Eclampsia: Risk in Pregnancy

Pre-eclampsia is a clinical syndrome comprising of hypertension, oedema and proteinuria. Pre-eclampsia when complicated with convulsions (or seizures) is termed Eclampsia. It affects the nulliparous women (first time pregnant) aged more than 35 years of age. The disease may occur quietly without any warning symptoms.

The exact cause of the disorder is unknown but it is believed to be strongly genetic in origin. Basic cause for such condition is the excess of extra cellular fluid that is unevenly distributed in the extra cellular spaces. Pre-existing hypertension or some renal disorder act as the risk factors.

There is tendency for seizure activity in the obstetric woman with pre-eclampsia even without any underlying neurological disorder. These seizures may occur before, during or after the delivery and may occur once or even repeatedly. The aura before the seizure attack comprises of symptoms like headache, visual disturbances and pain in the epigastric region and right hypochondrium (liver region).

The seizures occur more commonly after 36 weeks of gestation. The early sign noticeable by the doctor is the presence of a ‘large for date’ uterus in a woman with her first pregnancy. After 20 weeks of pregnancy, the blood pressure is noted to be elevated beyond 140/90 mm Hg.

Other symptoms include oedema, which is seen over hands and face. There may be cyanosis, fever or hemorrhage. On examination, severe cerebral vasoconstriction is seen. All pregnant women with convulsions are said to be suffering from eclampsia, unless some other underlying disorder is proved.

The presence of normal level of blood pressure does not rule out the seizure activity. Poor pre-natal care may prevent early detection and treatment of pre-eclampsia, thereby increasing the risk of eclampsia.

Treatment aims at the control of convulsions, correction of hypoxia and maintaining the blood pressure. Proper bed rest should be advised to the patient.

Delivery must be done only after the foetus has attained lung maturity. The patient and the family must be educated about the condition even after delivery so as to make them able to take proper care of the mother and the baby.

Such women are more probable to have hypertension in future pregnancies and are also at risk to suffer from essential hypertension.