Eclampsia is the most severe form of pregnancy poisoning. The pregnant woman may experience seizures, and the patient may even fall into a coma. Before eclampsia occurs, there is usually preeclampsia. This is usually manifested by increased blood pressure as well as increased excretion of protein by the kidneys.
What is eclampsia?
Eclampsia is a severe condition in pregnancy that is often accompanied by seizures. These seizures are similar to epileptic seizures. Preeclampsia occurs in about 5 percent of all pregnancies, and eclampsia is the result. Excessive protein in the urine (proteinuria) and elevated blood pressure are the first signs of preeclampsia. The actual eclampsia can occur as early as the 20th week of pregnancy and persist until 6 weeks after delivery. However, permanent damage to the mother can be ruled out.
Causes
If a pregnant patient suffers from eclampsia, there is a lack of blood flow to the placenta. The reason for this is that the blood vessels cannot form large enough. However, good blood flow to the placenta is of great importance for supplying the child with nutrients and oxygen. As a result, the mother’s blood pressure increases, which improves the supply of nutrients to the child. In this context, the placenta also sends out signal substances that alter the kidneys and thus the excretion of protein. The exact causes of the disturbance in the development of the blood vessels of the placenta have not been clarified with certainty. Nevertheless, at least certain factors responsible for increasing the risk of developing eclampsia are known in medicine. Eclampsia thus occurs primarily in first-time mothers and in young pregnant women under 20 years of age. Obesity, diabetes and a tendency to thrombosis in pregnant women are also risk factors. Women whose mothers have already had eclampsia also have an increased risk.
Symptoms, complaints, and signs
Eclampsia usually occurs in the last trimester of pregnancy, less commonly right at birth or even after birth. The condition is severe, so patients require intensive medical observation and treatment. Eclampsia is usually preceded by what is known as preeclampsia. The first signs are severe water retention, protein excretion through the urine and very high blood pressure. However, these symptoms can also have other causes, so medical clarification is urgently needed. If the patient visits the doctor or, even better, the hospital in good time, a reliable diagnosis can be made. Causes of eclampsia can also be severe overweight of the mother. Eclampsia is characterized by severe seizures that strongly resemble those of epilepsy. During the seizures, loss of consciousness or clouding of consciousness may occur. Harbingers are severe headache, flickering before the eyes, as well as various neurological deficits, dizziness to vomiting, disturbances of vision. During eclampsia, comatose states may even occur. If risk factors are present, it is advisable to arrange preventive monitoring with the doctor, as well as regular check-ups. Along with obesity, multiple pregnancy is one of the greatest risks, and most often eclampsia occurs in first-time mothers. However, there are exceptions, so possible symptoms should be taken seriously in any case.
Diagnosis and course
It is important to detect and treat preeclampsia at an early stage in order to avoid eclampsia. Therefore, the patient’s blood pressure is measured at all screening examinations during pregnancy. In addition, a test of the urine for the content of protein is performed. As soon as pre-eclampsia is suspected, further measurements of blood pressure are necessary. In order to determine kidney values, liver values, the number of blood platelets as well as the factors of blood clotting, a blood sample is also taken. A color-coded ultrasound is also used to determine the blood flow to the placenta and the child’s condition is checked regularly. A medical history continues to be taken when the diagnosis is made. In addition to high blood pressure and proteinuria, typical symptoms of preeclampsia include water retention (edema) in mostly atypical areas such as the hands and face.A sudden increase in weight may be the first sign of edema. Many patients also suffer from visual disturbances, headaches and so-called double vision, as well as nausea. Often the liver is also involved when preeclampsia starts very quickly. One sign of this is nausea and severe abdominal pain on the right side. This can also lead to a sometimes dramatic deterioration in the health of the expectant mother. The course of eclampsia is always dependent on early detection and treatment of pre-eclampsia. Complications such as impaired growth, detachment of the placenta and, in the worst case, even death of the unborn child can occur as complications of eclampsia.
When should you see a doctor?
If a sudden significant weight gain is noticed, associated with increasing headaches and nausea, preeclampsia may be present. It is recommended to consult a doctor immediately. At the latest, if signs of eclampsia – high blood pressure, edema of the hands and face, visual disturbances and others – are added, this must be medically clarified. Pregnant women who are overweight, older (over 35) or have a family history of eclampsia are particularly at risk. Women who belong to these risk groups should have visual disturbances, headaches in the forehead and temple area, and other typical symptoms clarified quickly. Signs of a seizure and cardiovascular complaints are also best addressed with the gynecologist. If a severe feeling of illness suddenly develops, the doctor must be notified immediately. If there is right-sided abdominal pain and diarrhea, the liver may be affected – a clear warning sign of eclampsia. In order to exclude further complications, the disease must be clarified in any case and treated if necessary. In severe cases, hospitalization is required for this purpose.
Treatment and therapy
Eclampsia is generally caused by pregnancy, which is why treatment is also principally associated with the termination of pregnancy. However, the actual time of delivery is always made dependent on the health of the expectant mother as well as the week of pregnancy. If only mild preeclampsia is present, the patient is admitted to the hospital. There, the patient is given a high-protein diet and must stay in bed, lying on her left side. There is also regular monitoring of the conditions of mother and child. If eclampsia occurs before the 34th week of pregnancy, the administration of cortisol accelerates the lung maturation of the child. From the completed 36th week of pregnancy, induction of labor occurs. If the expectant mother suffers from severe preeclampsia, she is given sedatives and magnesium sulfate to prevent seizures. Furthermore, blood pressure is lowered with medication. In this case, an attempt is made to delay the birth until the 36th week of pregnancy, if the mother’s health permits. If a seizure occurs during eclampsia, it is stopped with sedatives and the birth is induced. Even after the birth, the mother must be closely monitored because seizures can still occur. Consequential damage from eclampsia is not to be feared if the mother is treated appropriately, but there is an increased risk in a further pregnancy.
Outlook and prognosis
In the past, the occurrence of eclampsia in pregnant women was tantamount to a death sentence. Today, the prognosis is somewhat more favorable. Early onset of pre-eclampsia in the early part of pregnancy worsens the prognosis. The course of so-called pre-eclampsia is then more dramatic. If left untreated, pre-eclampsia leads to eclampsia, which is accompanied by seizures. These also mean danger to the life of mother and child today. The prognosis of eclampsia is improved by better education of expectant mothers and pregnancy examinations. Even at the first signs of pre-eclampsia, physicians strive to improve the prognosis through appropriate measures. The associated high blood pressure endangers the child if it persists for a long time. If preeclampsia causes vascular damage to the placenta, the baby’s oxygen and nutrient supply are at risk. The survival prognosis for the unborn child deteriorates if the blood pressure is lowered too quickly.The earlier in pregnancy preeclampsia occurs, the more at risk the unborn child is. If preeclampsia occurs later, the chances for the child are better. The unborn child has a 50:50 chance if there is a severe course of the so-called HELLP syndrome. This is a complication of pre-eclampsia. It occurs in 4% to 12% of pregnant women who have severe preeclampsia.
Prevention
Because of its imprecise causes, prevention of eclampsia consists primarily of early detection and treatment of preeclampsia. Life-threatening complications for both mother and baby can be prevented. Above all, the best prevention of eclampsia is to keep all prenatal care appointments with your gynecologist and/ or midwife.
Follow-up care
In most cases of eclampsia, the affected person has very few or no options for follow-up care. In this case, the main focus of the disease is a very early diagnosis and subsequent treatment to prevent further complications or even death of the affected person. Therefore, a doctor should be consulted at the first signs of eclampsia so that the disease can be treated by a medical professional as soon as possible. Self-cure cannot occur in this case. In most cases, those affected by this disease are dependent on taking medication to alleviate the symptoms. The doctor’s instructions regarding dosage should always be followed. An inpatient stay in a hospital is also recommended in order to properly monitor the expectant mother’s values and immediately detect any discrepancies. If eclampsia is detected and treated at an early stage, it can be relatively well limited so that there is no further damage to the child and the mother. Many women also depend on the help and support of their partner and their own family in this process, so that it does not lead to psychological upsets or depression.
What you can do yourself
Eclampsia is a medical emergency that usually occurs after the 30th week of pregnancy, during or shortly after birth. Affected women are in acute danger of death and must immediately notify the emergency physician or, if they are already or still in the hospital, the nursing staff. The most important self-help measure is to recognize the preliminary stage of eclampsia, so-called pre-eclampsia, as such and to have it treated. Signs of preeclampsia include high blood pressure, water retention in the tissues, nausea, constant nausea that does not only occur in the morning, dizziness, flickering eyes and other visual disturbances or confusion. If preeclampsia develops into eclampsia, severe headaches and seizures are also common. Women who notice such symptoms during pregnancy should consult their gynecologist immediately. In addition, pregnant women should have all recommended preventive examinations performed, as this allows the onset of preeclampsia to be detected and treated promptly before it becomes life-threatening. These screenings are especially important for high-risk patients. These include women under 18 or over 35 years of age, women who suffer from severe obesity, and women who have already suffered from high blood pressure prior to pregnancy. Pregnant women who are at increased risk of eclampsia should choose their maternity hospital carefully and make sure that a doctor is always immediately available. Home birth should definitely be avoided in these cases.