Eclampsia

Eclampsia
A gross anatomy image of a placenta that has been cut after delivery
SpecialtyObstetrics
SymptomsSeizures, high blood pressure[1]
ComplicationsAspiration pneumonia, cerebral hemorrhage, kidney failure, cardiac arrest[1]
Usual onsetAfter 20 weeks of pregnancy[1]
Risk factorsPre-eclampsia[1]
PreventionAspirin, calcium supplementation, treatment of prior hypertension[2][3]
TreatmentMagnesium sulfate, hydralazine, emergency delivery[1][4]
Prognosis1% risk of death[1]
Frequency1.4% of deliveries[5]
Deaths46,900 hypertensive diseases of pregnancy (2015)[6]

Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia.[1] Pre-eclampsia is a hypertensive disorder of pregnancy that presents with three main features: new onset of high blood pressure, large amounts of protein in the urine or other organ dysfunction, and edema.[7][8][9] If left untreated, pre-eclampsia can result in long-term consequences for the mother, namely increased risk of cardiovascular diseases and associated complications.[10] In more severe cases, it may be fatal for both the mother and the fetus.[11]

The diagnostic criterion for pre-eclampsia is high blood pressure, occurring after 20 weeks gestation or during the second half of pregnancy.[1] Most often it occurs during the 3rd trimester of pregnancy and may occur before, during, or after delivery.[1] The seizures are of the tonic–clonic type and typically last about a minute.[1] Following the seizure, there is either a period of confusion or coma.[1] Other complications include aspiration pneumonia, cerebral hemorrhage, kidney failure, pulmonary edema, HELLP syndrome, coagulopathy, placental abruption and cardiac arrest.[1]

Low dose aspirin is recommended to prevent pre-eclampsia and eclampsia in those at high risk.[12] Other preventative recommendations include calcium supplementation in areas with low calcium intake and treatment of prior hypertension with anti-hypertensive medications.[2][3] Exercise during pregnancy may also be useful.[1] The use of intravenous or intramuscular magnesium sulfate improves outcomes in those with severe pre-eclampsia and eclampsia and is generally safe.[4][13] Treatment options include blood pressure medications such as hydralazine and emergency delivery of the baby either vaginally or by cesarean section.[1]

Pre-eclampsia is estimated to globally affect about 5% of deliveries while eclampsia affects about 1.4% of deliveries.[5] In the developed world eclampsia rates are about 1 in 2,000 deliveries due to improved medical care whereas in developing countries it can impact 10–30 times as many women.[1][14] Hypertensive disorders of pregnancy are one of the most common causes of death in pregnancy.[14] They resulted in 46,900 deaths in 2015.[6] Maternal mortality due to eclampsia occurs at a rate of approximately 0–1.8% of cases in high-income countries and up to 15% of cases in low- to middle- income countries.[15] The word eclampsia is from the Greek term for lightning.[16] The first known description of the condition was by Hippocrates in the 5th century BC.[16]

  1. ^ a b c d e f g h i j k l m n o "Chapter 40: Hypertensive Disorders". Williams Obstetrics (24th ed.). McGraw-Hill Professional. 2014. ISBN 9780071798938.
  2. ^ a b WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia (PDF). 2011. ISBN 978-92-4-154833-5. Archived (PDF) from the original on 2015-05-13.
  3. ^ a b Henderson, JT; Whitlock, EP; O'Connor, E; Senger, CA; Thompson, JH; Rowland, MG (20 May 2014). "Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force". Annals of Internal Medicine. 160 (10): 695–703. doi:10.7326/M13-2844. PMID 24711050. S2CID 33835367.
  4. ^ a b Smith, JM; Lowe, RF; Fullerton, J; Currie, SM; Harris, L; Felker-Kantor, E (5 February 2013). "An integrative review of the side effects related to the use of magnesium sulfate for pre-eclampsia and eclampsia management". BMC Pregnancy and Childbirth. 13: 34. doi:10.1186/1471-2393-13-34. PMC 3570392. PMID 23383864.
  5. ^ a b Abalos, E; Cuesta, C; Grosso, AL; Chou, D; Say, L (September 2013). "Global and regional estimates of preeclampsia and eclampsia: a systematic review". European Journal of Obstetrics, Gynecology, and Reproductive Biology. 170 (1): 1–7. doi:10.1016/j.ejogrb.2013.05.005. PMID 23746796.
  6. ^ a b Wang, Haidong; et al. (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  7. ^ Lambert, G; Brichant, JF; Hartstein, G; Bonhomme, V; Dewandre, PY (2014). "Preeclampsia: an update". Acta Anaesthesiologica Belgica. 65 (4): 137–49. PMID 25622379.
  8. ^ Brown, Mark A.; Magee, Laura A.; Kenny, Louise C.; Karumanchi, S. Ananth; McCarthy, Fergus P.; Saito, Shigeru; Hall, David R.; Warren, Charlotte E.; Adoyi, Gloria; Ishaku, Salisu (July 2018). "Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice". Hypertension. 72 (1): 24–43. doi:10.1161/HYPERTENSIONAHA.117.10803. ISSN 0194-911X. PMID 29899139. S2CID 49184061.
  9. ^ American College of Obstetricians Gynecologists; Task Force on Hypertension in Pregnancy (November 2013). "Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy" (PDF). Obstet. Gynecol. 122 (5): 1122–1131. doi:10.1097/01.AOG.0000437382.03963.88. PMC 1126958. PMID 24150027. Archived from the original (PDF) on 2016-01-06. Retrieved 2015-02-22.
  10. ^ Bokslag, Anouk; van Weissenbruch, Mirjam; Mol, Ben Willem; de Groot, Christianne J. M. (2016-11-01). "Preeclampsia; short and long-term consequences for mother and neonate". Early Human Development. Special Issue: Neonatal Update 2016. 102: 47–50. doi:10.1016/j.earlhumdev.2016.09.007. ISSN 0378-3782. PMID 27659865.
  11. ^ Chappell, Lucy C.; Cluver, Catherine A.; Kingdom, John; Tong, Stephen (2021-07-24). "Pre-eclampsia". Lancet. 398 (10297): 341–354. doi:10.1016/S0140-6736(20)32335-7. ISSN 1474-547X. PMID 34051884.
  12. ^ "Low-Dose Aspirin Use During Pregnancy". www.acog.org. Retrieved 2023-01-27.
  13. ^ McDonald, SD; Lutsiv, O; Dzaja, N; Duley, L (August 2012). "A systematic review of maternal and infant outcomes following magnesium sulfate for pre-eclampsia/eclampsia in real-world use". International Journal of Gynaecology and Obstetrics. 118 (2): 90–96. doi:10.1016/j.ijgo.2012.01.028. PMID 22703834. S2CID 20361780.
  14. ^ a b Arulkumaran, N.; Lightstone, L. (December 2013). "Severe pre-eclampsia and hypertensive crises". Best Practice & Research Clinical Obstetrics & Gynaecology. 27 (6): 877–884. doi:10.1016/j.bpobgyn.2013.07.003. PMID 23962474.
  15. ^ Ghulmiyyah, Labib; Sibai, Baha (2012-02-01). "Maternal Mortality From Preeclampsia/Eclampsia". Seminars in Perinatology. 36 (1): 56–59. doi:10.1053/j.semperi.2011.09.011. ISSN 0146-0005. PMID 22280867. S2CID 37681246.
  16. ^ a b Emile R. Mohler (2006). Advanced Therapy in Hypertension and Vascular Disease. PMPH-USA. pp. 407–408. ISBN 9781550093186. Archived from the original on 2017-09-10.