Pre-eclampsia and Eclampsia: Causes, Symptoms,Diagnosis and Treatment

What Is Preeclampsia?

> Formerly called toxemia, preeclampsia is a condition that pregnant women develop. It is marked by high blood pressure and a high level of protein in the urine. Preeclamptic women will often also have swelling in the feet, legs, and hands. This condition usually appears during the second half of pregnancy, often in the latter part of the second or in the third trimesters, although it can occur earlier.

> If undiagnosed, preeclampsia can lead to eclampsia, a serious condition that can put you and your baby at risk, and in rare cases, cause death. Women with preeclampsia who have seizures are considered to have eclampsia.

> There’s no way to cure preeclampsia, and that can be a scary prospect for moms-to-be. But you can help protect yourself by learning the symptoms of preeclampsia and by seeing your doctor for regular prenatal care. When preeclampsia is caught early, it’s easier to manage.

Causes

> The exact causes of preeclampsia and eclampsia — a result of a placenta that doesn’t function properly — are not known, although some researchers suspect poor nutrition, high body fat, or insufficient blood flow to the uterus as possible causes. Genetics plays a role, as well.

Risk for Preeclampsia

> Preeclampsia is most often seen in first-time pregnancies, in pregnant teens, and in women over 40. Other risk factors include:

> A history of high blood pressure prior to pregnancy
> A history of preeclampsia
> Having a mother or sister who had preeclampsia
> A history of obesity
> Carrying more than one baby
> History of diabetes, kidney disease, lupus, or rheumatoid arthritis

Signs and Symptoms of pre-eclampsia

@ In addition to swelling, protein in the urine, and high blood pressure, preeclampsia symptoms can include:

> Rapid weight gain caused by a significant increase in bodily fluid
> Abdominal pain
> Severe headaches
> Change in reflexes
> Reduced urine or no urine output
> Dizziness
> Excessive vomiting and nausea
> Vision changes

You should seek care right away if you have:

> Sudden and new swelling in your face, hands, and eyes (some feet and ankle swelling is normal during pregnancy.)
> Blood pressure greater than 140/90.
> Sudden weight gain over 1 or 2 days
> Abdominal pain, especially in the upper right side
> Severe headaches
> A decrease in urine
> Blurry vision, flashing lights, and floaters

You can also have preeclampsia and not have any symptoms. That’s why it’s so important to see your doctor for regular blood pressure checks and urine tests.

How Can Preeclampsia Affect Baby and Mother

> Preeclampsia can prevent the placenta from receiving enough blood, which can cause your baby to be born very small. It is also one of the leading causes of premature births, and the complications that can follow, including learning disabilities, epilepsy, cerebral palsy, hearing and vision problems.

In moms-to-be, preeclampsia can cause rare but serious complications that include:

> Stroke
> Seizure
> Water in the lungs
> Heart failure
> Reversible blindness
> Bleeding from the liver
> Bleeding after you’ve given birth

> Preeclampsia can also cause the placenta to suddenly separate from the uterus, which is called placental abruption. This can cause stillbirth.

Treatment for Preeclampsia and Eclampsia

# The only cure for preeclampsia and eclampsia is to deliver your baby. Your doctor will talk with you about when to deliver based on how far along your baby is, how well your baby is doing in your womb, and the severity of your preeclampsia.

√ If your baby has developed enough, usually by 37 weeks or later, your doctor may want to induce labor or perform a cesarean section. This is will keep preeclampsia from getting worse.

√ If your baby is not close to term, you and your doctor may be able to treat preeclampsia until your baby has developed enough to be safely delivered. The closer the birth is to your due date, the better for your baby.

√ If you have mild preeclampsia – also known as preclampsia with and without severe features, your doctor may prescribe:

> Bed rest either at home or in the hospital; you’ll be asked to rest mostly on your left side.
> Careful observation with a fetal heart rate monitor and frequent ultrasounds
> Medicines to lower your blood pressure
> Blood and urine tests

Your doctor also may recommend that you stay in the hospital for closer monitoring. In the hospital you may be given:

> Medicine to help prevent seizures, lower your blood pressure, and prevent other problems
> Steroid injections to help your baby’s lungs develop more quickly

PRINCIPLES OF MANAGEMENT:

1. Control fits:- Magnesium can be injected into the veins to prevent eclampsia-related seizures

2. Control blood pressure:- Hydralazine or another antihypertensive drug to manage severe blood pressure elevations

3. Monitoring fluid intake and urine output: Its the edema (pulmonary, cerebral, kidney failure) that kills the mother

4. Deliver the baby:- SVD or C/S as indicated

Treatment for Preeclampsia and Eclampsia

> For severe preeclampsia, your doctor may need to deliver your baby right away, even if you’re not close to term.

> After delivery, signs and symptoms of preeclampsia should go away within 1 to 6 weeks.

Magnesium Sulphate Dosage;

# Loading Dose

> Magnesium sulphate 20% Solution, 4g IV for 10-15 minutes
> Follow promptly with 10g of 50% magnesium sulphate solution, 5g in each buttock as deep IM injection with 1mL of 2% Lignocaine in the same syringe
> Ensure that aseptic technique is practised when giving magnesium sulphated deep IM injection.
> Warn the woman that a feeling of warmth will be felt when magnesium sulphate is given.
> If convulsions occur after 15 minutes, give 2g magnesium sulphate (50% solution) IV over 5 minutes

# Maintenance Dose

> 5g magnesium sulphate (50% solution) + 1 mls Lignocaine 2% IM every 4 hours into alternate buttocks.
> Continue treatment with magnesium sulphate for 24 hours after delivery or at the last convulsion, whichever occurs last.
> Before repeat administration, ensure that:
* Respiratory rate is at least 16 per minute
* Patellar reflexes are present
* Urinary output is at least 30 mls per hour over preceding four hours

# WITHHOLD OR DELAY DRUG IF:

> Respiratory rate falls below 16 per minute
> Patellar reflexes are absent
> Urinary output falls below 30mL per hour over the preceding 4 hours

# KEEP ANTIDOTE READY:

In case of respiratory arrest:
> Assist ventilation (mask and bag, anaesthesia apparatus, intubation)
> Give Calcium Gluconate 1g (10mL of 10% solution) IV slowly until respiration begins to antagonise the effects of magnesium sulphate…