Eclampsia
Hypertensive diseases of pregnancy remain a leading cause of maternal and perinatal mortality in both low- and high-resource countries, and eclampsia represents their most serious manifestation. Eclampsia is characterised by the occurrence of generalised
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Eclampsia
5.1
Definition, Incidence and Main Risk Factors
Hypertensive diseases of pregnancy remain a leading cause of maternal and perinatal mortality in both low- and high-resource countries, and eclampsia represents their most serious manifestation. Eclampsia is characterised by the occurrence of generalised tonic-clonic seizures (grand mal) in a woman who usually displays the typical symptoms, signs and laboratory findings of pre-eclampsia. The pathophysiologic mechanism behind eclamptic seizures remains incompletely understood, but endothelial lesion, exaggerated microvascular permeability, cerebral oedema and pericapillary haemorrhage are common findings. The episode usually starts with a slight tremor of the facial muscles, shortly followed by a generalised tonic seizure of 15–20 s and then develops into generalised tonic-clonic seizures which may last over 1 min. The total duration of the episode rarely exceeds 90 s. Occasionally, seizures may recur rapidly with uninterrupted generalised contracture. No respiratory movements occur during tonic-clonic seizures, and this can have serious consequences on maternal and fetal oxygenation. When the episode terminates, there is a deep and noisy inspiration followed by a comatose state that is usually superficial and of variable duration, with slow recovery of consciousness. Subsequent agitation may develop, and the woman usually refers amnesia to the event. Transient cortical blindness and focal motor deficits may follow. Cerebral haemorrhage complicates 1–2 % of cases. Eclampsia may occur during pregnancy (40–50 %), in labour (13–20 %) or in the postpartum period (28–40 %). With the implementation of policies for screening and early diagnosis of pre-eclampsia, as well as the prevention of seizures and prompt termination of pregnancy in cases of severe pre-eclampsia, the incidence of eclampsia has decreased dramatically over the last decades. In high-resource countries, pre-eclampsia is currently reported to occur in 2–8 % of pregnancies and eclampsia to complicate 0.2–0.3 % of these cases, for an overall incidence of 0.004– 0.02 % of births. In many low- and medium-resource countries, the reported incidences of pre-eclampsia and eclampsia are much higher. © Springer International Publishing Switzerland 2017 D. Ayres-de-Campos, Obstetric Emergencies, DOI 10.1007/978-3-319-41656-4_5
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Table 5.1 Risk factors for pre-eclampsia and eclampsia
Eclampsia
Primigravid Extremes of reproductive age Family history of pre-eclampsia Gestational or pre-existing diabetes Chronic hypertension or renal disease Multiple pregnancy Gestational trophoblastic disease Hereditary or acquired thrombophilia
The main risk factors for eclampsia are similar to those of pre-eclampsia and are listed in Table 5.1.
5.2
Complications
In high-resource countries, maternal mortality occurs in about 0.07 % of eclampsia cases, and the main causes are intracranial haemorrhage, acute pulmonary oedema and multi-organ failure. Maternal morbidity includes acute pulmonary oedema, disseminat
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