VERIFIED CONTENTAuthor: lek. Katarzyna Banaszczyk
Eclampsia and pre-eclampsia are groups of symptoms that may appear during pregnancy. These are serious disorders that require hospitalization and appropriate treatment. What is eclampsia and what is pre-eclampsia? What is the treatment of eclampsia and what can its consequences be for mother and baby?
Eclampsiais a consequence ofpre-eclampsiaoccurring in pregnant women. Eclampsia is the most severe form of pregnancy poisoning. The causes of pre-eclampsia are still not fully understood, but it is believed that these phenomena are due to abnormalities in the vascular endothelium and generalized vasoconstriction.
Pre-eclampsia - what is it?
Preeclampsia is a symptom complex also known as pre-eclampsia that occurs in women after their 20th week of pregnancy. In order to diagnose pre-eclampsia, we need to identify the presence of arterial hypertension, i.e. its elevated values (above 140/90 mm Hg, which is important - the measurement should be performed twice). Moreover, for recognition it is also necessary to state one of the following criteria:
- presence of significant proteinuria - this is the presence of protein in the urine in the amount over 300 mg per day,
- headache,
- visual disturbance,
- decrease in the number of platelets in the blood below 100,000 - which will be visible in the peripheral blood count,
- epigastric pain,
- confirmation of pulmonary edema,
- increase in the level of liver enzymes in the blood - we are talking about markers such as Alat and Aspat, it is necessary to find the values 2 times the norm,
- increase in creatinine concentration (which indicates abnormal kidney function).
Pre-eclampsia can progress to eclampsia, a more serious condition that threatens the lives of the baby and mother. However, it should be realized that up to 40% of patients with eclampsia had no previous history of pre-eclampsia.
Eclampsia - what is this phenomenon?
Eclampsia is the occurrence of convulsions associated with loss of consciousness in a pregnant woman. Eclampsia is the most important and common cause of death in pregnant womenThe cause of deaths for fetuses and newborns.
Such an attack of eclampsia in many cases is preceded by a sudden increase in blood pressure, however, it should be borne in mind that this condition is associated with severe hypertension in pregnancy only in about half of the cases. Eclampsia is more common in pregnant women under the age of 18 and over 35.
Eclampsia - clinical symptoms that indicate a risk of eclampsia
It is worth mentioning here the symptoms that may indicate the possibility of eclampsia. They mainly include:
- headache,
- dizziness,
- disturbance of consciousness,
- epigastric pains,
- visual disturbances such as double vision, spots in front of the eyes,
- anxiety,
- arousal,
- sudden, significant increase in blood pressure.
During fetal monitoring, episodes of bradycardia (during a pregnant woman's convulsions), i.e. an abnormal slowdown of the fetal heart rate below 110 beats per minute, may be observed.
Eclampsia - diagnosis
The diagnosis of this clinical condition is based primarily on the symptoms occurring in the pregnant woman. Be aware that, on rare occasions, eclampsia may occur during the puerperium (that is, six weeks after birth) and before the 20th week of pregnancy.
A helpful test performed by obstetric gynecologists is the assessment of the flow in the uterine artery - in the case of eclampsia, the resistance in this artery increases.
Eclampsia - treatment
Eclampsia, being a life-threatening condition, requires immediate intervention and appropriate treatment. In the case of seizures, the following application is used:
- magnesium sulfate - administered intravenously, in a dose of 4-6 grams. It is also used to prevent a seizure from recurring. Magnesium should also be administered after the completion of pregnancy, as eclampsia can also occur in the postpartum period,
- oxygen through the mask - which protects against hypoxia,
- bicarbonates - they are used to treat acidosis, their administration should depend on the blood gas results,
- blood pressure-lowering drugs - intravenous labetalol is recommended. Blood pressure should be maintained at 140-160 / 90-110 mm Hg.
Eclampsia - pregnancy termination
The only treatment for causing eclampsia is termination of pregnancy. For pregnancies<32. tygodnia zaleca się rozwiązanie ciąży przez cięcie cesarskie, które powinno się rozpocząć po około 15-20 minutach od ustąpienia drgawek. Uważa się, że w tej sytuacji ciążę powinno kończyć się z wyboru przez cięcie cesarskie.
Eclampsia - complications
Eclampsia is a clinical condition that may be associated with the occurrence of serious complications, including:
- hypoxia of the central brain system (we mean, first of all, the brain), which leads to its permanent damage and neurological disorders,
- placenta detachment - manifested mainly by increased uterine tone, abdominal pain, and vaginal bleeding, it is an indication for immediate termination of pregnancy by caesarean section. Placenta detachment may lead to intrauterine hypoxia of the fetus,
- disseminated intravascular coagulation syndrome (also called DIC for short) - a condition in which small blood clots form in the vessels as a result of the activation of coagulation processes. DIC may involve not only eclampsia, but also generalized infections of the body, as well as injuries and surgical procedures,
- acute renal failure,
- swelling and pneumonia,
- temporary loss of vision,
- sudden cardiac arrest,
- fetal death,
- prematurity.
Eclampsia and the HELLP team
HELLP syndrome occurs in up to 20% of women with eclampsia. In its course we are dealing with:
- haemolytic anemia - a breakdown of blood cells faster than in normal conditions, leading to anemia,
- increased levels of liver enzymes (Aspat, Alat),
- decreased level of platelets, i.e. thrombocytopenia,
- epigastric pain,
- nausea and vomiting, as well as decreased well-being.
The HELLP syndrome is significantly often complicated by acute renal failure and intravascular coagulation, which makes this condition an indication for early termination of pregnancy.
Eclampsia - differentiation of eclampsia from other diseases
The symptoms of eclampsia may also be part of the clinical picture of other diseases. Diseases with which it is worthwhile to differentiate eclampsia include:
- epilepsy - this diagnosis may be indicated by the presence of epileptic seizures in a history of a pregnant woman,
- meningitis - if neuroinfection is suspected, it is necessary to perform a cerebrospinal fluid test,
- poisoning, including psychoactive substances - sometimes it is necessary to perform toxicological tests,
- metabolic disorders, e.g. uremia, which is an element of chronic kidney failure, but also hypoglycaemia or abnormally low blood glucose - in this case it is worth measuring the level of creatinine and blood glucose,
- brain abscess or brain tumor - MRI of the central nervous system is of choice.
Eclampsia and the risk of complications in subsequent onespregnancies
As shown by scientific reports, the occurrence of eclampsia also affects the frequency of certain events in subsequent pregnancies. It is mainly about the increased risk of:
- bearing detachment,
- premature birth - delivery before the end of the 37th week of pregnancy,
- IUGR - i.e. intrauterine growth restriction,
- fetal death.
The risk of recurrence of eclampsia in subsequent pregnancies is described as 2%. Importantly, eclampsia also increases the risk of hypertension in a woman.
In conclusion, eclampsia is a serious condition that poses a serious threat to both mother and her baby. The mortality of pregnant women in this case is around 14%, depending on the given population.
If the above-described symptoms of eclampsia appear, you should go to the gynecology and obstetrics room as soon as possible, where specialists will confirm or exclude the presence of this clinical condition and decide on further treatment.