ECLAMPSIA

A comprehensive clinical guide covering definition, causes, pathophysiology, prevalence, clinical features, diagnosis, management, prognosis, and nursing considerations.

Definition

1. What is Eclampsia?

Eclampsia is a life-threatening obstetric emergency characterized by the onset of generalized tonic-clonic seizures in a woman with preeclampsia, not attributable to other neurological conditions.

Epidemiology

2. Prevalence

Eclampsia occurs in approximately 1 in 2,000–3,000 pregnancies in developed countries, but remains significantly higher in low-resource settings due to delayed antenatal care and poor detection of preeclampsia.

Etiology

3. Causes

• Abnormal placental implantation
• Inadequate trophoblastic invasion
• Placental hypoperfusion
• Endothelial dysfunction
• Genetic and immunological predisposition

Pathophysiology

4. Pathophysiology (Click to explore)

Placental Abnormality

Spiral Artery Failure

Placental Ischemia

Endothelial Injury

Systemic Vasospasm

Cerebral Edema

Seizures

Placental Abnormality: Incomplete trophoblastic invasion leads to poor vascular adaptation in early pregnancy.

Spiral Artery Failure: Arteries remain narrow and high-resistance, reducing uteroplacental blood flow.

Placental Ischemia: Reduced oxygenation triggers release of inflammatory and anti-angiogenic factors.

Endothelial Injury: Maternal blood vessels become dysfunctional, increasing permeability and clotting tendency.

Systemic Vasospasm: Widespread constriction leads to hypertension and organ hypoperfusion.

Cerebral Edema: Loss of autoregulation leads to fluid leakage in the brain (PRES syndrome).

Seizures: Severe neuronal irritation and cerebral edema trigger tonic-clonic convulsions.

Risk Factors

5. Risk Factors

• First pregnancy
• Age <18 or >35 years
• Chronic hypertension
• Diabetes mellitus
• Obesity
• Multiple gestation
• Previous preeclampsia

Presentation

6. Clinical Features

Prodromal signs

• Severe headache
• Visual disturbances
• Epigastric pain
• Hyperreflexia

Seizure phase

• Loss of consciousness
• Tonic-clonic movements
• Apnoea and cyanosis
• Postictal confusion

Diagnosis

7. Diagnosis

• Clinical seizure in pregnancy/postpartum
• Elevated blood pressure ≥140/90 mmHg
• Proteinuria
• Thrombocytopenia
• Elevated liver enzymes
• Renal impairment

Treatment

8. Management

Emergency Stabilization

• Airway protection
• Left lateral position
• Oxygen 8–10 L/min
• IV access

Magnesium Sulfate Therapy

Loading dose: 4 g IV + 10 g IM
Maintenance: 1–2 g/hour IV or 5 g IM every 4 hours

Antidote: Calcium gluconate 10% – 10 mL IV slowly

Antihypertensive Drugs

Drug	Dose
Labetalol	20 mg → 40 mg → 80 mg IV (max 220 mg)
Hydralazine	5–10 mg IV every 20–30 min
Nifedipine	10 mg oral

Definitive Treatment

Delivery of the fetus and placenta after stabilization remains the only curative treatment.

Outcome

9. Prognosis

Good if treated early. Delayed care increases risk of maternal stroke, renal failure, HELLP syndrome, and fetal death.

Clinical Notes

10. Additional Information

• Early antenatal care prevents most cases
• Monitor reflexes and respiration during magnesium therapy
• Strict fluid balance is essential

Fun Fact

11. Fun Fact

The word “eclampsia” comes from a Greek term meaning “flash of lightning,” referring to the sudden onset of seizures.