Eclampsia is the beginning of seizures in women with pre-eclampsia. Pre-eclampsia is a pregnancy disorder where there is high blood pressure and either a large amount of protein in the urine or other organ dysfunction. Onset may occur before, during, or after childbirth. Most common in the second half of pregnancy. Seizures are a kind of tonic-clonic and usually last about a minute. After a seizure there is usually a period of confusion or coma. Complications include aspiration pneumonia, cerebral hemorrhage, renal failure, and heart attack. Pre-eclampsia and eclampsia are part of a large group of conditions known as hypertensive disorders of pregnancy.
Recommendations for prevention include aspirin in those at high risk, calcium supplements in areas with low intake, and treatment of previous hypertension with drugs. Exercise during pregnancy can also be beneficial. The use of intravenous or intramuscular magnesium sulphate increases the yield in those with eclampsia and is generally safe. This is true in the developed and developing world. Breathing may need to be supported. Other treatments may include blood pressure medications such as hydralazine and emergency delivery of infants either through the vagina or through a cesarean section.
Pre-eclampsia is thought to affect about 5% of the delivery while eclampsia affects about 1.4% of deliveries. In developed countries the rate is about 1 in 2,000 births due to better medical care. Hypertensive disorders of pregnancy is one of the most common causes of death in pregnancy. They produce 46,900 deaths by 2015. About one percent of women with eclampsia die. The word eclampsia comes from the Greek term for lightning. The first known description of this condition was by Hippocrates in the 5th century BC.
Video Eclampsia
Signs and symptoms
Eclampsia is a pregnancy disorder characterized by seizures in the pre-eclampsia setting. Usually pregnant women experience hypertension and proteinuria before the onset of seizures (seizures).
- Long-lasting headaches (persistent)
- Blurred vision
- Photophobia (ie bright light causes discomfort)
- Abdominal pain
- Either in the epigastric area (the center of the abdomen above the navel, or the navel)
- And/or in the upper right quadrant of the abdomen (below the right side of the rib)
- Change the mental state (confusion)
These symptoms may appear before or after a seizure occurs. There may also be none of these symptoms that will develop.
Other cerebral signs may soon precede seizures, such as nausea, vomiting, headache, and cortical blindness. If complications of multi-organ failure occur, the signs and symptoms of the failed organs will appear, such as abdominal pain, jaundice, shortness of breath, and decreased urine output.
Onset
Eclampsia seizures usually occur during pregnancy and before delivery (antepartum period), but may also occur during labor and delivery (intrapartum period) or after the baby is born (postpartum period). If postpartum seizures develop, it is most likely to occur within the first 48 hours after delivery. However, late eclampsia postpartum seizures may occur until the end of 4 weeks after delivery.
Complications
There is a risk to the mother and fetus (fetus) when eclampsia occurs. The fetus may grow more slowly than usual in the uterus of a woman with eclampsia, called intrauterine growth restriction and may cause the child to appear small for gestational age or to be born with low birth weight. Eclampsia can cause problems with the placenta. The placenta may bleed (bleeding) or may begin to separate from the uterine wall. It is normal for the placenta to separate from the uterine wall during labor, but it is not normal to separate before delivery; this condition is called placental abruption and can be harmful to the fetus. Placental insufficiency may also occur, a condition in which the placenta fails to support proper fetal development because it can not provide the amount of oxygen or nutrients necessary for the fetus. During eclamptic seizures, fetal heart rate may become slower than usual (bradycardia). If any of these complications occur, fetal distress may occur. If the risk to fetal or maternal health is high, the definitive treatment for eclampsia is baby delivery. It may be safer to have a premature baby than to wait for fetal development for 40 weeks to complete, and as a result prematurity is also a potential complication of eclampsia.
In the mother, vision changes can occur as a result of eclampsia, and these changes may include blurred vision, one-sided blindness (either temporary due to fugax amaurosis or potentially permanent due to retinal release), or cortical blindness, affecting vision of both eyes. There are also potential complications in the lungs. The woman may have fluids slowly collecting in the lungs in a process known as pulmonary edema. During eclamptic seizures, it is possible for a person to regurgitate and inhale some of these ingredients in a process known as aspiration. If aspiration occurs, the woman may have trouble breathing immediately or may develop an infection in the later lung, called aspiration pneumonia. It is also possible that during respiration the seizure will temporarily stop or become inefficient, and the amount of oxygen reaching the woman's body and brain will decrease (in a state known as hypoxia). If it is difficult for a woman to breathe, she may need temporary breathing which is supported by a tool in a process called mechanical ventilation. In some cases of severe eclampsia, the mother may become weak and slow (lethargic) or even coma. These may be signs that the brain is swollen (cerebral edema) or bleeding (intracerebral hemorrhage).
Maps Eclampsia
Risk factors
Eclampsia, such as pre-eclampsia, tends to occur more frequently in the first pregnancy. Women who have long-term high blood pressure before pregnancy have a greater risk of pre-eclampsia. Furthermore, women with pre-existing vascular disease (diabetes or nephropathy) or thrombophilic diseases such as antiphospholipid syndrome are at higher risk for developing pre-eclampsia and eclampsia. Having a large placenta (multiple pregnancies, hydatidiform mole) also affects women for eclampsia. In addition, there is a genetic component: a woman whose mother or sister has a higher risk condition than otherwise. Women who have experienced eclampsia are at high risk for pre-eclampsia/eclampsia in subsequent pregnancies.
Mechanism
The presence of the placenta is necessary, and eclampsia heals if removed. Reducing blood flow to the placenta (placental hypoperfusion) is a key feature of the process. This is accompanied by an increase in the sensitivity of the maternal blood vessels to agents that cause narrowing of small arteries, which leads to reduced blood flow to some organs. Also, the activation of coagulation cascade may lead to the formation of microthrombi, which may further interfere with blood flow. Third, increased permeability of blood vessels results in a shift of extracellular fluid from blood to interstitial space, with a further decrease in blood flow, and edema. These events cause hypertension; kidney, lung, and liver dysfunction; and cerebral edema with cerebral dysfunction and seizures. Before symptoms appear, increased platelet and endothelial activation can be detected.
Placental hypoperfusion is associated with abnormal modeling of the maternal-mediated fetal placenta interface that may be immunologically mediated. Trophoblast invasion seems incomplete. The placenta produces a potent adrenomedulin vasodilator: it is reduced in pre-eclampsia and eclampsia. Other vasodilators are also reduced, including prostacyclin, thromboxane A2, nitric oxide, and endothelin, also causing vasoconstriction.
Eclampsia is a form of hypertensive encephalopathy: reduced cerebral vascular resistance, leading to increased blood flow to the brain, cerebral edema and resulting seizures. An eclamptic seizure usually does not cause chronic brain damage unless intracranial hemorrhage occurs.
Diagnosis
The signs of eclampsia are seizures, and the steps to diagnose eclampsia depend on what is already known when the seizure occurs.
If a pregnant woman has been diagnosed with pre-eclampsia during her current pregnancy and then develop seizures, she may be given a 'clinical diagnosis' of eclampsia without further examination. This means that the diagnosis of eclampsia is most likely to be given symptoms and medical history, and eclampsia can be considered a correct diagnosis until proven otherwise. However, if a woman has a seizure and it is not known whether she has preeclampsia, the test may help clear the diagnosis.
Vital signs
One of the core features of pre-eclampsia is high blood pressure. Blood pressure is a two-digit measurement. If one of the upper numbers (systolic blood pressure) is greater than 140 mmHg or lower number (diastolic blood pressure) greater than 90 mmHg, then the blood pressure is higher than the normal range and the person has high blood pressure. If the systolic blood pressure is greater than 160 or the diastolic pressure is greater than 110, hypertension is considered severe.
Laboratory testing
Another major feature of pre-eclampsia is proteinuria, namely the presence of excess protein in the urine. To determine whether there is proteinuria, urine can be collected and tested for protein; if there is 0.3 grams of protein or more in the urine of pregnant women collected for 24 hours, this is one of the diagnostic criteria for preeclampsia and raises the suspicion that seizures are caused by eclampsia.
In cases of severe eclampsia or pre-eclampsia, platelet levels in the blood may be low in conditions called thrombocytopenia. A full blood count, or CBC, is a blood test that can be performed to check platelet levels.
Other tests include: renal function tests (RFT), liver function tests (LFT), screen coagulation, 24 hour urine creatinine, and ultrasound/ultrasound placenta.
Differential diagnosis
Convulsions during pregnancy that are not associated with pre-eclampsia need to be distinguished from eclampsia. Such disorders include seizure disorders as well as brain tumors, brain aneurysms, and drug or medication seizures. Usually the presence of severe preeclampsia signs precedes and accompanies eclampsia, facilitating the diagnosis.
Prevention
Detection and management of pre-eclampsia is essential to reduce the risk of eclampsia. USPSTF recommends regular blood pressure checks through pregnancy to detect preeclampsia. Proper female management with pre-eclampsia generally involves the use of magnesium sulfate to prevent seizures.
Treatment
Four goals of eclampsia treatment are to stop and prevent further seizures, to control high blood pressure, to deliver the baby as soon as possible, and to monitor closely for multi-organ failure.
Convulsions
Convulsions are prevented and treated using magnesium sulphate. Studies showing the effectiveness of magnesium sulfate for eclampsia management were first published in 1955. Serum magnesium concentrations associated with maternal toxicity as well as neonatal respiratory depression, low muscle tone, and low Apgar scores were:
- 7.0-10.0 mEq/L: loss of patellar reflex
- 10.0-13.0 mEq/L: respiratory depression
- 15.0-25.0 mEq/L: atrioventricular conduction change and (further) complete heart block
- & gt; 25.0 mEq/L: cardiac arrest
With intravenous administration, the onset of anticonvulsant action is rapid and lasts about 30 minutes. After intramuscular administration the onset of action is about one hour and lasts for three to four hours. Effective anticonvulsant serum levels range from 2.5 to 7.5 mEq/liter. Magnesium is excreted only by the kidney at a rate proportional to plasma concentration and glomerular filtration.
Even with serum serum concentrations of therapy, recurrent seizures may occur, and additional magnesium may be required, but with close monitoring for respiratory, cardiac, and neurologic depression. If administration of magnesium with high serum concentrations fails to control seizures, the addition of intravenous anticonvulsants may be used, facilitating intubation and mechanical ventilation, and to avoid magnesium toxicity including maternal thoracic paralysis.
Magnesium sulfate produces better results than diazepam, phenytoin or a combination of chlorpromazine, promethazine and pethidine.
Blood pressure management
The agent of choice for controlling blood pressure during eclampsia is hydralazine and/or labetalol. This is because of their effectiveness, lack of negative effects on the fetus, and work mechanism.
Shipping
If the baby has not been born, steps should be taken to stabilize the woman and deliver it quickly. This needs to be done even if the baby is immature, because eclamptic conditions are not safe for infants and mothers. Since eclampsia is a manifestation of a type of dysfunction or failure of a non-infectious multiorgan, other organs (liver, kidney, lung, cardiovascular system, and coagulation systems) need to be assessed in preparation for labor (often caesarean), unless the woman is already in labor continue. Regional anesthesia for caesarean section is contraindicated when coagulopathy has developed.
Monitoring
Invasive hemodynamic monitoring may be selected in risky eclamptic women for or with cardiovascular disease, renal disease, refractory hypertension, pulmonary edema, or poor urine output.
Etymology
Greek nouns "????????" , eklampsÃÆ'a , showing "light bursts"; metaphorically, in this context, "a sudden event." The New Latin term first appeared in Johannes Varandaeus' 1620 treatise on gynecology Tractatus de affectibus Renum et Vesicae . The term pregnancy toxemia is no longer recommended: placental toxins are not the cause of eclampsia, as previously believed.
Popular culture
In Downton Abbey, the historical drama television series, Lady Sybil's character died (in season 3, episode 5) eclampsia shortly after the birth of a child.
In Call Midwife , a drama series of medical television held in London in the 1950s and 1960s, a character (in season 1, episode 4) named Margaret Jones was hit with pre-eclampsia, eventually progressing from the condition coma to death. The term "toxemia" is also used for that condition, in the dialogue.
At House M.D. , the US drama's television drama series, Dr. Cuddy, the director of the hospital, adopted a baby whose teenage mother died from eclampsia and had no other parent figure available.
References
External links
- Eclampsia in Curlie (based on DMOZ)
Source of the article : Wikipedia
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