Eclampsia

Causes

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

• Blood vessel problems
• 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.

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 disease
• Multiple pregnancies (twins, triplets, etc.)
• Teenage pregnancy

Symptoms

Symptoms of eclampsia include:

• 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

Exams and Tests

The health care provider will do a physical exam to check for 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 main treatment for severe preeclampsia to prevent eclampsia. Prolonging the pregnancy can be dangerous to both you and the baby.

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

You may be given medicine to prevent seizures. Such medicines are called anticonvulsants. Magnesium sulfate is a safe drug for both you and your baby.

Your doctor may prescribe medication to lower high blood pressure. If your blood pressure remains high, delivery may be needed.

Possible Complications

Women with eclampsia or preeclampsia have a higher risk for:

• Separation of the placenta (placenta abruptio)
• Premature delivery that leads to complications in the baby
• A blood clotting problem called DIC (disseminated intravascular coagulation)

When to Contact a Medical Professional

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 alertness.

You need urgent care if you have bright red vaginal bleeding, little or no movement in the baby, severe headache, severe right upper abdominal pain, vision loss, nausea or vomiting.

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.

Alternative Names

Toxemia with seizures

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.

Stead LG. Seizures in pregnancy/eclampsia. Emerg Med Clin N Am. 2011;29:109-116

Houry DE, Salhi BA. Acute complications of pregnancy. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 176.

Update Date: 2/26/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, 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., Health Solutions, Ebix, Inc.