Doctor's Notes on Eclampsia During Pregnancy
Eclampsia is a life-threatening complication of pregnancy that can follow untreated preeclampsia (high blood pressure and protein in the urine) that causes a pregnant woman to develop seizures or coma. The cause of preeclampsia or eclampsia is not known, but risk factors include multiple gestations, women older than 35 years, high blood pressure prior to pregnancy, diabetes, other medical problems (such as connective tissue and kidney diseases), obesity, and African American ethnicity.
Symptoms of eclampsia in the mother include seizures or convulsions, elevated blood pressure (hypertension), excess protein in the urine, blurred vision, seeing spots, severe headaches, blindness (occasionally), upper abdominal pain (due to changes that affect the liver), and excess bruising (due to problems with blood clotting). Symptoms of eclampsia that affect the baby include diminished placental blood flow and impaired fetal development (due to hypertension in the mother). A baby may not grow properly and may be smaller than anticipated.
Eclampsia During Pregnancy Symptoms
The most common symptom of eclampsia is seizures or convulsions. Similar to preeclampsia, other changes and symptoms may be present and vary according to the organ system or systems that are involved. These changes can affect the mother, the baby, or more commonly both mother and baby together. Some of these following symptoms may be perceived by the pregnant woman, but, more commonly, she is unaware that she has this disease:
- The most common sign of preeclampsia is elevated blood pressure and is also found in eclampsia. Again, the patient may be unaware that she is hypertensive.
- Blood pressure may be only minimally elevated, or it can be dangerously high. The degree of blood pressure elevation varies from woman to woman, and also varies during the progression and resolution of the disease process. Some women never have significant blood pressure elevation (including approximately 20% of women with eclampsia).
- A common belief is that the risk of eclampsia rises as blood pressure increases above 160/110 mm Hg.
- The kidneys may be unable to filter the blood efficiently. There may also be an abnormal excretion of protein in the urine. The first sign of excess urinary protein is usually determined on a urine specimen obtained at the time of a routine prenatal visit. It is unusual for a patient to experience symptoms related to excess urinary protein loss. In rare cases, there may be excretion of a large amount of urinary protein.
- Nervous system changes can include blurred vision, seeing spots, severe headaches, convulsions, and, occasionally, blindness. Any of these symptoms require immediate medical attention, preferably at a hospital which provides obstetrical care, as the emergent delivery of the infant may be required.
- Changes that affect the liver can cause pain in the upper abdomen. This pain may be confused with the pain of indigestion or gallbladder disease. Other more subtle changes that affect the liver can alter platelet function, thus compromising the ability of the blood to clot. Excess bruising may be a sign of impaired platelet activity.
- The hypertension that is characteristic of preeclampsia can diminish placental blood flow, thus impairing fetal development. As a result, the baby may not grow properly and may be smaller than anticipated. In severe cases, fetal movements may be lessened as a result of impaired oxygenation of the fetus. A patient should call her physician immediately if she notices a marked decrease in fetal movement.
Eclampsia During Pregnancy Causes
- No one knows what exactly causes preeclampsia or eclampsia, although abnormalities in the endothelium (the inner layer of blood vessel walls) have been considered as a potential cause.
- Since the exact cause of preeclampsia or eclampsia is poorly understood, it is not possible to effectively predict when preeclampsia or eclampsia will occur, or to enact any preventative measures that might prevent these problems from developing.
- Preeclampsia usually occurs during an initial (first) pregnancy.
A typical pregnancy lasts 40 weeks from the first day of your last menstrual period (LMP) to the birth of the baby. It is divided into three stages, called trimesters: first trimester, second trimester, and third trimester. The fetus undergoes many changes throughout maturation.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.