Eclampsia

In this podcast produced in associated with Oxford University Press we discuss pre-eclampsia and eclampsia.

 

Lecture by

Video Duration: 16 minutes

  • Eclampsia
    Created by Paige Leigh Roberts
    General
    Epidemiology

    Convulsions superimposed on pre-eclampsia (hypertension and proteinuria)

    Any convulsion during pregnancy should be treated as eclampsia

    Pre-eclampsia occurs in 2-5% of the population and eclampsia complicates a significant proportion.

    *Still at risk of eclampsia for 2 days after delivery - half of all eclamptic fits occur in this time period*

    Pathology

    Poorly understood - thought to be immunological and originate from the placenta.

    Top three causes

    As with pre-eclampsia, risk factors include:

    • First pregnancies/first pregnancy with new partner
    • Older women
    • Multiple pregnancy or large placenta
    Clinical Features
    Symptoms

    Headache - occipital, severe and unremitting. Not helped by analgesics

    Visual disturbance - flashing lights, blurring of vision

    Abdominal pain - central, may be in the RUQ. May be mistaken for heartburn

    Signs

    High BP

    Brisk reflexes indicate an imminent seizure

    Signs of cerebral oedema

    Investigations
    Cultures

    None

    Bloods

    ABG - following a fit or if unconscious

    FBC & clotting (concerns about bleeding or haemolysis)

    U&E (renal involvement)

    LFT (liver involvement)

    Glucose (low glucose is associated with acute fatty liver)

    Ca and Mg (if Mg Sulphate is being used to control or prevent fits)

    Uric acid (aid in diagnosis)

    Toxicology screen (if concerns this is not an eclamptic fit)

    Imaging

    CXR (look for pulmonary oedema, cardiomegaly, signs of inhalation)

    CT/MRI (if suspect a space occupying lesion or there is abnormal neurology follwoing a fit)

    Scopic/Biopsy

    None

    Functional

    EEG

    CTG

    Treatment
    Conservative

    None

    Medical
    1. ABC
    2. Control HTN - labetolol IV or nifedipine PO
    3. Most seizures self-terminate - magnesium sulphate to stop fits and prevent further fits.
    4. Never deliver an unstable patient, deliver once stable as disease will only go away once the placenta is delivered.
    Surgical

    None

  • Pre-eclampsia
    Created by Tom Goldsmith
    General
    Epidemiology

    The development of hypertension and proteinuria after the 20th week of gestation. (Hypertension defined as a BP of >140/90mmHg and Proteinuria as >0.3g/24h)

    Occurs in 6% of nulliparous women; recurrence in 15% of women with a history of pre-eclampsia.

    Pathology

    Incompletely understood; inadequate trophoblastic placental arteriole infiltration is thought to be associated, causing a poorly perfused placenta. Inappropriate inflammatory response causes systemic vasospasm and increased capillary permeability, resulting in hypertension and proteinuria.

    Complications include seizures (and status epilepticus), HELLP syndrome, DIC and acute renal failure

    Top three causes

    Risk factors:

    First pregnancy, Large placenta, Extremes of maternal age; many others.


    Clinical Features
    Symptoms

    Often asymptommatic.

    Headache, nausea, vomiting, visual disturbance, epigastric pain

    (All fairly general, consider alongside examination findings)

    Signs

    Specific: Hypertension and proteinuria

    General: Odema (pulmonary and peripheral)

    Investigations
    Cultures

    Urinary protein dip (with urinary culture to exclude infection as cause of proteinuria if positive)

    Protein: Creatanine ratio (or 24 hour Urinary Protein)

    Bloods

    FBC, U&E, LFT, Clotting

    Imaging

    Fetal Ultrasound monitoring in mild/ moderate hypertension

    Uterine artery doppler

    Consider Chest X ray

    Scopic/Biopsy

    None

    Functional

    EEG, CTG (acutely)

    Treatment
    Conservative

    Careful monitoring with regular blood pressure checking and fetal ultrasound scans

    Medical

    Blood pressure: Nifedipine to initially lower BP; Labetalol thereafter

    Magnesium Sulphate to prevent and treat

    Steroids if identified before 34 weeks and preterm delivery is anticipated

    Surgical

    Induction of labour or caesarean section depending on the severity of disease and current gestation