Eclampsia
Pre-eclampsia characterized by the presence of seizures / From Wikipedia, the free encyclopedia
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Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia.[1] Pre-eclampsia is a hypertensive disorder of pregnancy that presents with three main features: new onset of high blood pressure, large amounts of protein in the urine or other organ dysfunction, and edema.[7][8][9] If left untreated, pre-eclampsia can result in long-term consequences for the mother, namely increased risk of cardiovascular diseases and associated complications.[10] In more severe cases, it may be fatal for both the mother and the fetus.[11]
Eclampsia | |
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A gross anatomy image of a placenta that has been cut after delivery | |
Specialty | Obstetrics |
Symptoms | Seizures, high blood pressure[1] |
Complications | Aspiration pneumonia, cerebral hemorrhage, kidney failure, cardiac arrest[1] |
Usual onset | After 20 weeks of pregnancy[1] |
Risk factors | Pre-eclampsia[1] |
Prevention | Aspirin, calcium supplementation, treatment of prior hypertension[2][3] |
Treatment | Magnesium sulfate, hydralazine, emergency delivery[1][4] |
Prognosis | 1% risk of death[1] |
Frequency | 1.4% of deliveries[5] |
Deaths | 46,900 hypertensive diseases of pregnancy (2015)[6] |
The diagnostic criterion for pre-eclampsia is high blood pressure, occurring after 20 weeks gestation or during the second half of pregnancy.[1] Most often it occurs during the 3rd trimester of pregnancy and may occur before, during, or after delivery.[1] The seizures are of the tonic–clonic type and typically last about a minute.[1] Following the seizure, there is either a period of confusion or coma.[1] Other complications include aspiration pneumonia, cerebral hemorrhage, kidney failure, pulmonary edema, HELLP syndrome, coagulopathy, placental abruption and cardiac arrest.[1]
Low dose aspirin is recommended to prevent pre-eclampsia and eclampsia in those at high risk.[12] Other preventative recommendations include calcium supplementation in areas with low calcium intake and treatment of prior hypertension with anti-hypertensive medications.[2][3] Exercise during pregnancy may also be useful.[1] The use of intravenous or intramuscular magnesium sulfate improves outcomes in those with severe pre-eclampsia and eclampsia and is generally safe.[4][13] Treatment options include blood pressure medications such as hydralazine and emergency delivery of the baby either vaginally or by cesarean section.[1]
Pre-eclampsia is estimated to globally affect about 5% of deliveries while eclampsia affects about 1.4% of deliveries.[5] In the developed world eclampsia rates are about 1 in 2,000 deliveries due to improved medical care whereas in developing countries it can impact 10-30 times as many women.[1][14] Hypertensive disorders of pregnancy are one of the most common causes of death in pregnancy.[14] They resulted in 46,900 deaths in 2015.[6] Maternal mortality due to eclampsia occurs at a rate of approximately 0-1.8% of cases in high-income countries and up to 15% of cases in low- to middle- income countries.[15] The word eclampsia is from the Greek term for lightning.[16] The first known description of the condition was by Hippocrates in the 5th century BC.[16]