An eclamptic seizure is a rare but serious complication of pregnancy, characterized by the onset of convulsions in a pregnant individual with preeclampsia. Preeclampsia is a blood pressure disorder that develops after 20 weeks of gestation, involving high blood pressure and protein in the urine, or other organ dysfunction. Eclampsia represents the most severe progression of this condition, where the high blood pressure and other physiological changes affect the brain, leading to seizures. This medical emergency can occur during pregnancy, labor, or after delivery, often within the first 48 hours postpartum.
Warning Signs and Symptoms
Before an eclamptic seizure, many individuals experience warning signs, often stemming from severe preeclampsia. These can include a persistent, severe headache that does not improve with standard pain relief. Vision changes are also common, including blurred vision, seeing spots or flashing lights, light sensitivity, or temporary loss of vision.
Other indicators may involve upper abdominal pain, frequently located on the right side beneath the ribs, along with nausea or vomiting. Sudden, significant swelling, particularly in the face and hands, can be a symptom. During the seizure itself, the individual may lose consciousness abruptly. The body might stiffen, and muscles can contract and jerk rhythmically, potentially leading to biting the tongue or loss of bladder or bowel control.
Underlying Causes and Risk Factors
The exact cause of eclampsia is not fully understood, but it is linked to issues with the development and function of the placenta. Abnormal formation of blood vessels in the placenta can lead to poor blood flow, triggering inflammatory responses and affecting blood vessels throughout the mother’s body, including the brain. This can result in impaired cerebral blood flow regulation and cerebral edema, which may then initiate a seizure.
Several factors can increase a person’s likelihood of developing preeclampsia and subsequently eclampsia. A first-time pregnancy, carrying multiple babies (e.g., twins or triplets), or age (under 20 or over 35) increase risk. Pre-existing health conditions like chronic high blood pressure, diabetes, kidney disease, or autoimmune disorders also elevate the risk. A personal or family history of preeclampsia or eclampsia further increases susceptibility.
Medical Intervention and Treatment
Immediate medical intervention for an eclamptic seizure focuses on stopping the convulsion and preventing recurrence. Magnesium sulfate is the primary medication used for this purpose, administered intravenously. This medication helps to stabilize brain activity and reduce the likelihood of further seizures, with doses often continued for at least 24 hours after the last seizure or delivery.
In addition to seizure control, managing dangerously high blood pressure is a priority to prevent further complications. Medications like hydralazine, labetalol, or nifedipine may be given intravenously to lower blood pressure to safer levels. The only definitive resolution for eclampsia is the delivery of the baby and placenta.
The timing of delivery is determined by the mother’s stability and the baby’s gestational age. If the mother’s condition is stabilized and the pregnancy is at or beyond 37 weeks, labor induction is often considered. If the eclampsia is severe or the mother’s or baby’s health is at immediate risk, an emergency delivery, sometimes by Cesarean section, may be necessary regardless of gestational age. Close monitoring continues after birth, as eclampsia can also develop or recur in the postpartum period.
Health Complications for Mother and Infant
Eclampsia can lead to several serious health complications for both the mother and the infant. For the mother, potential severe outcomes include stroke due to uncontrolled high blood pressure or cerebral edema, and disseminated intravascular coagulation (DIC), a severe blood clotting disorder. Organ damage, particularly to the liver and kidneys, can occur, and some individuals may develop HELLP syndrome, which involves red blood cell destruction, elevated liver enzymes, and low platelet count. Placental abruption, where the placenta separates from the uterine wall prematurely, is another serious risk, potentially causing heavy bleeding and compromising fetal oxygen supply.
For the infant, complications are primarily related to the necessary premature delivery. Babies born prematurely may face breathing difficulties due to underdeveloped lungs, low birth weight, and challenges with feeding. Reduced blood flow to the placenta caused by preeclampsia can also lead to intrauterine growth restriction (IUGR), where the baby does not grow as expected. In severe instances, these complications can result in stillbirth or neonatal death.