Eclampsia, Causes, Diagnosis, Treatment, Prevention, Complications

Eclampsia is a pregnancy complication characterized by high blood pressure and seizures before, during or after delivery. This emergency condition can occur after the sufferer has preeclampsia.

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Eclampsia, Causes, Diagnosis, Treatment, Prevention, Complications

Eclampsia is an advanced condition of preeclampsia. Eclampsia is generally rare, but must be treated immediately because it can endanger the life of pregnant women and their fetuses. This condition generally occurs when the gestational age reaches 20 weeks or more.

Causes of Eclampsia

Until now, the causes of preeclampsia and eclampsia are not known with certainty. However, this condition is thought to be caused by abnormalities in the shape and function of the placenta.

Although the cause is unknown, there are several factors that are thought to trigger preeclampsia and eclampsia, namely:

History of preeclampsia in a previous pregnancy
Family history of preeclampsia or eclampsia
Pregnant at the age of less than 20 years or more than 40 years
History of diabetes, kidney disease, sickle cell anemia, obesity, and autoimmune diseases, such as lupus and antiphospholipid syndrome (APS)
Twin pregnancy
The pregnancy being undertaken is the result of IVF method

Symptoms of Eclampsia

The main symptom of eclampsia are seizures that occur before, during, or after labour. Eclampsia always follows preeclampsia. Meanwhile, preeclampsia itself can arise from the age of 20 weeks of pregnancy.

Preeclampsia is characterized by blood pressure that is more than 140/90 mm Hg, the presence of protein in the urine, and can be accompanied by swelling in the legs. If not treated, preeclampsia can lead to eclampsia.

In some cases, impending eclampsia can occur which is characterized by:

Blood pressure is getting higher
Severe headache
Nausea and vomiting
Abdominal pain, especially in the upper right
Swelling in hands and feet
Impaired vision
Decreased frequency and amount of urine (oliguria)
Increased levels of protein in the urine

If it continues, sufferers can experience seizures. These seizures can occur before, during, or after labour.

Eclampsia seizures can occur once or repeatedly. However, there are two phases of seizures that can occur when experiencing eclampsia, namely:

First phase

In this phase, the spasm lasts 15–20 seconds, which is accompanied by twitching of the face, then muscle contractions occur throughout the body.

Second phase

The second phase of seizures lasts for 60 seconds, starting in the jaw, then radiating to the facial muscles, eyelids, and finally spreading to the rest of the body. In this phase, eclampsia seizures cause the muscles to contract and relax repeatedly in a fast time.

When to see a doctor

Immediately take it to the emergency room at the nearest hospital if you see a pregnant woman having seizures or symptoms of impending eclampsia as mentioned above. Early treatment is needed to prevent eclampsia and complications.

Pregnant women who have high blood pressure during pregnancy or have been diagnosed with preeclampsia are advised to have their pregnancies checked more often.

While in a normal pregnancy, follow the routine check-up schedule to the doctor as follows:

Week 4 to 28: 1 month
28th to 36th week: once every 2 weeks
Week 36 to 40: 1 week

Diagnosis of Eclampsia

To diagnose eclampsia, the doctor will ask the family who brought the pregnant woman to the hospital about the seizures she is experiencing, including a history of previous prenatal checks, illnesses, and preeclampsia.

After that, the doctor will carry out a thorough physical examination to determine whether the condition of the pregnant woman and fetus is stable.

To make a diagnosis, the doctor will carry out several supporting examinations, which include:

Blood test, to check the number of blood platelets
Urine test, to determine the level of protein in the urine
Liver function tests, to check for damage to the liver
Kidney function tests, including urea and creatine, to measure the level of creatine in the kidneys and detect kidney damage
Ultrasonography (USG), to check the condition of the fetus

Eclampsia Treatment

The only way to treat eclampsia is to deliver the baby. In pregnant women with preeclampsia who are at risk of experiencing eclampsia, doctors will carry out several treatments, such as:

Provide blood pressure control drugs and vitamins
Suggest bed rest in the hospital or at home under the supervision of a doctor
Monitor the condition of the fetus and pregnant women regularly

In pregnant women who experience eclampsia, doctors will give anti-seizure drugs. Infusion of magnesium sulfate (MgSO4) is the first choice for treating seizures in eclampsia.

However, if the seizures do not improve with magnesium sulfate, the doctor can give benzodiazepines and phenytoin.

Early labour

Pregnant women who experience severe preeclampsia or eclampsia will be advised to undergo labor as soon as possible. However, if the fetus is not old enough to be born, the doctor will give corticosteroid injections to accelerate the maturation of the fetal lungs.

Meanwhile, if eclampsia occurs in pregnant women with a gestational age of 34 weeks or more, the doctor will recommend delivery by caesarean section.

Eclampsia complications

Without proper treatment, eclampsia can cause serious complications, including the death of the pregnant woman and fetus. Untreated eclampsia can also cause a number of health complications, such as:

Side effects of seizures, such as biting the tongue, broken bones, head injuries, and aspiration pneumonia due to gastric contents entering the respiratory tract
Damage to the central nervous system, bleeding in the brain, impaired vision, even blindness, due to repeated seizures
Organ damage, such as kidney failure and liver failure
HELLP syndrome and disorders of the circulatory system, such as disseminated intravascular coagulation (DIC)
Pregnancy disorders, for example fetal growth retardation, placental abruption, oligohydramnios, or babies born prematurely
Coronary heart disease and stroke
The risk of experiencing preeclampsia and eclampsia in subsequent pregnancies

Eclampsia Prevention

There is no specific way to prevent preeclampsia or eclampsia. However, there are several efforts that can be made by expectant mothers and pregnant women to reduce the risk of eclampsia, namely:

Undergo routine control to the doctor during pregnancy
Maintain ideal body weight before and during pregnancy
Do not smoke and do not consume alcoholic beverages
Take additional supplements according to doctor's advice

For pregnant women who are at high risk of experiencing preeclampsia, giving aspirin can prevent eclampsia. However, the administration of aspirin must be on the advice of a doctor.

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