The term eclampsia refers to a serious condition that can occur during pregnancy, characterised by seizures and potentially life-threatening complications for both the mother and unborn child. It can occur unexpectedly, usually after the 20th week of pregnancy. However, this is a rare condition and affects less than 3% of individuals with pre-eclampsia, a pregnancy-related hypertensive disease.

Awareness of the underlying factors is crucial for prompt diagnosis and management. It is also essential for medical students to cover their syllabus when preparing for exams like MBBS and NEET PG. 

Here’s what you need to know about eclampsia: its causes, symptoms, risk factors, diagnosis, and treatment options.

What is Eclampsia?

Eclampsia is defined by generalised seizure(s) in a pregnant woman with pre-eclampsia. It is an obstetric complication characterised by high blood pressure with or without proteinuria (an excess of protein in the urine) or other signs of organ dysfunction after 20 weeks gestation.

Following are some additional details about the condition:

• Eclampsia is an advanced form of pre-eclampsia and can lead to maternal and foetal morbidity if not treated promptly.
• Pre-eclampsia and eclampsia are part of the spectrum of hypertensive disorders in pregnancy. 
• In contrast, pre-eclampsia can be without symptoms or with mild symptoms such as oedema, but eclampsia is characterised by the development of seizures, indicating a severe diagnosis. 

It is essential to note this spectrum, as early detection and intervention strategies hinge on it.

What are the Causes of Eclampsia?

The aetiologies of eclampsia are multifactorial and not fully understood but are suggested by multiple factors associated with its occurrence. These include:

• Genetics: Family history can play a factor in susceptibility.
• Immunological Factors: Abnormal Immunoglobulin G (IgG) may lead to endothelial dysfunction.
• Abnormal Trophoblastic Invasion: Defective implantation of the placenta is related to pre-eclampsia and eclampsia. 
• Coagulation Disorders: Disruption of blood clotting mechanisms may amplify risk.
• Vascular Endothelial Injury: Injuries to blood vessel linings can cause hypertension or organ impairment.
• Nutritional Deficiencies: Low levels of vital vitamins and minerals can increase the risk.

Pathophysiology of Eclampsia

• Extreme hypertension during eclampsia results in abnormal regulation of cerebral blood flow, resulting in loss of autoregulation and subsequent risk of cerebral oedema. 
• This can lead to seizures and other neurological problems. 
• The pathophysiology of eclampsia includes increased production of certain proteins and cytokines while undergoing a state of endothelial dysfunction.

What are the Risk Factors of Eclampsia?

Several risk factors increase the likelihood of developing eclampsia, particularly in women with pre-eclampsia:

• Oligohydramnios: The absence of amniotic fluid during pregnancy can increase the risk of Deep Vein Thrombosis (DVT).
• Family History: A family history of pre-eclampsia or eclampsia is a risk factor.
• Previous Pre-eclampsia: Women with a history of pre-eclampsia in a prior pregnancy are at increased risk of developing eclampsia.
• Multiple Pregnancies: The risk is higher in pregnancies that include more than one fetus.
• Chronic Hypertension: Having high blood pressure before pregnancy is a major risk.
• Insufficient Prenatal Care: The absence of regular prenatal examinations can result in untreated pre-eclampsia, subsequently elevating the chance of eclampsia.

Additional risk factors include obesity, chronic hypertension, renal disease, and inadequate prenatal care.

What are the Symptoms of Eclampsia?

Eclampsia is defined as the occurrence of generalised seizures, typically tonic-clonic, that may occur before, during, or after delivery. Here are some of the major symptoms:

• Seizures: The hallmark symptom of eclampsia.
• Confusion or Coma: Post-seizure states.
• Aspiration Pneumonia: Risk due to aspiration during seizures.
• Cerebral Hemorrhage: Potential complication due to severe hypertension.
• Kidney Failure: Resulting from severe organ dysfunction.

Other complications associated with eclampsia include: 

• Pulmonary oedema 
• HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelets) syndrome 
• Coagulopathy 
• Placental abruption 
• Cardiac arrest

How to Diagnose Eclampsia Condition?

A clinical diagnosis of eclampsia occurs when a woman with pre-eclampsia develops seizures: 

• Pre-eclampsia is diagnosed with high blood pressure after 20 weeks of gestation, with evidence of organ dysfunction (proteinuria, elevated liver enzymes, or thrombocytopenia). 
• Results from blood tests and urine analysis are essential to evaluate organ function and to confirm the diagnosis.

Diagnostic Criteria

• Hypertension: Systolic pressure ≥ 140 mmHg or diastolic pressure ≥ 90 mmHg.
• Proteinuria: Presence of excess protein in the urine.
• Organ Dysfunction: Signs include increased liver enzymes or thrombocytopenia.

Monitoring Eclampsia

Foetal and maternal monitoring is essential. This can include: 

• Routine blood pressure monitoring 
• Blood tests to examine the liver and kidney function 
• Foetal monitoring to ensure the baby’s well-being 
• Ultrasound to help evaluate the fetus’s growth and amniotic fluid levels

What are the Treatment Options for Eclampsia?

Treatment for eclampsia involves immediate management of seizures with:

• Magnesium Sulfate: Administered intravenously to prevent seizures.
• Blood Pressure Management: Medications to control hypertension, like hydralazine or labetalol.
• Delivery: Often necessary to resolve eclampsia.
• Post-Delivery Care: Continued monitoring and treatment to prevent complications.

This includes close observation for signs of organ dysfunction and management of any ongoing hypertension or other complications that may arise.

Long-Term Management for Eclampsia

• Monitoring for potential long-term effects on cardiovascular health and ensuring that blood pressure is well-controlled postpartum. 
• Women who have experienced eclampsia may be at increased risk for future cardiovascular events, making ongoing health monitoring essential.

FAQs About Eclampsia

1. What are the three types of eclampsia?

Eclampsia can be classified based on the timing of pregnancy. Antepartum eclampsia occurs before labour, intrapartum eclampsia happens during labour, and postpartum eclampsia develops after delivery, typically within 48 hours, but can occur up to six weeks postpartum. Each type requires immediate medical intervention to prevent severe complications.

2. What BP causes eclampsia?

Eclampsia is typically associated with severe hypertension, where systolic blood pressure is ≥160 mmHg or diastolic blood pressure is ≥110 mmHg. However, seizures can still occur at lower blood pressure levels, especially in women with pre-eclampsia. Monitoring and managing high blood pressure during pregnancy is crucial to preventing complications like eclampsia.

3. What is stage 4 eclampsia?

There is no formal staging system for eclampsia, but severe cases can lead to multi-organ failure, cerebral haemorrhage, or coma, often considered the most critical stage. This advanced state requires intensive care, including seizure control, blood pressure management, and potential emergency delivery to save both the mother and the baby.

4. What is the first treatment for eclampsia?

The first-line treatment for eclampsia is intravenous magnesium sulfate, which helps prevent and control seizures. Blood pressure medications like hydralazine or labetalol are also administered to manage severe hypertension. In most cases, delivery of the baby is the definitive treatment, as eclampsia is only resolved after childbirth.

5. Who is most at risk for eclampsia?

Women at the highest risk for eclampsia include those with pre-eclampsia, chronic hypertension, kidney disease, diabetes, or a history of eclampsia in previous pregnancies. Other risk factors include multiple pregnancies, obesity, insufficient prenatal care, and autoimmune disorders. Early screening and prenatal monitoring are essential for managing high-risk pregnancies.

6. What is a CBC blood test for pre-eclampsia?

A Complete Blood Count (CBC) test helps assess complications of pre-eclampsia, such as low platelet count (thrombocytopenia), anaemia, and potential organ dysfunction. It is part of a broader diagnostic approach, along with liver function tests and kidney function assessments, to evaluate the severity of pre-eclampsia and guide treatment decisions.

Conclusion

Eclampsia is a severe complication of pregnancy that requires immediate medical attention to prevent maternal and foetal morbidity. Understanding the causes, symptoms, risk factors, diagnosis, and treatment options for eclampsia is essential for healthcare providers and pregnant women. 

Early detection and management of pre-eclampsia can significantly reduce the risk of eclampsia. Proper prenatal care and timely intervention can save lives and improve outcomes for both mothers and babies. 

DocTutorials offers comprehensive educational materials, including video lectures, study aids, mentorship, question banks, mock tests, and more. They can be ideal for medical professionals and students interested in learning about pregnancy-related complications and their management. Enrol in our NEET PG courses today and solidify your exam preparation!