Eclampsia

Overview: 

Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia. Pre-eclampsia is a disorder of pregnancy in which there is a high blood pressure and either large amounts of protein in the urine or other organ dysfunction. 

1. Symptoms: 

• Muscle aches and pains 

• Seizures 

• Severe agitation 

• Unconsciousness 

2. Treatment: 

Delivery is the treatment of choice for severe eclampsia. Delivering the baby relieves the condition. Prolonging the pregnancy can be dangerous to both mother and infant. Medicine can be given to prevent seizures (anticonvulsants). Magnesium sulfate is a safe drug for both mother and baby, however, if fetus is delivered while the mother is receiving magnesium sulfate, it may depress the respiratory drive. Other medications can be given to lower blood pressure. If the blood pressure remains high, delivery of the fetus is imminent. 

The cause of eclampsia is not well understood. Researchers believe the following may play a role: 

• Blood vessels 

• Brain and nervous system (neurological factors) 

• Diet 

• Genes 

Eclampsia follows preeclampsia, a serious complication of pregnancy that includes high blood pressure and excess and rapid weight gain. Women at high risk for seizures have severe preeclampsia and: 

• Abnormal blood tests 

• Head aches 

• Very high blood pressure 

• Vision changes 

The following increases a woman’s chance for getting preeclampsia: 

• Being 35 or older 

• Being African American 

• First pregnancy 

• History of diabetes, high blood pressure, or kidney (renal) disease 

• Multiple pregnancies (twins, triplets, ect.) 

• Teenage pregnancy 

3. Prognosis: 

 The prognosis for women with eclampsia largely depends on timely diagnosis and treatment. With prompt management, including antihypertensive medications, magnesium sulfate to prevent seizures, and early delivery, most women recover without long-term complications. However, severe cases can lead to life-threatening complications such as stroke, organ failure, or HELLP syndrome. Women who experience eclampsia are at increased risk for future cardiovascular issues and may have a higher likelihood of developing preeclampsia in subsequent pregnancies. The fetus may also face risks, including preterm birth, IUGR, and neonatal complications, but with proper care, the outcomes for both mother and baby can improve. Women in the United States rarely die from eclampsia. Most women will have good outcomes for their pregnancies complicated by preeclampsia or eclampsia. 

4. Potential complications: 

• Permanent neurologic damage from recurrent seizures or intracranial bleeding 

• Renal insufficiency and acute renal failure 

• Fetal changes-IUGR, placenta abruption, oligohydramnios 

• Hepatic damage and rarely hepatic rupture 

• Hematologic compromise and DIC 

• Increased risk of recurrent preeclampsia/eclampsia with subsequent pregnancy 

• Maternal or fetal death 

5. What situations should an RT be ready for when dealing with mothers that have eclampsia?  

• Respiratory Distress During Seizures: Eclampsia seizures can lead to respiratory distress in the affected woman. The RT may need to provide immediate respiratory support, such as oxygen therapy, to ensure adequate oxygenation during and after the seizures. 

• Administration of Magnesium Sulfate: Magnesium sulfate is commonly used to prevent and control seizures in eclampsia. The RT may be involved in monitoring the respiratory effects of magnesium sulfate, as it can potentially depress the respiratory drive, especially if the fetus is delivered while the mother is still receiving the medication. Prepare to give the correct respiratory support. 

• Blood Pressure Management: High blood pressure is a characteristic feature of eclampsia. Medications may be administered to lower blood pressure, and the RT may need to monitor the respiratory impact of these medications, as some antihypertensive drugs can influence respiratory function. 

• Emergency Cesarean Section (C-Section): In severe cases of eclampsia, where the health of the mother and baby is at risk, an emergency C-section may be required. The RT must be prepared for a sudden change in the birthing plan and ready to assist with any respiratory needs that may arise during or after the surgery. 

• Monitoring Neonatal Respiratory Distress: Babies born to mothers with eclampsia, especially if delivered prematurely, may face respiratory challenges. The RT in the neonatal unit may need to provide specialized respiratory care to newborns experiencing respiratory distress or complications. 

• Management of Potential Complications: Eclampsia can lead to various complications, including neurologic damage, renal insufficiency, and hematologic compromise. The RT may need to address respiratory implications associated with these complications.