The World of Pregnancy

Eclampsia: Causes, Symptoms, Paraclinic Diagnosis & Treatment!

Each year, there are tens of thousands of women and their families around that are affected by eclampsia. This is a illness specific to pregnant women, and has a special character because the signs occur very suddenly and late, so there`s no way whatsoever to be prevented. The causes of this condition aren`t known yet.

Eclampsia

What Is Eclampsia?

Eclampsia is a serious medical condition which occurs near the end of pregnancy, and is characterized by hypertension and seizures. It`s a dangerous condition, which can be fatal for both mother or fetus. The urine test is vital in finding this illness.

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The illness starts most of the time in the last trimester of pregnancy in women who are pregnant for the first time. In the first stage, there`s an arterial hypertension which occurs, existing an excess of proteins in edema and urine. In the second phase, there`re headaches, sore throat, visual lighting, vertigo as well as a pain in the area of the stomach. Finally, this condition resembles with an epilepsy crisis and consists in a loss of consciousness and convulsions. Sometimes, it triggers during or soon after birth. The absence of treatment may lead to the mother`s and fetus`s death.

Causes

No one knows exactly the causes of eclampsia. Still, this affection has the tendency of occurring mostly in young pregnant women, who are found in their first pregnancy. Women with pre-existing vascular diseases (arterial hypertension, diabetes, nephropathy) or with thrombophilic diseases (antiphospholipid syndrome) have a higher risk of developing eclampsia. Also, toxaemia is associated with issues related to the placenta: multiple pregnancy, hydatidiform mole. Moreover, there`s a genetic component: the patients with mothers or sisters who had toxaemia are prone to a higher risk.

Pathogeny

Despite in-depth research, the definite cause of this illness hasn`t been identified. It`s considered that at the basis of the condition`s crisis are stroke, cerebral edema, hypertensive encephalopathy, haemorrhage and mechanisms of cerebral vasoconstriction. Eclampsia produces lots of systemic disorders: hepatic (hepatocellular damage, periportal necrosis, subcapsular hematoma), cardiovascular (increase of peripheral vascular resistance, generalized vasospasm, decrease of venous pressure), haematological (decrease in plasma volume, coagulopathies, increase in blood viscosity and haemoconcentration), central nervous system disorders (cerebral edema, cerebral super-perfusion, cerebral haemorrhage) as well as hepatic (hepatocellular damage, periportal necrosis, subcapsular hematoma). The severity of these systemic disorders is often related with maternal medical factors and obstetrical factors.

Symptoms

The main signs of this condition are high blood pressure and the protein presence in the urine. That`s why with every consultation during your pregnancy you`ll have your blood pressure measures and you`ll give urine samples for analysis. So, it`s critical to visit the doctor on a regular basis. Also, it`s possible that these signs occur independently of each other and don`t really mean this condition has installed. Sudden swelling of the feet and hands might be a symptom, although again, this sign is common during pregnancy.

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At the onset of the illness, pregnant women don`t feel bad. However, in the following stages, various signs may occur, such as vomiting, pain in the upper abdomen, headaches or dizziness. Although all these signs might have other causes as well, a medical consultation is a must.

What Are the Risks?

This illness may cause issues for both the mother and baby. In the case of this medical condition, the placenta is no longer able to supply sufficient nutrients or oxygen to the baby, therefore stopping the normal development and growth of the baby.

As the illness evolves, it`s possible that the maternal brain, lungs, kidneys and liver are affected. In the more severe situations, the woman may experience crises, coma or might even die, although these situations rarely occur.

Paraclinic Diagnosis

The paraclinic examination needs to include the following laboratory tests: serum glucose measurement, blood count, liver function tests (LDH, AST), urine analysis for protein identification, electrolyte determination (calcium, magnesium). The most common hematological change is thrombocytopenia, which occurs in 17% of patients with eclampsia. CID is less common. The imaging diagnosis is recommended in case there are doubts regarding the diagnosis or to identify some possible lesions secondary to eclampsic crisis. A computerized tomography can exclude the intracranial haemorrhage, cerebral venous thrombosis and central nervous system lesions. Although a computerized tomography in eclampsia isn`t a routine examination, it was noticed abnormalities in over 50% of pregnant women. – More info!

Differential Diagnosis

  • Angioma;
  • Hypertensive encephalopathy;
  • Cerebral haemorrhage;
  • Metabolic disturbances;
  • Cerebral anneurysm;
  • Meningitis;
  • Cerebral vasculitis;
  • Primary aldosteronism;
  • Cerebral venous thrombosis.

Treatment

If you have a high blood pressure and have been found protein in your urine, you will perhaps be hospitalized to be supervised. Once the medical condition has occurred, the safest way is to choose a C-section or to induce labor. These interventions will be performed even if your pregnancy is at an early development stage. In most cases, the patient will heal without sequelae and there won`t be any recurrence during the following pregnancies. However, between 5% and 10% of women have complications for long periods of time (cardiac, cerebral or renal).

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Eclampsia can be prevented by systematically detecting symptoms of renal impairment (proteinuria, blood pressure) as well as the immediate precursors of the condition.

Complications

  • Cortical blindness;
  • CID;
  • Permanent neurological lesions;
  • Kidney failure;
  • Maternal or fetal death;

Prognosis

Around 25% of women with eclampsia will experience arterial hypertension in the following pregnancies.

In the case of most pregnant women who suffered this illness, the following pregnancies will be normal, although there`s a high risk of recurrence. If the condition has occurred twice, the risk of developing the disease the third time is quite high.

Image courtesy of ogpnews.com
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