Eclampsia and Pre-Eclampsia - Symptoms, Causes and Treatment

Eclampsia and pre-eclampsia are serious complications of pregnancy, which may occur during the second half of pregnancy, usually after 20 weeks of pregnancy. In some women, eclampsia or pre-eclampsia may occur only during work or even after the baby is born.

Although most pregnancies affected by pre-eclampsia can reach 37 weeks of pregnancy, which characterizes full-term pregnancy, they are at high risk for complications, including the risk of maternal or fetal mortality.

Blood pressure measurement
Blood pressure measurement
 


What is pre-eclampsia

Pre-eclampsia is a complication of pregnancy characterized by hypertension and proteinuria (loss of protein in the urine) that begins after 20 weeks of gestation. In some patients, pre-eclampsia also causes injury to important organs, such as the liver, kidney, lungs, and brain.

There are 4 types of hypertension that can occur during pregnancy:
  • 1. Chronic hypertension - is the hypertension that the patient had before she became pregnant and will continue to have during and after gestation.
  • 2. Gestational hypertension - is hypertension that appears only after the 20th week of gestation in women who have never had high blood pressure.
  • 3. Pre-eclampsia - is the appearance of high blood pressure after the 20th week of pregnancy, associated with loss of protein in the urine, called proteinuria. Pre-eclampsia cures after delivery.
  • 4. Pre-eclampsia superimposed on chronic hypertension - is pre-eclampsia that occurs in women who were previously hypertensive.

Pre-eclampsia appears to occur due to problems in the development of placenta vessels early in pregnancy during implantation of the placenta in the uterus. As pregnancy develops and the placenta grows, the lack of perfect vascularization leads to a low blood perfusion and may cause placental ischemia. The placenta in distress due to lack of adequate circulation produces a series of substance that when falling in the maternal blood circulation causes uncontrolled blood pressure and injury to the kidneys.

Risk factors

  • Pregnancy in women over the age of 40 or under 18
  • Family history of pre-eclampsia (including in the father's family)
  • Pre-eclampsia in a previous pregnancy
  • Multiple pregnancy (twins, triplets, etc.)
  • Women previously hypertensive (chronic hypertension)
  • Obesity
  • Diabetes mellitus
  • Chronic kidney disease
  • Prolonged time interval between pregnancies
  • Pregnant women with autoimmune diseases
  • First pregnancy

Symptoms

Pre-eclampsia occurs in 5% to 10% of pregnancies. 75% of cases are mild and 25% are severe. It may occur at any time during the twentieth week until a few days after delivery.

Hypertension that arises after the 20th week of gestation is the most common symptom. However, to characterize pre-eclampsia and gestational hypertension not only it is necessary that there is also the presence of proteinuria (at least 300 mg of protein in a urine test 24 hours)

Almost every pregnant woman has edema (swelling), but a sudden and rapid worsening of edema, mainly affecting the face and hands, may be a sign of pre-eclampsia.

HELLP syndrome

HELLP syndrome is the severe form of pre-eclampsia. This is the acronym in English for the terms hemolysis, elevated liver enzymes and low platelets.
  • Haemolysis means destruction of red blood cells, which leads to the appearance of hemolytic anemia
  • Increased liver enzymes (TGO and TGP) are a sign of liver damage, which is still a type of hepatitis associated with pre-eclampsia
  • As well as hemolysis, platelet destruction also occurs, which ultimately causes a reduction in their concentration in the bloodstream.

In addition to HELLP syndrome, there are other manifestations of severe pre-eclampsia such as blurred vision-type neurological changes, headaches, mental confusion and even convulsive crisis. When the latter occurs, we are faced with the picture of eclampsia, explained later.

Arterial pressures above 160/110 mmHg, severe abdominal pain, proteinuria above 5 grams (5000 mg) per day, significant decrease in urine volume, pulmonary edema and severe fetal growth failure are other signs and symptoms of pre-eclampsia serious.

Regarding the fetus, the risks of pre-eclampsia include premature placental abruption, poor growth and intrauterine development, and premature delivery.

Treatment

The definitive treatment is the induction of labor. Pre-eclampsia does not always occur at gestational ages that allow the induction of labor without harm to the fetus. On the other hand, the non-termination of pregnancy can have serious consequences for the mother. Therefore, the decision to induce labor or prolong pregnancy should take into account gestational age, severity of pre-eclampsia, and maternal and fetal health conditions.

In some cases, the mother may be hospitalized for a closer follow-up of the disease progression, trying to postpone delivery as close as possible to the 40th week of gestation. Whenever possible, the preference is for normal delivery.

Hypertension should be controlled, but this does not interfere with the course of the disease or maternal/fetal mortality. It is important to remember that some famous antihypertensives like Enalapril, captopril and Adalat are contraindicated during pregnancy. Control of blood pressure in pregnancy should be done only under the guidance of the obstetrician-gynecologist.

The use of corticosteroids is indicated to temporarily treat the complications of HELLP syndrome, but mainly to accelerate the maturation of the fetal lungs in case of induction of labor before term.

Prevention of seizures is important and can be done with the administration of magnesium sulfate just before delivery.

What is eclampsia

Eclampsia is the most severe spectrum of hypertension in pregnancy, which includes gestational hypertension, pre-eclampsia, and eclampsia per se.

The characterization of eclampsia is due to the presence of one or more seizures in a pregnant woman with pre-eclampsia already established.

Contrary to what was previously thought and what the names pre-eclampsia and eclampsias might suggest, one disease is not evolution to another. Eclampsia is actually just a serious manifestation of pre-eclampsia.

In fact, the vast majority of pregnant women with severe pre-eclampsia will not present with eclampsia, and although uncommon, women with mild pre-eclampsia may complicate with seizures. Therefore, there is no linear evolution between the two diseases.

Up to 30% of seizures occur at delivery or up to 48 hours after the baby is born. Seizures last for an average of 1 minute and are usually preceded by headache, visual changes, or severe abdominal pain. Treatment is with magnesium sulfate.

The presence of eclampsia is an indication for induction of labor after stabilization of the condition. The termination of pregnancy is the only curative treatment. 70% of pregnant women with eclampsia who do not interrupt their pregnancies will have serious, life-threatening complications. In women with low gestational age (less than 32 weeks) cesarean section may be indicated.

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