Eclampsia is the most severe, critical form of gestosis, occurring with convulsive syndrome, loss of consciousness, development of post-eclampsia coma. The danger lies in the high probability of severe complications in a pregnant woman: cerebral hemorrhage, pulmonary edema, premature placental abruption, renal and hepatic insufficiency, as well as fetal death. The diagnosis is based on the clinical picture and laboratory data. Treatment is aimed at creating rest, relieving seizures, restoring and maintaining vital functions. With eclampsia, an early delivery of a pregnant woman is indicated.
ICD 10
O15 Eclampsia
General information
Clinical gynecology and obstetrics regards eclampsia as an extreme degree of severe gestosis. Convulsions, depression of consciousness and a comatose state in eclampsia develop rapidly, which caused the name of this pathology, translated from Greek meaning “a flash like lightning”. Less common is the convulsive form of eclampsia, which is accompanied by a cerebral hemorrhage.
Pathology develops in 1-1.5% of cases of all late pregnancy toxicosis (gestosis). In most cases, pathology is preceded by other clinical forms of toxicosis – dropsy, nephropathy and preeclampsia, which can replace each other gradually or rather quickly. This disease develops more often during the second half of pregnancy (in 68-75% of cases), less often during childbirth (27-30%), in some cases in the first 24-48 hours of the postpartum period (1-2%).
Causes
The determining factor in the development of eclampsia is damage to brain cells due to critical hypertension, vasoconstriction of blood vessels, increased permeability of the hemato-encephalic barrier, decreased cerebral blood flow, and impaired potassium-calcium balance.
Eclampsia, as a rule, develops against the background of persistent, unresponsive therapy, nephropathy or preeclampsia. Of particular importance is the failure of a pregnant woman to comply with the instructions of an obstetrician-gynecologist, diet and rest, abuse of bad habits. The risk group for the development of eclampsia includes pregnant women:
- primiparous of critical age (young and over 35 years old),
- with arterial hypertension,
- obesity,
- glomerulonephritis,
- diabetes mellitus,
- gastritis, colitis,
- systemic lupus erythematosus,
- rheumatoid arthritis, and other pathologies.
Aggravating obstetric factors include multiple pregnancy, trophoblastic disease, toxicosis of previous pregnancy, preeclampsia or eclampsia in close relatives.
Classification
According to the leading clinical feature, cerebral, renal, hepatic, comatose forms of eclampsia are distinguished.
- In the cerebral form, the determining disorder is a severe degree of arterial hypertension and related complications — ischemic or hemorrhagic stroke.
- The renal form, except for seizures and coma, is characterized by the development of anuria.
- The hepatic form is accompanied by deep metabolic disorders, hypoproteinemia, severe endotheliosis.
- Especially severe — comatose form of eclampsia proceeds without convulsions.
Symptoms of eclampsia
Usually, the development of eclampsia is preceded by a state of preeclampsia, characterized by headache, nausea, visual impairment, pain in the epigastrium and hypochondrium on the right, increased excitability and convulsive readiness. A typical eclampsia clinic includes sudden loss of consciousness and the development of a convulsive seizure. Convulsions in eclampsia have their own characteristics: at first there are separate small contractions of the facial muscles (15-30 seconds), which are replaced by tonic convulsions — spasm of skeletal muscles (15-20 seconds), and then by generalized clonic convulsions (convulsions) covering the muscles of the trunk and limbs.
With eclampsia, there may be one convulsive seizure or a whole series of them. A convulsive seizure is accompanied by short-term apnea, cyanosis, pupil dilation, tongue biting, foam discharge from the mouth. The duration of a convulsive attack is usually no more than 1.5-2 minutes. After the convulsions disappear, the pregnant woman falls into a coma. In the absence of the following attacks, there is a gradual restoration of consciousness. In some cases, a prolonged eclamptic coma develops, from which the patient may not come out.
An attack can be provoked by pain, any tension, an external stimulus (bright light, noise, loud sound), etc. Sometimes eclampsia develops rapidly right during childbirth with insufficient pain relief of contractions, difficult nature of labor (for example, with a narrow pelvis), excessively strong labor activity or its hyperstimulation. Eclampsia after cesarean section is possible in the case of early extubation performed before normalization of hemodynamic parameters, liver and kidney function, restoration of adequate independent breathing.
Complications
During a seizure and after it, a woman may develop pulmonary edema, asphyxia, cerebral hemorrhage, premature placental abruption. Due to intrauterine hypoxia, stillbirth often occurs.
Diagnostics
Disease is an acute, suddenly developing condition, therefore, traditional methods of examination of pregnant women (gynecological examination, ultrasound, ultrasound of uteroplacental blood flow) do not have diagnostic significance. The diagnosis of eclampsia is based on the observation of typical manifestations that make it possible to distinguish this form of gestosis from other brain lesions — aneurysms, epilepsy, tumors, as well as uremic and diabetic coma. Typical for eclampsia is:
- its connection with pregnancy,
- occurrence in the second half of gestation (after the 22nd week) or in the first postpartum day,
- previous severe gestosis with critical arterial hypertension
- short-term symptoms of preeclampsia.
In the case of eclampsia, there is no aura characteristic of epilepsy — i.e., small precursor symptoms. In order to exclude pulmonary edema, chest radiography is performed; CT and NMRI are used to assess the state of the brain.
Treatment of eclampsia
The principles treatment provide for the provision of complete rest for the pregnant woman, both physical and mental; the adoption of urgent measures to compensate and restore vital functions and prevent repeated seizures.
A patient with this disease is under constant monitoring of blood pressure, ECG, heart rate, EEG and laboratory parameters (CBS, electrolytes, hemoglobin, platelets, blood gas composition, etc.). For hourly monitoring of diuresis, catheterization of the bladder is performed. When eclampsia is carried out:
- long-term ventilation to ensure adequate blood oxygenation;
- drip intravenous administration of magnesium sulfate (to lower blood pressure and prevent seizures), dextran solution (to normalize the rheological properties of blood), glucose (to improve brain metabolism), diuretics (to relieve swelling of organs).
- the appointment of sedatives or narcotic drugs – allows you to prevent the recurrence of eclampsia attacks.
After the relative stabilization of the pregnant woman’s condition, careful delivery is indicated, more often by caesarean section. During the development of a convulsive seizure, resuscitation measures are carried out. Treatment of severe forms of eclampsia requires the involvement of a neurologist or neurosurgeon.
Prognosis and prevention
The prognosis for eclampsia is determined by the number and duration of seizures, as well as the duration of coma. Prevention of the extreme form of gestosis — eclampsia – requires prevention of the development of late toxicosis during pregnancy, timely detection and correction of dropsy, nephropathy and preeclampsia.
