Eclampsia
Eclampsia is a serious medical condition that can affect women during pregnancy. It is a continuation or complication of preeclampsia, a rare, serious condition in which high blood pressure can cause seizures during pregnancy.
Pregnant women with pre-eclampsia or severe hypertension during pregnancy are at risk of experiencing eclampsia which is characterized by seizures followed by decreased consciousness or coma. Eclampsia is rare, but if it occurs it must be treated immediately. This is because the condition has the potential to threaten the safety of the mother and fetus in the womb.
Symptoms of Eclampsia
Eclampsia symptoms can appear at any time during pregnancy. However, the emergence of eclampsia in pregnant women is always preceded by preeclampsia. Here are the most common symptoms of preeclampsia, including:
- Severe headache.
- Excessive weight gain during pregnancy, more than 1 kg per week.
- Vision problems, such as loss of vision, blurred vision, and double vision.
- Nausea, vomiting, or stomach pain
- Swelling of the hands, feet, and face.
If preeclampsia has progressed to eclampsia, symptoms may include:
- Seizures, initially twitching or spasms in the facial muscles and then spreading throughout the body.
- Decreased consciousness or coma occurs after a whole-body seizure occurs.
It should be noted that some symptoms of preeclampsia or eclampsia that occur may be caused by other health conditions, such as kidney disease or diabetes. Therefore, it is important to immediately see a doctor if you experience one or a number of these symptoms. This aims to ensure that the symptoms felt can really be known the cause.
Causes of Eclampsia
Until now, the exact cause of eclampsia is unknown. However, the condition of eclampsia is thought to be related to several things, such as:
- Abnormalities in the placenta and its function.
- Weak blood flow to the placenta.
- Damage to placental blood vessels.
- Genetic factors.
Risk Factors for Eclampsia
There are several risk factors that can cause complications from preeclampsia, thus triggering eclampsia. Here is a description of these risk factors, including:
- Getting pregnant at an older age (over 35 years) or adolescence (under 20 years).
- Have a history of eclampsia in a previous pregnancy.
- Have a history of hypertension before pregnancy.
- History of gestational diabetes, which is diabetes that occurs during pregnancy.
- Twin pregnancy.
- Family history of pre-eclampsia or eclampsia.
- Obesity.
- Has a history of lupus, rheumatoid arthritis, and kidney disease.
- Pregnant women who suffer from autoimmune diseases.
- Have undergone in vitro fertilization or IVF.
Diagnosis of Eclampsia
In pregnant women with seizures, the doctor will determine whether the seizures are due to complications of preeclampsia or other causes. Supporting examinations that can help establish the diagnosis:
- Blood Laboratory Tests. Complete blood count can help doctors detect complications of preeclampsia and eclampsia, namely HELLP syndrome with signs of decreased hemoglobin, increased liver enzymes, and thrombocytopenia. Other tests with coagulation studies include prothrombin time (PT), partial prothrombin activation time (aPTT), fibrinogen, and D-Dimer to detect disseminated intravascular coagulation (DIC) which is another complication of preeclampsia and eclampsia.
- Urine Examination. Proteinuria, protein detected in the urine is the most common sign of eclampsia and is very helpful in diagnosing previously undetected pre-eclampsia.
- Kidney Function Examination. Kidney function can be detected by examining serum creatinine which will increase if there is kidney damage due to pre-eclampsia and eclampsia.
- Ultrasonography Examination. This examination is done to see the condition of the placenta and the condition of the fetus, check the fetal heart rate, and fetal growth. An ultrasound examination can be done immediately after a seizure to assess the condition of the fetus, whether there is fetal distress due to the seizure.
- Other Imaging Examinations. For example, CT Scan and MRI can be performed if there is suspicion of complications in the brain such as swelling of brain tissue (edema cerebral) and brain bleeding due to seizures.
Eclampsia Treatment
Seizures in eclampsia are a life-threatening emergency for both mother and baby. Therefore, delivery is the primary treatment that can be done to treat eclampsia.
Meanwhile, first aid for eclampsia symptoms is to stop the seizures using drugs. Here is a description of the drugs used as first aid for eclampsia, namely:
- Anticonvulsant (anti-seizure) drugs: Magnesium sulfate slow intravenous injection. Magnesium sulfate can relax muscles that are spasming. Magnesium sulfate is given by slow intravenous injection to stop the seizure, then maintenance therapy with magnesium sulfate infusion for 24 hours even though there is no seizure to avoid recurrent seizures.
- Lorazepam or Diazepam can be given if there are contraindications to magnesium sulfate
- Phenytoin can be given if you experience repeated seizures even though magnesium sulfate has been given.
- Antihypertensive drugs should be given as soon as possible after magnesium sulfate is given if the blood pressure is above 160/110 mmHg. The target blood pressure is 140–160/90–110 mmHg. Antihypertensive drugs that can be used are labetalol or nifedipine.
- Diuretic drugs such as furosemide can be given if there is fluid in the lungs (pulmonary edema).
After the seizures are managed, the next step is to give birth to the baby. The birth process can be through normal vaginal delivery or cesarean section, depending on the mother’s condition and gestational age. If the gestational age is full term, the mother’s condition allows for normal delivery, and there is no fetal distress, then normal vaginal delivery will be attempted.
Patients can also be given labor induction with an injection or infusion of oxytocin to stimulate uterine contractions if there are not enough contractions for normal delivery. If there is fetal distress and the mother’s condition does not allow for normal delivery, then a cesarean delivery is performed immediately. If the gestational age is not yet full term or less than 34 weeks, then a corticosteroid injection can be given to stimulate lung maturation in the baby.
Complications of Eclampsia
Delayed diagnosis and treatment of eclampsia can cause serious complications and threaten the lives of the mother and fetus, including maternal and fetal death. Some complications of eclampsia that can occur or can still occur after delivery:
- Occipital brain damage due to seizures can cause blindness.
- Intracranial hemorrhage due to recurrent seizures.
- Acute renal failure.
- HELLP syndrome.
- Disseminated intravascular coagulation (DIC), a condition in which blood clots form throughout the blood vessels along with bleeding.
Prevention of Eclampsia
The cause of preeclampsia and eclampsia is not known for certain, so specific prevention to prevent eclampsia is not known. To minimize the risk of eclampsia, it can be done
- Routine pregnancy check-ups so that preeclampsia can be detected as early as possible and treated immediately.
- In women who already have hypertension before pregnancy, controlling blood pressure and keeping blood pressure stable can reduce the risk of preeclampsia and eclampsia in pregnancy.
- Weight control before planning pregnancy
When to See a Doctor?
It is better to have regular pregnancy check-ups so that preeclampsia can be detected early and can be treated immediately so that eclampsia complications do not arise. If family or relatives have signs or symptoms like those above, discuss them with a doctor immediately. Especially if you are at high risk or have been diagnosed with preeclampsia, you should have regular pregnancy check-ups with a doctor.
