Eclampsia is a serious condition that can occur in mothers when preeclampsia becomes uncontrolled or does not get resolved. In the developed world, this is a condition which is rarely seen as most cases of escalating preeclampsia are detected before they get to this point.
However, it is still estimated that around 1 in every 2,000-3,000 pregnant women will become eclamptic. Eclampsia is very rare before the 20th week of pregnancy, with most cases occurring between weeks 20-31.
Eclampsia is classified as an obstetric emergency, where the well-being of a mother and her baby are potentially compromised. It can also be life threatening, so immediate access to an obstetric hospital and specialist medical care is a priority.
Signs of Eclampsia
Elevated blood pressure
Coma or seizures (fits); these are the defining signs of eclampsia
Decreased kidney function
Signs of foetal distress where the baby’s heartbeat slows down from its normal rate
Low platelet count
Severe agitation and restlessness
Muscular aches and pains
It is possible for some mothers to develop signs of eclampsia without having all the symptoms of preeclampsia first. Other than an elevated blood pressure, there may be no signs or symptoms beforehand. Even after the baby is delivered, some women may have post-partum seizures and will require close observation and medication to prevent them.
What Happens in Eclampsia?
In cases of eclampsia, the mother’s blood vessels go into spasm and are unable to transport oxygen and nutrients to her own body and to her baby. Vital organs such as her liver, kidneys and brain are compromised with a reduction in their normal blood flow and are unable to function effectively. Fits are common because the brain is starved of oxygen.
Risk Factors for Developing Eclampsia
More common in very young pregnant women and those over the age of 35 years
Eclampsia is more common in women who are having their first pregnancy – Primigravidas
Women who live in lower socio-economic areas where there are other risk factors such as poor nutrition and compromised access to healthcare (this may also be because early detection of preeclampsia is not as easily achieved)
Genes are thought to play a role, though exactly how or why is not well understood
For some women, the structure and function of their brain and nervous system, though exactly how is also not entirely clear
Maternal diet, in particular poor nutrition
Being of African descent
Having a pregnancy that is already being impacted by complications such as hypertension, diabetes or instability
Carrying a multiple pregnancy such as twins, triplets or more
Warning Signs for Developing Preeclampsia
The development of visual disturbances, such as seeing flashing lights or having blurred vision
A consistently high blood pressure
Abnormal readings on blood tests
Having a headache that doesn’t go away
Treatment for Eclampsia
Prevention is better than cure with eclampsia. Early diagnosis through monitoring every pregnant woman during their antenatal period helps to detect problems early. Checking urine for the presence of protein, watching that her blood pressure is stable and not high, in particular the diastolic or bottom reading, and being observant for fluid retention will all help to “flag” problems.
Bed rest is sometimes recommended.
Hospitalisation is usually necessary when eclampsia has been diagnosed.
Monitoring the foetal heartbeat and growth. Sometimes foetal heart tracing – Cardiotocograph (CTG tracing) is done. Ultrasounds are a sound and effective diagnostic tool for assessing foetal growth and development.
Monitoring the mother’s blood pressure. Anti-hypertensive medication is often prescribed to lower the blood pressure to within normal, safe limits.
Diuretic medication may also be prescribed to help rid the body of excess fluids that can accumulate in the lung.
Anti-convulsant medication may be prescribed in cases of fitting. The most commonly used drug is Magnesium Sulphate.
In severe cases of eclampsia, the only effective treatment is stabilisation of the mother and to stop her fits. Oxygen and anti-convulsant medication is given to maximise the flow of oxygen to her brain and to the baby. Immediate delivery of the baby by caesarian section is performed, even if this means the baby will be premature.
Complications of Eclampsia
Placental abruption is a major risk with both preeclampsia and eclampsia
Premature delivery of the baby and its associated risks
A blood clotting disorder called Disseminated Intravascular Coagulation (DIC) can occur
In extreme cases, death of the mother and or her baby may happen, but with careful monitoring and specialist care the likelihood of this is extremely small
The overall aim of eclampsia management is to reduce the risk of harm to the mother and her baby. If possible, delivery of the baby by caesarian section is deferred until 32- 34 weeks of gestation in cases of severe eclampsia. When it is assessed to be mild, then delivery is often held off until week 36 or beyond. Balancing the risks of eliminating maternal harm with infant prematurity is the most important factor in eclampsia management.
Remember
It is important to attend each antenatal appointment as recommended by your midwife or doctor - even if you feel and look well. Preeclampsia and eclampsia are not always detectable other than through blood pressure-readings and urine testing.
