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Eclampsia is a serious condition which can occur in mothers when preeclampsia becomes uncontrolled or does not resolve. In the developed world, this is a condition which is rarely seen as most cases of escalating preeclampsia are detected before they get to this point. However, it is still estimated that around 1 in every 2,000-3,000 pregnant women will become eclamptic. Eclampsia is very rare before the 20th week of pregnancy, with most cases occurring between weeks 20-31.
Eclampsia is classified as an obstetric emergency, where the well-being of a mother and her baby are potentially compromised. It can also be life threatening, so immediate access to an obstetric hospital and specialist medical care is a priority.
It is possible for some mothers to develop signs of eclampsia without having all the symptoms of preeclampsia first. Other than an elevated blood pressure, there may be no indications beforehand which cause concern. Even after the baby is delivered, some women will have post-partum seizures and require close observation and medication to stop them fitting.
In cases of eclampsia, the mother’s blood vessels go into spasm and are unable to transport oxygen and nutrients to her own body and to her baby. Vital organs such as her liver, kidneys and brain are compromised with a reduction in their normal blood flow and are unable to function effectively. Fitting is common because the brain is starved of oxygen.
The primary issue with treatment for preeclampsia begins with prevention in the first place. Early diagnosis through monitoring every pregnant woman during their ante-natal period helps to detect problems early. Checking urine for the presence of protein, watching that her blood pressure is stable and not high, in particular the diastolic or bottom reading, and being observant for fluid retention will all help to “flag” problems.
In severe cases of eclampsia, the only effective treatment is stabilisation of the mother and to stop her fitting. Oxygen and anti-convulsant medication is given to maximize the flow of oxygen to her brain and to the baby. Immediate delivery of the baby by caesarian section is performed, even if this means it will be premature.
The overall aim of eclampsia management is to reduce the risk of harm to the mother and her baby. If possible, delivery of the baby by caesarian section is deferred until 32-34 weeks of gestation in cases of severe eclampsia. When it is assessed to be mild, then delivery is often held off until 36 week or beyond. Balancing the risks of eliminating maternal harm with infant prematurity is the most important factor in eclampsia management.
It is important to attend each ante-natal appointment as recommended by your midwife or doctor -even if you feel and look well. Preeclampsia and eclampsia are not always detectable other than through blood pressure readings and urine testing.