Eclampsia During Pregnancy
In recent decades, there has been a noticeable increase in pregnancy and postpartum complications related to high blood pressure, such as preeclampsia and eclampsia, in the United States. These conditions pose significant risks, potentially leading to severe and life-threatening problems for both mothers and infants. However, early detection significantly improves manageability.
Understanding eclampsia, and its connection to preeclampsia, and taking proactive measures are crucial for expectant mothers to safeguard their health. Below, we explore essential information that every mom-to-be should be aware of regarding these conditions and offer insights on protective measures.
What is eclampsia?
Eclampsia is a serious and potentially life-threatening complication that can occur during pregnancy or shortly after childbirth. It is often preceded by a condition called preeclampsia, which is characterized by high blood pressure and signs of damage to organs, such as the liver and kidneys. If preeclampsia is not effectively managed, it can progress to eclampsia.
Eclampsia is marked by the onset of seizures (convulsions) in a pregnant woman who has preeclampsia, and it can also occur during labor or after delivery. These seizures can lead to various complications, including brain and organ damage.
The exact cause of eclampsia is not fully understood, but it is believed to be related to problems with the placenta and blood vessels. Women with preeclampsia, young pregnant women, and those with a history of hypertension are at a higher risk of developing eclampsia.
Prompt medical attention and intervention are crucial in managing eclampsia. Treatment may involve controlling seizures, managing high blood pressure, and delivering the baby, depending on the gestational age. Regular prenatal care and monitoring play a vital role in early detection and prevention of eclampsia. Pregnant individuals should be aware of the signs and symptoms of preeclampsia, such as high blood pressure, protein in the urine, severe headaches, and vision changes, and seek medical attention if they experience these symptoms.
What causes eclampsia?
The exact causes of preeclampsia and eclampsia remain elusive, and researchers are actively investigating various factors that might contribute to these pregnancy complications. While a definitive explanation is yet to be identified, potential factors that are believed to play a role include:
- Blood Vessel Problems: Issues with blood vessels, their function, or structure.
- Brain or Nervous System Problems: Complications related to the brain or nervous system.
- Genetic Factors: Inherited factors that may increase the susceptibility to preeclampsia and eclampsia.
- Placental Abnormalities: Problems with the placenta, such as insufficient blood flow.
- Environmental Exposures: Exposure to certain environmental factors that might contribute to the development of these conditions.
- Cardiovascular Changes or Inflammation: Alterations in the cardiovascular system or inflammation within the body.
- Hormonal Imbalances: Disruptions in hormonal regulation.
- Maternal Diet: The mother’s dietary habits and nutritional intake during pregnancy.
- Certain Autoimmune Disorders: Presence of autoimmune disorders that can affect pregnancy.
Understanding the interplay of these factors and how they contribute to preeclampsia and eclampsia is an ongoing area of research in maternal health.
What are the symptoms of eclampsia?
Eclampsia is often characterized by seizures, loss of consciousness, or severe agitation, typically occurring close to or during delivery. Additionally, postpartum seizures may manifest within the first 48 hours after childbirth. While seizures are a prominent symptom of eclampsia, they are usually preceded by other warning signs. Women at risk of eclampsia may experience:
- Severe Headaches: Intense headaches can be an early indicator of eclampsia.
- Nausea or Vomiting: Persistent nausea or vomiting may be associated with the development of eclampsia.
- Stomach Pain: Abdominal pain, particularly in the upper abdomen, can be a symptom to watch for.
- Hand or Facial Swelling: Swelling, especially in the hands or face, may be indicative of the condition.
- Vision Disturbances: Changes in vision, such as double vision, blurred vision, or the presence of missing areas in the visual field, can precede eclampsia-related seizures.
These warning signs are crucial indicators that should prompt immediate medical attention. Recognizing and addressing these symptoms promptly can contribute to the effective management and prevention of complications associated with eclampsia. Regular prenatal check-ups and communication with healthcare providers are essential for monitoring and addressing potential risks during pregnancy.
How does eclampsia differ from preeclampsia?
Eclampsia can arise as a complication of untreated preeclampsia, a condition characterized by a sudden and significant increase in blood pressure during pregnancy or shortly after childbirth.
When preeclampsia is not adequately identified, diagnosed, and managed, it has the potential to progress and transform into eclampsia. Eclampsia is marked by seizures and/or loss of consciousness in pregnant or postpartum women. In severe instances, it can even lead to a coma.
While the concept of eclampsia may evoke concerns, it’s essential to recognize that this complication is exceptionally rare. Although 5 to 8 percent of pregnant women in the U.S. are diagnosed with preeclampsia, the majority of cases can be effectively treated before escalating to eclampsia. Regular prenatal care, early detection, and appropriate medical interventions play a crucial role in managing and mitigating the risks associated with these conditions.
Who is most at risk for eclampsia?
Women with preeclampsia have an increased likelihood of developing eclampsia. Several factors can elevate the risk of being diagnosed with preeclampsia and subsequently experiencing eclampsia:
- Age Over 35: Advanced maternal age, particularly being over 35, is associated with a higher risk of pregnancy complications, including preeclampsia and eclampsia.
- Ethnicity (Black): Black women face a higher likelihood of encountering preeclampsia and eclampsia, with a 60 percent increased risk compared to white women.
- Medical Conditions: Certain health conditions, such as diabetes, high blood pressure, kidney disease, or autoimmune diseases like lupus, can contribute to blood vessel and organ damage, increasing the susceptibility to preeclampsia and eclampsia.
- Obesity: Being obese is linked to a greater risk of high blood pressure and complications during pregnancy, including preeclampsia.
- History of Preeclampsia or Pregnancy Complications: If you or a family member has a history of preeclampsia or experienced complications in a previous pregnancy, the risk may be higher.
- Multiple Pregnancies: Carrying twins, triplets, or other multiples raises the chances of pregnancy risks, including preeclampsia and, if left untreated, eclampsia.
- Pregnancy Spacing: Women with pregnancies spaced fewer than two years apart or more than 10 years apart may be at a higher risk.
- Infertility Treatments (IVF): In vitro fertilization (IVF) has been associated with an increased risk of preeclampsia, although modified natural IVF cycles might have a lower risk compared to programmed cycles, according to some research.
How is eclampsia diagnosed?
The diagnosis of eclampsia typically involves blood or urine tests and monitoring a woman’s blood pressure. In cases where a pregnant woman or someone who has recently given birth exhibits symptoms such as seizures or lapses into a coma, healthcare providers would conduct these tests.
It remains a challenge for experts to predict which women with preeclampsia will progress to eclampsia. However, eclampsia appears to be more prevalent in women experiencing severe preeclampsia symptoms, including very high blood pressure, headaches, abdominal pain, or changes in vision. Additionally, abnormal blood test results may manifest in these women before the onset of seizures.
How is eclampsia treated?
Eclampsia is a critical and life-threatening emergency that requires immediate intervention to halt seizures, lower a woman’s blood pressure, and safeguard both the mother and baby. The typical course of treatment includes:
- Anti-seizure medications: Administration of magnesium sulfate, a mineral compound, is often employed to stop an ongoing seizure and prevent future occurrences.
- Blood pressure medications: Antihypertensive medications are used to reduce a woman’s elevated blood pressure.
- Delivery of the baby: In many cases, allowing the pregnancy to progress poses risks to both the mother and the baby, necessitating prompt delivery even if the due date is still some time away. This step is crucial in ensuring the well-being of both the woman and her child.
What are the complications of eclampsia?
While eclampsia is infrequent, untreated cases can result in severe complications for both mothers and babies, such as:
- Stroke, kidney failure, or organ damage: Persistent high blood pressure can lead to strokes and potential damage to organs like the kidneys, liver, brain, heart, and lungs in women.
- HELLP syndrome: This syndrome, occurring in 1 to 2 in 1,000 pregnancies and more frequently in severe preeclampsia or eclampsia cases (10 to 20 percent), can have serious implications for both mother and baby.
- Premature birth: The necessity to promptly address preeclampsia or eclampsia often results in immediate delivery, even if it leads to premature birth.
- Poor fetal growth: Preeclampsia and eclampsia can impede the baby’s ability to receive sufficient oxygen and nutrients, potentially restricting proper growth.
- Placental abruption: Although rare, this serious complication occurs when the placenta separates from the uterine wall before delivery, posing risks of heavy bleeding, fetal distress, or an increased likelihood of stillbirth.
What you can do to prevent eclampsia
While experts cannot accurately predict which women with preeclampsia may develop eclampsia, taking proactive steps to prioritize your health and recognizing the signs of both conditions can contribute to better outcomes for both you and your baby.
Follow these guidelines to reduce your risk of eclampsia and preeclampsia:
- Attend prenatal visits: Regular checkups with your healthcare provider enable the early detection of preeclampsia symptoms. If diagnosed, your practitioner will closely monitor you and your blood pressure to prevent the progression to eclampsia.
- Consider low-dose aspirin: If recommended by your doctor, taking 81 mg of aspirin daily can be a preventive measure for women at high risk of preeclampsia, starting between 12 to 28 weeks until delivery. Always consult with your doctor before initiating any medication or supplement during pregnancy.
- Be aware of warning signs: Recognize late-pregnancy symptoms such as severe headaches, upper abdominal pain (especially on the right side), nausea or vomiting, shortness of breath, decreased urine output, or swelling of the face or hands. Seek immediate medical attention if you experience vision changes or suspect a seizure. Call 911 in case of emergency.
- Maintain a healthy lifestyle: While a direct link to a lower risk of preeclampsia or eclampsia hasn’t been established, adopting a nutritious diet and engaging in regular exercise contributes to overall well-being and health throughout your pregnancy.
Concerning remedies such as vitamin C or E supplementation, adopting a low-salt diet, or taking fish oil, the current evidence is insufficient to establish their effectiveness. If you are contemplating these measures, it’s advisable to consult with your doctor before initiating any changes.
Reflecting on serious pregnancy conditions like eclampsia can be disconcerting. Fortunately, many women can be identified in the pre-eclamptic stage, before the onset of the most severe complications. With prompt and appropriate treatment, coupled with diligent follow-up care, the majority of women experiencing eclampsia can typically regain normal health after delivery. This underscores the importance of regular prenatal checkups and open communication with your healthcare provider throughout your pregnancy journey.
References
- American College of Rheumatology, Antiphospholipid Syndrome Opens a new window, March 2019.
- American Family Physician, Venous Thromboembolism During Pregnancy Opens a new window, June 2008.
- What to Expect When You’re Expecting, 5th edition, Heidi Murkoff.
- WhatToExpect.com, 13 Benefits of Exercise During Pregnancy, October 2018.
- American College of Obstetricians and Gynecologists, Preventing Deep Vein Thrombosis, Opens a new windowMarch 2020.
- Centers for Disease Control and Prevention, Venous Thromboembolism (Blood Clots) and Pregnancy Opens a new window, August 2020.
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