Definition During pregnancy, sudden high blood pressure, swelling of the face and hands and protein in the urine signal a condition called pre-eclampsia. It becomes eclampsia if seizures unrelated to an existing seizure disorder occur.
What is going on in the body? One in 200 pregnant women who have pre-eclampsia will go on to have eclampsia. No one knows its exact cause, but eclampsia rarely occurs before a pregnancy is 20 weeks along. The seizures of eclampsia are marked by general abnormal electrical activity in the brain. This causes muscle spasms, loss of consciousness and short-term memory problems.
Usually the seizures start before the baby is born. When seizures happen after birth, about half occur within the first 48 hours. However, the seizures may happen as late as 6 weeks after birth.
What are the signs and symptoms of the condition? Signs of pre-eclampsia in a pregnant woman are:
blood pressure of 140/90 or higher
swelling of the face or hands
protein in the urine
Women who have these signs are at high risk for eclampsia. Usually there are no clues or warning signs before a seizure. A woman with eclampsia may have one or many seizures. Afterward, she may hyperventilate, or breathe very rapidly, to make up for the lack of oxygen during the seizure itself. A fever at this point is a sign of serious trouble.
During or after a seizure, a woman may:
bite her tongue.
break bones.
harm her head.
breathe fluids into her lungs.
develop fluid and swelling in her lungs that make it hard to breathe.
experienced a detached retina in the eye. The retina is a light-sensitive membrane at the back of the eye which can separate from supporting structures.
What are the causes and risks of the condition? No one knows what causes eclampsia. Theories about why seizures might occur in pregnancy involve:
small clots that block blood vessels in the brain and restrict oxygen
narrowing of tiny arteries in the brain
areas of bleeding in the brain
high blood pressure
genetic risks
Pre-eclampsia is the only known risk factor for eclampsia. It occurs more often:
What can be done to prevent the condition? The disease cannot be prevented. All pregnant women should get early antenatal care so that blood pressure changes can be followed closely. Early diagnosis and treatment of pre-eclampsia may prevent much more serious problems for the mother and her baby.
How is the condition diagnosed? Doctors use signs and tests for diagnosis. A woman may have pre-eclampsia if she:
suddenly gains weight in 2 days
has swelling in her hands and face
has a blood pressure of 140/90 or higher
has protein in her urine
has a low or dropping platelet count
shows certain abnormalities in blood tests, including anaemia and changes that affect clotting factors
has abnormal liver function tests
has headaches not relieved by rest and analgesia
has lasting pain in her lower belly, or abdomen
A woman is diagnosed with eclampsia if she:
has seizures
What are the long-term effects of the condition? Pre-eclampsia causes no permanent damage. It does not make a woman more likely to develop high blood pressure. As long as a woman does not have high blood pressure, pre-eclampsia recurs only about 30% of the time in a later pregnancy. If a woman does have high blood pressure, it recurs about 70% of the time.
Eclampsia is a different story. As soon as it occurs, the baby must be delivered. Rarely, a mother with eclampsia dies due to blood clots, liver or kidney failure, infection, or other complications. Women who have had eclampsia also have a higher lifetime risk of developing high blood pressure and dying due to heart attacks or strokes.
What are the risks to others? The need for a quick delivery may mean the baby is born too early. That may cause health and developmental problems.
The placenta may tear away from the uterus; this is known as placenta abruptio. It can keep the baby from getting enough oxygen and could cause his or her death.
What are the treatments for the condition? Eclampsia is treated by delivering the baby. If the baby is older than 28 weeks, a caesarean section (c-section) is usually done. During a caesarean delivery the baby is delivered through an incision made in the abdomen. Prolonging the pregnancy can harm the mother or cause the baby to die. Before a c-section is done, the mother's seizures and blood pressure may need to be controlled with drugs, such as magnesium sulfate.
What are the side effects of the treatments? Side effects depend upon the treatment used. Surgery may result in bleeding, infection, or even death. magnesium sulfate can cause circulation and breathing problems, abnormally low blood pressure, or other symptoms.
What happens after treatment for the condition? After the baby is born, a woman may still have seizures for up to 6 weeks. Her doctor will closely monitor blood pressure, urine and blood tests, and any other symptoms.
If a baby is born prematurely and has health problems, hospitalisation and care will be needed.
How is the condition monitored? Pre-eclampsia often recurs in later pregnancies. Early antenatal care is key to recognising warning signs and managing the disease.
Author: Eva Martin, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
