Eclampsia

Eclampsia is an attack of tonic-clonic convulsions in a pregnant woman following previous severe preeclampsia or superimposed preeclampsia. There are also forms without preeclampsia ( eclampsia sine preeclampsia ) or forms without convulsions, only unconsciousness ( eclampsia sine eclampsia ). Seizures occur most often at the end of pregnancy and during childbirth, rarely also in the sixth trimester.

Pathogenesis
The cause of eclampsia is a generalized spasm in the CNS, which leads to hypoxia and then to brain edema , resulting in morphological changes in the brain tissue.

Progress [ edit | edit source ]

 * 1) Prodrome phase – restlessness, twitching of the face, turning of the bulbs and head to the side, severe headaches, nausea , pain in the epigastrium, vomiting.
 * 2) The phase of tonic convulsions - affecting the masticatory muscles, chest muscles and diaphragm ( apnea ), then back muscle spasms - opisthotonus , upper limbs - boxing position, lasts a few seconds.
 * 3) The phase of clonic convulsions – the body is reeling in uncoordinated movements, the hands perform a movement reminiscent of tambora drumming, may last several minutes.
 * 4) Coma - after the convulsions subside, the woman falls into a coma, mydriasis , hyporeflexia, deep breathing, after waking up there is amnesia.


 * If untreated, the seizure may recur and status eclampticus occurs.

First Aid
The first aid kit is prepared in the delivery room and contains: airway (complete set) to secure the airways, diazepam (we apply 5–10 mg iv) and MgSO 4 4–6 g/5 min iv The use of magnesium alone has better results, than using diazepam alone.


 * We will introduce a nasogastric tube (prevention of aspiration ), a permanent catheter, oxygen, and put the woman in a dark room before giving birth.
 * If a seizure occurs, regardless of the fetus, we terminate the pregnancy by caesarean section . It is better to bring the woman out of the coma and stabilize her before the operation, but in an urgent situation we also operate in a coma.

Complications
Complications include CNS hemorrhage, pulmonary edema , circulatory failure , uterine hypertonus, and premature placental abruption with development of DIC , anemia , hepatorenal failure. After managing the acute condition - in the ICU, we monitor, antihypertensive treatment continues, we apply MgSO 4 , we maintain circulation, we monitor. Then we translate to Sect. six-month-old – we monitor BP every 4 hours, laboratory. After discharge, we check once a week for 6 weeks (obstetrician and internist).

Related Articles

 * Hypertension in pregnancy
 * Hypertension
 * Antihypertensives
 * Preeclampsia