Eclampsia

Eclampsia

Eclampsia is the highest severity of preeclampsia; the main clinical manifestation is convulsions with loss of consciousness, not associated with any other cerebral pathology (for example, epilepsy or cerebral hemorrhage). Eclampsia is accompanied by impaired consciousness, arterial hypertension, edema, and proteinuria. Eclampsia usually develops in the third trimester of pregnancy or within 24 hours after delivery. If convulsions appear more than 48 hours after childbirth, eclampsia is unlikely (it will be necessary to exclude the pathology of the central nervous system). Predominant age. More often occurs in young primiparous and primiparous older than 40 years.

Etiology

• • See Prelampsia.
  • Possibly severe cerebral vasoconstriction leading to seizures
  • Hemorrhages in the central nervous system appear as a result of an increase in blood pressure in the capillaries, leading to their rupture
  • There is an opinion about the probable participation in the pathogenesis of vasospasm of trophoblast tissue.

Risk factors

• • Critical age of nulliparous (young and over 35 years old)
  • Multiple pregnancy, trophoblastic disease
  • Arterial hypertension and kidney disease
  • History of eclampsia and/or preeclampsia
  • Eclampsia and/or preeclampsia in close relatives
  • Inattentive management of a pregnant woman (early diagnosis and treatment of preeclampsia and preeclampsia significantly reduce the risk of developing eclampsia),

Pathomorphology. Cerebral edema, plethora, thrombosis, hemorrhage; brain damage is the root cause of 20% of deaths in eclampsia.

Clinical picture

• • Convulsions (local and generalized)
  • Harbingers of seizures: a steady increase in diastolic blood pressure, headache, visual disturbances, pain in the epigastric region or the right upper quadrant of the abdomen. See Preeclampsia
  • Each seizure of eclampsia lasts 1-2 minutes and consists of four periods: preconvulsive, tonic convulsions, clonic convulsions and seizure resolution.
  • Convulsions are possible against the background of normal blood pressure.
  • Loss of consciousness, cyanosis (not always).
  • Proteinuria (80%), edema (70%), arterial hypertension.
  • Possible DIC, thrombocytopenia, impaired liver function, renal failure.
  • Predisposition to pulmonary and cerebral edema during infusion therapy. An increase in the volume of extracellular fluid, inadequately distributed in extracellular spaces, and a decrease in BCC (blood clotting).

Laboratory research

• • Analysis of peripheral blood – the concentration of Hb is most often not changed, Ht 34-38%
  • The content of total protein is often reduced, and not always only due to albumin
  • Residual blood nitrogen – likely to decrease, increases infrequently during a seizure
  • Analysis of urine. The specific weight during normal pregnancy is 1020-1025, with late toxicosis – 1015-1020
  • Urea nitrogen: during normal pregnancy – 780-1,000 mg%, with preeclampsia – 480-500 mg%
  • Urea clearance during normal pregnancy -120-125, with preeclampsia – 51-60
  • Creatinine clearance during normal pregnancy is 170 ml/min, with preeclampsia — 60-200 ml/min. Special Studies
  • CT or MRI to detect masses and hemorrhages is performed when focal neurological symptoms or uncharacteristic symptoms appear
  • CSF examination to rule out meningitis, encephalitis. Differential Diagnosis
  • Epilepsy
  • A brain tumor
  • Rupture of a cerebral aneurysm
  • Until another cause is identified, all pregnant women with seizures are diagnosed with eclampsia.

Treatment:

Diet. Salt free diet. In severe condition – parenteral nutrition. Tactics of conducting

• • Relief of seizures. In case of loss of consciousness and coma, consultation of a neurologist is necessary.
  • Constant monitoring of the hemodynamic parameters of the mother and fetus, respiratory rate, severity of reflexes (determination after 15 minutes); determination of hourly diuresis.
  • Immediate delivery! In the absence of conditions for its implementation – caesarean section. In the postpartum and postpartum periods, it will be necessary to completely replenish the blood loss.
  • Infusion therapy – Ringer solution with lactate and 5% glucose solution at a rate of 60-120 ml / h under constant control of BCC and Ht. The volume of infusion therapy is 300-1,500 ml, with delivery by caesarean section – up to 2,500-3,000 ml.
  • Glucocorticoids, as well as drugs that improve cerebral circulation (cavinton, nootropil, etc.).
  • Intensive therapy of preeclampsia is continued for up to three days.
  • Antihypertensive therapy, if necessary, is continued until the discharge of the puerperal.
  • Prevention of purulent-inflammatory complications. Supervision at the therapist within 1 year. Relief of seizures
  • Fixed position of the patient to avoid trauma, attribution and retraction of the tongue.
  • Aspiration of mucus from the mouth and upper respiratory tract.
  • Humidified oxygen or ventilation. Indications for IVL:
  • ineffectiveness of the measures taken (an attack of eclampsia continues)
  • disturbance of consciousness outside the attack
  • convulsive readiness
  • cardiac arrest – in this case, a combination of mechanical ventilation with cardioresuscitation measures is necessary.
  • Drug therapy
  • Magnesium sulfate
  • 20 ml 25% solution i.v.
  • Then after 4 hours 50% solution (5 g) i.v.
  • The introduction of magnesium sulfate is safe under the following conditions (check before each injection): the knee jerk is preserved, breathing is not depressed, diuresis is not less than 25 ml / h
  • Diazepam (sibazon) 2 ml 0.5% IV solution (2 mg/min) until symptom relief or cumulative dose of 20 mg
  • Promedol nbsp; – 1 ml 2% solution in / in
  • Diprazine – 0.025 g
  • Precautions
  • With a decrease in BCC, diuretics are contraindicated
  • Hypermolar products can cause liquid blood to leak through capillaries
  • drug interaction. Combinations of prescribed products can cause respiratory depression. With the development of this complication, calcium chloride is used (10 ml of 10% solution IV slowly).

Complications

• • 56% of patients have transient neurological disorders, including cortical blindness.
  • Most women do not experience long-term effects of eclampsia
  • Fetal death.

Course and forecast

• • 25% of women with eclampsia have hypertension in their next pregnancy, 5% have severe hypertension, and 2% have eclampsia
  • Women who have already given birth with eclampsia are at high risk of developing essential arterial hypertension.
  • Women who have given birth with eclampsia have a higher mortality rate than those who have given birth. Prevention
  • Careful monitoring of pregnant women
  • Frequent determination of blood pressure in pregnant women with arterial hypertension
  • Identification and treatment of preeclampsia.

See also Gestosis. Arterial hypertension during pregnancy, Preeclampsia ICD O15 Eclampsia Notes. Eclampsia without seizures – a variant of eclampsia with impaired consciousness, arterial hypertension, edema and significant proteinuria in the absence of convulsive seizures

• Postpartum eclampsia – convulsions and coma, accompanied by arterial hypertension, edema and proteinuria, developed within 48 hours after childbirth.