Eclampsia is a rare condition seen in pregnant woman. It is a severe complication of preeclampsia. It is a serious condition which is characterised by high blood pressure and convulsions. It is preeclampsia complicated with generalized tonic clonic convulsions. Incidence of eclampsia is about 1 in every 2000- 3000 pregnancies every year. The exact cause of eclampsia is not known. Insufficient blood supply to placenta may contribute to eclampsia and preeclampsia. Eclampsia occurs after 20 weeks of pregnancy.
Clinical presentation:
• High blood pressure of pregnant lady
• Proteinuria
• Blurring of vision
• Severe headache
• Convulsions
• Confusion
Pathophysiology:
A) Theory of vasogenic edema
B) Loss of cerebral autoregulation leads to cerebral hyper perfusion in occipital and parietal area .
This causes blurring of vision and throbbing occipital headache (suggesting severe signs of impending eclampsia)
Cerebral hyperperfusion causes cerebral edema which releases excitatory neurotransmitters in the brain leading to convulsions.
Dangers of eclampsia:
• Placental abruption
• Massive cerebral hemorrhage
Most common cause of death in pregnant lady with eclampsia is due to massive cerebral hemorrhage.
• Aspiration pneumonia
• Pulmonary edema
• Cardiopulmonary arrest
• Renal failure
• Blindness (can be due to retinal ischemia or cerebral infarct)
Time of occurrence of eclampsia:
• Antepartum
• Third trimester (most commonly)
• Intrapartum
• Postpartum usually within 48 hrs of delivery
Prognosis of eclampsia depends on the duration that a woman stays in state of eclampsia.
More the duration worse is the prognosis.
Therefore, antepartum period is the most dangerous time for woman because the cause of eclampsia i.e., placenta is still inside the woman’s body.
Risk factors of eclampsia and preeclampsia:
• Preeclampsia in previous pregnancy
• Chronic hypertension or gestational hypertension
• Chronic Kidney disease
• First pregnancy (primiparity)
• Twin or triplets
• Extremes of age of mother (<20 or > 35)
• Diabetes Mellitus
• Multiple pregnancy
• Obesity
Investigation:
• Complete blood count (to look for platelet count <1 lakh/mm3)
• Kidney function test (to check for serum creatinine levels)
• Liver function test (to check for SGOT and SGPT levels)
• Check for pulmonary edema
• Check for blurring of vision
• Check for headache
Treatment of eclampsia:
1. To stop and prevent further convulsions
2. Control increased blood pressure
3. Deliver baby as quickly as possible ( definitive treatment of eclampsia)
For delivering baby vaginal route is preferred by using induction of labor (cesarean section is done in obstetric indication )
4. Monitoring for end organ changes
Management of eclampsia:
Woman with eclampsia are managed in 3 steps:
1. Stabilization
2. Airway (Godell’s airway)
3. Magnesium sulphate (drug of choice)
Administration of magnesium sulphate:
A) Pritchard regime (Intravenous + intramuscular)
• Loading dose = 4 gm slow IV + 5-5 mg IM in each buttock.
• Maintainance dose = 5 mg on alternate bottock every 4 hrs.
B) Susan Regime (intravenous)
• Loading dose = 4-6 gm diluted in 100 ml normal saline given slow IV for 10-20 mins.
• Maintainance dose = 1-5 gm in 100 ml normal saline of IV infusion per hour.
Duration of administering magnesium sulphate:
If seizures occurred before delivery of baby, continue magnesium sulphate for 24 hours after delivery.
If seizures occurred after delivery of baby, continue magnesium sulphate for 24 hours after the occurrence of last seizure.
Monitoring of woman with eclampsia continues even after delivery of baby because of complication of pulmonary edema which may occur due to fluid overload.
None of the drug listed above should be taken without proper consultation of the doctor.This post is just for educational purpose and not for any clinical purpose.
Contributor- Medico Eshika Keshari
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