Complication of gestosis
Eclampsia is the most terrible acute complication of gestosis (or pre-eclampsia): we are talking about a complex exclusive pregnancy syndrome, characterized by the appearance of convulsions, mental confusion, headache, vision changes and coma.
Eclampsia is a potentially deadly disease, which unfortunately still has many victims: pregnant women with hypertension, edema and proteinuria (trilogy of symptoms that marks preeclampsia) must be constantly monitored, because they are more exposed to the risk of eclampsia.
Complications
A state of preeclampsia can rapidly precipitate in eclampsia: the collapse of the clinical picture is always symptomatic - therefore the woman is aware of the problem - and is characterized by marked convulsive crises.
In addition to seizures, headache, mental confusion and coma, pregnant women with eclampsia can experience serious complications:
- Hepatic changes
- Temporary / permanent blindness: typical visual disturbances of eclampsia can degenerate into total blindness (sometimes reversible)
- Disseminated intravascular coagulation
- Neurological complications: coma + motor deficits
- Coagulation defects: ↓ fibrinogen, ↑ prothrombin time, presence of circulating fibrin degradation products
- Intracranial hemorrhage (or hematoma)
- Cerebral infarction
- Kidney failure
- Maternal and / or fetal death
- Rupture of the hepatic capsule: a rare complication that causes both the mother and the fetus to die
- Respiratory distress syndrome
- Hemolytic-uremic syndrome: microangiopathy + thrombocytopenia + renal failure + hemolytic anemia
- Cerebral venous thrombosis
Diagnosis
Not necessarily the appearance of convulsions in a pregnant woman is synonymous with eclampsia. The differential diagnosis is therefore of primary importance, and must be placed with all the diseases that can induce seizures: cerebral aneurysm, convulsions from reaction to a drug, brain tumor.
The most useful diagnostic tests to ascertain a suspicion of eclampsia are:
- Renal function test
- Liver function test
- Analysis of blood coagulation capacity: evaluation of prothrombin time and fibrinogen plasma concentration
- Plasma concentration
- Urine analysis: as we know, proteinuria is one of the recurrent symptoms in gestosis and eclampsia. From what has been said, it is understandable how the analysis of urine in 24 hours is essential to diagnose a possible proteinuria (proteins:> 300mg / 24 h or> 1g / L urine).
- Blood count: complete laboratory test, useful for evaluating the quantity of blood components and for determining the level of hemoglobin and hematocrit.
- Trans-abdominal ultrasound: used to estimate gestational age. This diagnostic test is also used to ascertain or deny a possible detachment of the placenta, a symptom that clearly complicates the clinical picture of eclampsia.
When convulsions occur during the first trimester of gestation, it is conceivable that the cause lies in CNS alterations. To ascertain or deny the hypothesis, the woman can undergo more diagnostic tests: CT scan of the head (computed tomography), lumbar puncture or rachicentesis (to ascertain or deny a hypothetical meningitis or ongoing haemorrhage), determination of electrolyte levels urine.
No laboratory test is useful for predicting maternal or fetal outcome in women with eclampsia.
Prognosis
A state of preeclampsia (gestosis) increases the risk of complications, such as fetal growth retardation, low birth weight, pre-term birth, respiratory distress syndrome and, of course, eclampsia.
It is estimated that the maternal eclampsia mortality rate is 1.8%; 35% of women with eclampsia experience at least one of the serious complications.
In the next article we will try to understand which therapeutic strategies can be undertaken to prevent and treat eclampsia.
