Eclampsia

Also known as: Toxemia with seizures

Definition

Eclampsia is seizures (convulsions) in a pregnant woman that are not related to a preexisting brain condition.

Causes, incidence, and risk factors

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

However, no theories have yet been proven.

Eclampsia follows preeclampsia, a serious complication of pregnancy that includes high blood pressure and excess and rapid weight gain.

It is difficult to predict which women with preeclampsia will go on to have seizures. Women at high risk for seizures have severe preeclampsia and:

Abnormal blood tests
Headaches
Very high blood pressure
Vision changes

Eclampsia occurs in about 1 out of every 2,000 to 3,000 pregnancies. The following increase 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, etc.)
Teenage pregnancy

Symptoms

Muscle aches and pains
Seizures
Severe agitation
Unconsciousness

Symptoms of preeclampsia include:

Gaining more than 2 pounds per week
Headaches
Nausea and vomiting
Stomach pain
Swelling of the hands and face
Vision problems

Signs and tests

The health care provider will do a physical exam and rule out other possible causes of seizures. Blood pressure and breathing rate will be checked and monitored.

Blood and urine tests may be done to check:

Blood clotting factors
Creatinine
Hematocrit
Uric acid
Liver function
Platelet count
Protein in the urine

Treatment

If you have preeclampsia your health care provider should carefully monitor you for signs of worsening and potential eclampsia. Delivery is the treatment of choice for severe preeclampsia in an attempt to prevent eclampsia. Delivering the baby relieves the condition. Prolonging the pregnancy can be dangerous to both you and your infant.

With careful monitoring, the goal is to manage severe cases until 32 - 34 weeks into the pregnancy, and mild cases until 36 - 37 weeks have passed. This helps reduce complications from premature delivery.

You may be given medicine to prevent seizures (anticonvulsant). Magnesium sulfate is a safe drug for both you and your baby. Your doctor may prescribe medication to lower high blood pressure, but you may have to deliver if your blood pressure stays high, even with medication.

Expectations (prognosis)

Women in the United States rarely die from eclampsia.

Complications

There is a higher risk for separation of the placenta (placenta abruptio) with preeclampsia or eclampsia. There may be complications for the baby due to premature delivery.

A blood clotting abnormality called DIC (disseminated intravascular coagulation) may occur.

Calling your health care provider

Call your health care provider or go to the emergency room if you have any symptoms of eclampsia or preeclampsia. Emergency symptoms include seizures or decreased consciousness.

Prevention

It is important for all pregnant women to get early and ongoing medical care. This allows for the early diagnosis and treatment of conditions such as preeclampsia. Treating preeclampsia may prevent eclampsia.

References

ACOG Practice Bulletin Committee. Diagnosis and management of preeclampsia and eclampsia. Obstet Gynecol. 2002;99:159-167.

Gabbe SG, Niebyl JR, Simpson JL. Obstetrics - Normal and Problem Pregnancies. 4th ed. New York, NY: Churchill Livingstone; 2002:974-983.

Sibai BM. Hypertension. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 33.

Review date:: February 21, 2010
Reviewed by:: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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