Eclampsia

Key concepts

Eclampsia is the most feared complication of gestosis: it is a potentially deadly syndrome, characterized by convulsions often associated with mental confusion, coma and visual deficits.

Eclampsia: causes

The cause of eclampsia is not known. Possible risk factors include: alteration of the endocrine system, increase in free fatty acids, vascular endothelial damage, deficiency of coagulation capacity, incorrect diet, infections, nulliparity.

Eclampsia: symptoms

The main symptoms of eclampsia are: convulsions, mental confusion, visual changes, epigastric pain, nausea, headache and vomiting. In the fetus, eclampsia can cause fetal distress, placental abruption and placental hemorrhage.

Eclampsia: diagnosis

The diagnostic strategies for ascertaining eclampsia are: renal / hepatic function test, analysis of blood coagulation capacity, plasma concentration, urine analysis, blood count, transabdominal ultrasound.

Eclampsia: therapy

The drugs used in therapy to prevent eclampsia are: antihypertensives, anticonvulsants, antiplatelet agents, steroids. It is recommended to follow a diet rich in antioxidants.

Definition of eclampsia

Eclampsia is a serious acute complication of pregnancy, which puts a woman's life at serious risk: precisely, we are talking about the most formidable complication of pre-eclampsia, a multi-systemic syndrome characterized by the simultaneous presence of edema, arterial hypertension and proteinuria . The main symptom of eclampsia is the appearance of convulsions, often associated with mental confusion, coma and visual deficits.

Step back to understand ...

Pre-eclampsia ( toxemia gravidarium, or gestosis) is a complex syndrome that can occur only during pregnancy. By definition, preeclampsia must be characterized by the simultaneous presence of three elements:

1. Pressure increase:> 140-160mmHg (systolic pressure) and> 90-110 mmHg for diastolic → remember that 10% of pregnancies are complicated by hypertension
2. Proteinuria (urinary protein excretion):> 1g / L urine or> 300mg / 24h
3. Clear appearance of edema (swelling), especially in the lower limbs, extremities, face and trunk

Eclampsia is therefore a possible consequence of gestosis, and manifests itself in the parturient also in the absence of neurological alterations.

The triggering cause of eclampsia is not known, and is still under investigation; despite what has been said, it seems that the diet, the genetic predisposition and the state of health of the blood vessels play a decisive role in the triggering of this dramatic syndrome.

Eclampsia is a terrible disease that can cause the expectant mother to die. A woman suffering from preeclampsia must necessarily and constantly be monitored, to intervene promptly in the event of a worsening of symptoms. Some doctors recommend preventive therapy with anticonvulsant drugs (eg magnesium sulfate) to minimize the risk of eclampsia in women with gestosis.

Incidence

Eclampsia generally develops during or after the 20th week of gestation; however, there are also cases of postpartum eclampsia. From the medical statistics reported in the scientific journal Hypertension, it is clear that 90% of women affected by eclampsia show the first symptoms during the 28th week of gestation.

It is estimated that the majority of pregnant women manifest the first signs of eclampsia during the third trimester of pregnancy: 80% of these women experience convulsions during childbirth (or in any case after the first 48 hours after the birth of the child). Some cases of eclamptic seizures were diagnosed shortly before delivery, 23 days later or even 20 weeks after the birth of the child.

It is estimated that eclampsia occurs in a pregnancy every 2, 000-3, 000.

Causes

The main cause responsible for eclampsia is not yet clear. What is certain and indisputable is that eclampsia is a consequence of gestosis, the most serious and the most feared of all.

However, a mix of environmental and genetic factors seems to increase the risk of eclampsia in pregnant women.

We see, below, what are the risk factors involved in the degeneration of gestosis in eclampsia, according to a scientific study reported in the journal Hypertension :

• Improper nutrition (food shortages or excess; excess sodium in the diet; lack of calcium and magnesium)
• Endocrine disturbance
• Changes in blood coagulation capacity
• Increased free fatty acids
• Increase in insulinemia
• Vascular endothelial damage
• Unfavorable outcome of the previous pregnancy
• Age over 35 years
• Twin pregnancies
• Infections
• nulliparity
• Genetic predisposition
• First pregnancy

In addition to these risk factors, additional, possible, eclampsia-predisposing diseases have also been identified:

• Lack of protein S or protein C (anticoagulant factors)
• Pregnancy diabetes
• Connective and vascular tissue disorders
• Chronic hypertension
• Systemic lupus erythematosus
• Kidney diseases
• Obesity
• Antiphospholipid antibody syndrome

Symptoms

By definition, the distinctive symptom of eclampsia is convulsions, which are often accompanied by other prodromes:

1. General confusion
2. Visual deficiencies (eg blurred vision, blindness)
3. Epigastric pain
4. Nausea
5. Headache
6. He retched

The symptoms described above are "premonitory", that is to say they are useful signs to signal a possible (and imminent) collapse of the typical clinical picture of gestosis (let us remember once again that eclampsia constitutes the most formidable complication of gestosis).

Eclampsia can be compared to a time bomb: convulsions and warning symptoms are not the only prodromes that characterize the clinical picture. The eclampsia triggers a series of chain events that, if not promptly intervened, lead to death.

Eclampsia is in fact a real syndrome, which involves more organs and tissues: blood, liver, kidneys, heart and CNS can be simultaneously compromised. From the above, the severity of eclampsia is clearly understandable.

The most frequent symptoms associated with eclampsia are summarized in the table.

We must not forget, however, that the fetus is also involved in the eclampsia of the mother: the syndrome can cause severe fetal distress, detachment of the placenta or placental hemorrhage.

In the next articles we will focus on the possible complications derived from eclampsia, on diagnostic strategies and currently available therapies.