It is a disorder experienced by pregnant women in which the patient’s blood pressure rises greatly and the urine contains protein.
There may also be some other organ dysfunction.
Eclampsia is basically the most critical pre-eclampsia condition in which women start to have seizures.
These seizures caused in eclampsia generally last about a minute and the person experiences confusion after the episode ends and may even go into a coma.
Eclampsia is included in the hypertensive disorders of pregnancy.
Usually affecting women in their second half of pregnancy, eclampsia can occur even after delivery.
Eclampsia seizures also include staring episodes and a marked decrease in alertness along with violent seizures.
Eclampsia is very rare, affecting only about 0.5% of women with pre-eclampsia.
Preeclampsia and eclampsia
Preeclampsia is a disease that occurs as a complication of pregnancy.
It can appear at any stage after the 20th week of pregnancy.
The first sign of the disorder is usually high blood pressure.
If the condition progresses, it can cause damage to many of the pregnant woman’s organs and can restrict the growth of the unborn baby.
In severe pre-eclampsia, placental abruption can also occur with serious consequences for both mother and baby.
If not managed correctly, severe pre-eclampsia can progress to swelling of the brain, which can lead to a seizure.
This complication of preeclampsia is called eclampsia.
Other organs can also be affected in complicated cases, such as kidney failure or heart failure.
Since eclampsia is related to pre-eclampsia, you may also have some symptoms of pre-eclampsia.
Some of these symptoms include:
- Women typically experience hypertension which is an increase in blood pressure before the onset of the seizures that signal eclampsia.
- Proteinuria is also a main symptom of eclampsia, which basically means the presence of a large amount of protein in the urine.
- Seizures are actually the symptom that denotes the progression of eclampsia from preeclampsia.
- These eclampsia seizures affect the brain, therefore other symptoms may also show up. These include nausea, vomiting, headaches, and even cortical blindness due to severe brain damage.
- Multi-organ failure can also occur after the seizure caused by eclampsia, which can lead to new symptoms such as pain in the abdomen, jaundice, decreased urination, and wheezing or shortness of breath.
- Symptoms of eclampsia can also include fetal intrauterine growth retardation, which means delayed growth of the baby in the womb.
- Seizures in the mother caused by eclampsia can also cause fetal distress and a decreased heart rate of the fetus, a condition known as bradycardia.
- A fairly common complication of eclampsia is pulmonary edema, which means fluid build-up in the lungs. About 3% of people with eclampsia have this symptom.
- Placental abruption which means separation of the placenta and bleeding from the placenta can also occur due to eclampsia.
- Restlessness, muscle aches, and headaches are also some of the symptoms of eclampsia.
Causes of eclampsia
Although the exact cause of preeclampsia remains unknown, the leading theory is based on altered placental function in early pregnancy.
This “first stage” of the disease of placental dysfunction is usually followed by a “second stage” of systemic disease, throughout the body in the mother, where the body reacts to this disease with an excessive inflammatory reaction.
This response precedes the onset of symptomatic classic clinical disease. Among other things, the disease affects the blood vessels of the pregnant woman.
The arteries carry oxygen-rich blood from the heart to all tissues and organs in the body.
Large arteries branch into smaller and smaller arteries. These small tubules are called capillaries.
The changes in the arteries and capillaries that occur in pre-eclampsia and the effects these changes have are explained below:
Narrowing of the arteries
The inner surface (walls) of the arteries is lined by a thin layer called the endothelium.
The body has a large number of endothelial cells, together as a tissue organ, this organ would be the size of the liver.
In pre-eclampsia, endothelial cells become diseased (endotheliosis).
Within the walls of the arteries is a layer of muscle that controls the diameter (size) of the arteries.
Chemicals released by damaged endothelial cells cause this muscle layer to contract, causing the arteries to narrow (vasoconstriction) causing high blood pressure (hypertension).
The function of the kidneys is to act as a filter during urine production as the blood passes through both kidneys.
Proteins, which are present in the bloodstream, are retained and do not normally pass into the urine.
In pre-eclampsia, systemic inflammation also affects the kidneys, that is, the filter (glomerulus) of the kidney begins to lose its function and causes proteins to appear in the urine.
Due to damage, endothelial cells become permeable, which means that substances can diffuse through the cells.
As a result, the fluid leaks from the blood vessels into the surrounding tissue.
This reduces the volume of blood circulating within the blood vessels and causes the blood to thicken due to loss of fluid.
Loss of fluid from the blood also causes swelling of the tissues into which it leaks.
This type of swelling is known as edema.
Edema can occur in all soft tissues in the body, including organs such as the liver, lungs, and brain.
Coagulation within the blood vessels
Damaged endothelial cells can release chemicals that cause the blood to clot.
As a result, blood clots form on the walls of the damaged vessels.
To avoid occlusion of blood vessels in the rest of the circulation, the clotting process is counteracted by activating a process called fibrinolysis in which clots dissolve as they form.
In severe cases of pre-eclampsia, clotting and fibrinolysis can lead to a condition called disseminated intravascular coagulopathy, which can deplete the ability to clot throughout the body and lead to uncontrollable bleeding.
Clots form from proteins and cells in the blood, called platelets.
If clotting and fibrinolysis deplete available platelets before new ones are formed, the level of freely circulating platelets in the blood will decrease.
This condition is known as thrombocytopenia.
Combined effects of these changes
Reduced blood flow
High blood pressure normally increases the rate at which blood flows through the circulatory system.
However, several other factors work together to decrease blood flow, narrow arteries (vasoconstriction), decreased blood volume, increased blood viscosity, and blood clots within the vessels.
The effect of these factors combined outweighs the effect of increasing blood pressure.
Consequently, blood flow to the body’s tissues and organs decreases.
Edema, caused by damaged endothelium, is made worse by high blood pressure.
However, edema is not always present in patients with preeclampsia, and the absence of edema does not rule out the possibility of the disease becoming severe.
It must be remembered that edema is very common in uncomplicated pregnancies.
Therefore, the mere presence of edema does not automatically imply the presence of preeclampsia.
Destruction of red blood cells
In severe pre-eclampsia, a combination of factors can lead to another complication, namely the destruction of red blood cells.
This process, known as hemolysis, reduces the number of red blood cells, which in turn reduces the amount of oxygen that can be carried in the blood.
The effect on the mother’s organs
Hypertension with reduced blood flow and decreased oxygen levels in the blood can cause various organs of the pregnant woman and the placenta to malfunction.
The placenta is a temporary organ of fetal origin that develops within the uterus after a woman becomes pregnant.
It supplies the fetus (the developing baby) with oxygen and nutrients, and removes waste products produced by the fetus.
Risk factors for eclampsia
Although eclampsia is a very serious disease that can be life-threatening for both mother and baby, it is relatively rare in the Western world.
Data on how many women suffer from eclampsia suggest that the problem affects about 5 women out of 10,000 who give birth, or about half a tenth of one percent of all pregnant women.
About a fifth of all cases occur between 20 and 31 weeks of pregnancy, about a third occur at term during delivery or 48 hours before.
Eclampsia is extremely rare before the 20th week of pregnancy, and cases that arise during this time are typically a sign of some other underlying disorder, such as a molar pregnancy or a metabolic problem.
The data indicate that while minority groups appear to be most at risk, this is most likely an effect of socioeconomic factors, such as access to health care, rather than a true biological effect.
Risk factors for eclampsia and people who are at higher risk for the problem of eclampsia include:
- Those who suffer from pre-eclampsia are prime candidates for getting eclampsia as well. So, it is better to control it before it becomes more troublesome.
- Young mothers who are under the age of 20 and women who are pregnant for the first time are more likely to get eclampsia. This is believed to be due to his new exposure to paternal antigens.
- Hypertension is another risk factor for eclampsia.
- Women with kidney disease or diabetes are at higher risk for eclampsia.
- Having a large placenta is also a risk factor for eclampsia. This can happen due to multiple gestation or some other reason.
- Women with a family history of the disease are at a higher risk of developing eclampsia. If you have a sister or mother who already had eclampsia, then they probably have it too.
- Similarly, women who have already had eclampsia or pre-eclampsia in a pregnancy are at a higher risk of contracting it again when they become pregnant again and if they become pregnant again.
- Additionally, women who are older than 35 are also at higher risk for eclampsia.
- If a woman is pregnant with twins, she has a higher chance of getting eclampsia and is therefore at higher risk.
- A history of poor diet and nutrition can also be a risk factor for eclampsia.
Diagnosis of eclampsia
In normal pregnancy, 80% of women experience swelling of the feet and sometimes the hands.
Edema may play a role in the suspected diagnosis of preeclampsia, but only if the swelling is severe and occurs additionally over the sacrum (back), arms, and face.
In mild preeclampsia, there is generally little evidence of organ dysfunction.
In severe cases, however, significant organ malfunction can occur, causing symptoms such as headache, abdominal pain, blurred vision, nausea, and vomiting.
Recognition of these symptoms plays an important role in the diagnosis of severe preeclampsia.
If the patient has seizures or any other symptoms, the doctor will prescribe some tests to determine why she has these symptoms and to diagnose the problem and eliminate the possibility of eclampsia.
Blood and urine tests are used to assess the extent and severity of the disease and to reveal the degree of deterioration in kidney function.
There are many blood tests that a doctor can order from their patients, but the most common one that doctors prescribe is the hematocrit, which measures the number of red blood cells and platelets.
Low levels of red blood cells indicate the presence of hemolysis (destruction of red blood cells).
Low platelet levels reveal consumption due to clotting.
Elevated levels of liver enzymes in the blood are a sign of liver failure.
Platelets help doctors determine whether or not the blood is clotting properly.
They help determine whether the woman has pre-eclampsia or eclampsia and also help assess kidney and liver functions.
Too much creatinine in the blood can mean pre-eclampsia or eclampsia, although it may be due to some other reason.
Creatinine is a muscle waste product that is excreted from the body through the kidneys.
If the kidneys are damaged, creatinine begins to accumulate in the body due to its insufficient excretion which may indicate eclampsia.
The doctor may also ask you to test your urine to see if it contains protein or not.
This can help the doctor assess the presence or risk of eclampsia.
If blood tests reveal low levels of red blood cells and platelets, as well as high levels of liver enzymes, then a pregnant woman is said to have HELLP syndrome, suffer from hemolysis, elevated liver enzymes, and decreased platelets.
HELLP syndrome is a complication of severe preeclampsia.
HELLP syndrome complicates 10% to 20% of severe preeclampsia cases and is associated with significant complications in the mother and fetus.
Treatments for eclampsia
The only permanent treatment for eclampsia is delivering the baby even though doctors may prescribe certain medications.
The doctor may decide to have the patient deliver the baby early if she develops eclampsia.
This decision usually depends on the health and growth of the baby, how far along the pregnancy is, and how severe the eclampsia is.
Basically it is about these two situations:
If the baby has matured
If you are close to reaching your term of 37 weeks or more and the baby has matured enough, the doctor may decide to perform a cesarean section or induce labor and deliver your baby.
This will cure your eclampsia effectively.
If the baby is not mature enough
If the baby has not matured enough to deliver safely, the doctor may prescribe some medications until he or she is old enough that it can be safely delivered if he is suffering from eclampsia.
The more mature your baby is and the closer it is to your due date, the safer it will be for the mother and her baby.
If this is the case, then some measures should be taken, which are as follows:
If the pregnant woman has eclampsia and is having seizures, she can be given anticonvulsants to cure it.
Doctors may also prescribe some low-dose aspirin for you.
Apart from that, doctors may also prescribe some blood pressure lowering drugs to control hypertension.
There are some things that you can also do, if you are suffering from eclampsia, to get out of this situation. They are the following:
- Eat a healthy and balanced diet with all the nutrients the body needs.
- You need to be proactive and undergo frequent check-ups, in addition to monitoring the baby.
- Get enough rest.
- Avoid stress, tension and anxiety.
- Take all of your medications exactly as your doctor prescribed.
Effects of eclampsia for the baby
If eclampsia is treated properly, the effects on the baby should be very small.
But if eclampsia affects the placenta by reducing blood flow to it, it can result in a decrease in the supply of oxygen, blood, and nutrients to the fetus.
This can cause suffocation, placental abruption, and in some cases even fetal death even though it is very rare.
Placental abruption, which refers to the separation of the placenta from the uterus, is a condition that, if it occurs, leaves doctors no choice but to perform an emergency cesarean section to save the baby’s life.
This problem caused by eclampsia can also cause the baby to be born with low weight and various health problems.
Although the problems related to eclampsia resolve once the baby is born, there is still an increased risk of the mother developing eclampsia and pre-eclampsia in subsequent pregnancies.