will be placed in your bladder so that the urine can be measured carefully and also means you do not have to get up and go to the toilet. You will feel like there are lots of wires and tubes. You will be monitored extremely closely.

Once you are stable, the baby’s wellbeing would be checked, usually with monitoring of the heart rate.

The best treatment for eclampsia is giving birth. You may still have a vaginal delivery if you and the baby are stable and there are no other concerns. Eclampsia can still happen after birth; the management remains the same.

Sometimes a CT or MRI of the brain is arranged to make sure there are no other reasons for a seizure.

Empowerment

Eclampsia is a rare and frightening emergency to happen to anyone in pregnancy. All hospitals caring for pregnant women are trained in the management of this situation. Sometimes transfer to a larger hospital with different facilities for the birth of more premature babies is needed. This may happen whilst you are still pregnant or sometimes your baby is transferred after birth by a specialised retrieval team. Everything is done to try to keep you and your baby safe and to have you together as soon as possible.

Most woman recover from eclampsia well after their delivery. There are some things you can do to help your recovery:

• Eat a healthy diet.
• Stay active.
• Get plenty of rest.
• Attend any medical follow up appointments.
• Try to keep your stress levels low.
• Take your medications as directed.

Feeling fully informed and knowing what to expect may make you feel prepared. This can be difficult with Eclampsia as it can be unexpected and sudden. Asking for a debrief either whilst you are still in hospital or a few weeks or months after can help with understanding and processing what has happened. Partners are often forgotten in this scenario and so recognising that they may benefit from this debrief too is important. Connecting with others who experienced what you are going through can be of great comfort and sharing stories may be of support.

In a future pregnancy, you would be managed as a high-risk pregnancy with close surveillance. It is likely you would be offered a daily low dose aspirin to try to reduce the risk of pre-eclampsia or eclampsia. It is important to let any future pregnancy care providers know if you have experienced either pre-eclampsia or eclampsia in other pregnancies.

Useful Links

The Australian Action on Pre-eclampsia Inc

 www.aapec.org.au

Pre-eclampsia Foundation

https://www.preeclampsia.org/postpartum-preeclampsia

COPE – Centre for Perinatal Excellence

https://www.cope.org.au/getting-help/e-cope-directory/

Panda - Perinatal Mental Health

https://panda.org.au/