Eclampsia Output
Eclampsia Output
Eclampsia Output
What is Eclampsia?
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.
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.
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).
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.