Eclampsia — seizures in a pregnant woman that are unrelated to a preexisting brain condition — is a serious complication of preeclampsia, which is pregnancy-induced high blood pressure coupled with large amounts of protein in the urine. Eclampsia is rare, complicating less than one percent of all pregnancies, and characterized by one or more seizures during pregnancy or in the postpartum period. According to the Preeclampsia Foundation, eclampsia is usually treatable when caught early. If it is left untreated, however, seizures can result in coma, brain damage, and potentially in maternal or infant death. In the United States, with the availability of high quality prenatal care, most cases of preeclampsia are promptly managed with medications, and the incidence of eclampsia is decreasing.
Causes of Eclampsia
A large number of conditions can cause seizures in pregnancy. Eclampsia, known as preeclampsia of the brain, is defined as seizures that cannot be attributed to other causes in a woman with preeclampsia. Although the exact cause of eclampsia is not well understood, it is thought that several factors may contribute to the condition. These include blood vessel problems, brain and nervous system disorders, poor maternal diet, and heredity.
Signs and Symptoms of Eclampsia
Seizures during pregnancy may be mild, or they can be severe and accompanied by convulsions, muscle aches and pains, severe agitation, and unconsciousness. If you had preeclampsia leading up to eclampsia, then you will probably have high blood pressure (140/90 mm Hg or greater) and protein in the urine. You may also have symptoms of preeclampsia, which include:
- Weight gain of more than two pounds in a week
- Nausea and vomiting
- Upper abdominal pain
- Swelling of the hands and face
- Changes in vision
Some women with preeclampsia have no symptoms, however. The only indications of preeclampsia may be abnormal laboratory findings, which can be obtained only with regular prenatal office visits.
Risk Factors for Eclampsia
Risk factors for eclampsia are similar to those for preeclampsia. According to a study of the incidence of eclampsia in California, women at higher risk for eclampsia had the following factors in common:
- Aged 15 – 20 or over 40
- African American race
- Preexisting cardiac disease
- Lupus erythematosus
- Twin pregnancy
Diagnosis of Eclampsia
If you have a seizure during pregnancy, you may be evaluated in the hospital or by your doctor, depending on the severity of the seizure. Your doctor will perform a thorough evaluation to determine the cause and to ensure accurate and prompt treatment. You may need to be evaluated by a neurologist or other specialist, especially if a seizure disorder is suspected.
Although eclampsia may be detected before or after delivery, it more commonly is seen after delivery, at which point it is typically a medical emergency. Tests for eclampsia are similar to those for preeclampsia and include blood pressure measurements and urine tests. While protein in the urine is an important finding for diagnosis of preeclampsia, it is only one of the tests required. Your doctor will also order blood tests to review your blood clotting factors, creatinine, hematocrit, uric acid, liver function, and platelet count. The results could indicate other problems that might worsen or complicate your condition. Brain-computed tomography may be necessary in certain circumstances to rule out conditions such as stroke.
Treatment of Eclampsia
If you were treated for preeclampsia, the chances of eclampsia developing are very low. If preeclampsia is diagnosed before 37 weeks’ gestation, your doctor will recommend bed rest, medication, or hospitalization, depending on your symptoms. You may be given anticonvulsive medication to help prevent seizures, antihypertensive agents to lower your blood pressure, and corticosteroids to improve liver and platelet functioning. Other medicines may include corticosteroid injections to help your baby’s lungs develop, if your condition was diagnosed before 37 weeks. Magnesium can be injected into the veins to prevent eclampsia-related seizures.
Whether you are resting at home or in the hospital, you will be carefully monitored during this period with frequent ultrasounds and blood and urine tests.
For severe preeclampsia or eclampsia, immediate delivery by induction or Cesarean section may become necessary, even if you are not close to term. The only cure for preeclampsia and eclampsia during pregnancy is to deliver your baby.
Eclampsia that develops during labor can be difficult for your doctor to diagnose and treat because it may appear very similar to stroke. If you have facial or arm muscle weakness or a facial deficit, your doctor will suspect stroke. Brain-computed tomography can usually detect most cases of hemorrhagic stroke. If your blood pressure is greater than 180/120 mmHg, your doctor will attempt to decrease the risk of convulsions and reduce blood pressure.
Complications of Eclampsia
According to The American Congress of Obstetricians and Gynecologists, acute-onset, persistent, severe hypertension, whether systolic (greater than or equal to 160 mm Hg) or diastolic (greater than or equal to 110 mm Hg) in pregnant or postpartum women with preeclampsia or eclampsia constitutes a hypertensive emergency. Severe systolic hypertension may be the most important predictor of cerebral hemorrhage and infarction, and if not treated expeditiously it can result in maternal death. Most women who die from preeclampsia or eclampsia die postpartum, after prenatal monitoring is discontinued.
Women with preeclampsia or eclampsia may have a higher risk for separation of the placenta (placenta abruption), premature delivery, and blood clotting disorders. Eclampsia found early in the pregnancy is more often complicated by HELLP syndrome — Hemolysis (the breakdown of red blood cells), Elevated Liver enzyme levels, and Low Platelet count) — than eclampsia found later in pregnancy. Late pregnancy complications that are common in women with eclampsia include cerebrovascular hemorrhage/disorders, peripartum cardiomyopathy, amniotic fluid embolism, and venous thromboembolism.
Prevention of Eclampsia
If you have high blood pressure or an existing condition that places you at risk for preeclampsia or eclampsia, it is essential that you take very good care of yourself while you are pregnant and be conscientious about going to every one of your prenatal visits. This allows for the early diagnosis and treatment of preeclampsia, which may prevent eclampsia.