slide presentation eclampsia

• My presentations

Auth with social network:

Download presentation

We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!

Presentation is loading. Please wait.

To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video

Published by Roberta Porter Modified over 9 years ago

Similar presentations

Presentation on theme: "Eclampsia."— Presentation transcript:

Definition of Terms Seizure Epileptic Seizure Epilepsy

Preeclampsia Maternal Affinity Group October 23, 2013.

Hypertension in Pregnancy

The ACOG Task force on hypertension in pregnancy

Hypertensive Disorder in Pregnancy

Complications of Pregnancy Author: Evelyn M. Hickson, RN, MSN, CNS, WCC.

HYPERTENSIVE DISORDERS OF PREGNANCY Dr. Dianne MP Graham, MD, CCFP Based on Guidelines From SOGC ALARM Course & WHO Guide on Managing Complications in.

Eclampsia/postpartum angiopathy epilepsy Cerebrovascular accidents Hemorrhage Ruptured aneurysm or malformation Arterial embolism or thrombosis Cerebral.

Diabetes during pregnancy

Fetal Monitoring RC 290 Estriol By-product of estrogen found in maternal urine –Production requires functional placenta and fetal adrenal cortex Levels.

Pre- eclampsia ImpendingEclampsia It is a disease of pregnancy characterized by BP 140/ 90 or more. BP 140/ 90 or more. After 20 week gestational.

1-Gestetional Thrombocytopenia.

Pre-eclampsia, Eclampsia and HELLP syndrome Dr.Victor M De Leon Anzures Hospital O,horan UCIA Medicina Critica y Terapia Intensiva.

 To educate pregnant women on the importance of prenatal care and educate them on the complications that pertain to human pregnancy.  To be knowledgeable.

MANAGEMENT HTN IN PREGNANCY. DEFINITIONS The definition of gestational hypertension is somewhat controversial. Some clinicians therefore recommend close.

With one woman dying during pregnancy or complications of childbirth every minute of every day, and 3.6 million neonatal deaths per year, maternal and.

NYU Medical Grand Rounds Clinical Vignette Demetrios Tzimas, PGY 2 October 27, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.

About project

© 2024 SlidePlayer.com Inc. All rights reserved.

Preeclampsia: Etiologies and Management

Jan 02, 2020

610 likes | 743 Views

Preeclampsia: Etiologies and Management. Dr. Mahmoud A. Ismail Professor and Chief of Maternal Fetal Medicine. Classification of the Hypertensive Disorders Complicating Pregnancy. Chronic Hypertension (Primary and Secondary) Preeclampsia/eclampsia Superimposed preeclampsia

Share Presentation

• superimposed preeclampsia
• gestational hypertension
• chronic hypertension
• superimposed preeclampsia 20
• bp control prevent preeclampsia

Presentation Transcript

Preeclampsia: Etiologies and Management Dr. Mahmoud A. Ismail Professor and Chief of Maternal Fetal Medicine

Classification of the Hypertensive Disorders Complicating Pregnancy • Chronic Hypertension (Primary and Secondary) • Preeclampsia/eclampsia • Superimposed preeclampsia • Gestational hypertension (re-designated “transient” when pressure normalizes postpartum).

Causes of hypertension in pregnancy superimposed pre-eclampsia secondary hypertension pre- eclampsia essential hypertension gestational hypertension (Brown, Buddle 1997)

Cardiovascular Adaptation in Normal Pregnancy • Early systemic vasodilation with increased CO • Modest decrements in BP despite large increases in ECV • Early and marked increase in arterial compliance • Marked stimulation of the renin-aldosterone systems • Refractoriness to infused vasopressors (eg, AII) • Early renal vasodilation and hyperfiltration • no increase in PGC • renal vasodilation appears mediated by relaxin, via the endothelin B receptor-NO by increasing vascular MMP-9 & 2 activity (rat MMP-2 mRNA increased) • Significant Na (volume) retention; sensed as normal • BP may rise towards nonpregnant level near term

BP throughout gestation in 6000 normal pregnancies (white women, 25-34)Christianson et al 1976

DEFINITIONS Hypertension: BP > 140 systolic and/or 90 diastolic (Severe: BP > 170 systolic and/or 110 diastolic) probably too high Protienuria: >300 mg/24h, spot Cr/Protein = 0.3, Dipstick 1+ (high false + & -) Preeclampsia: De Novo hypertension and proteinuria after midpregnancy

Many women with mild to moderate hypertension can discontinue their medications in early pregnancy due to physiological gestational vasodilation • Failure of this physiological decrease in BP may predict poorer outcome • Monitor pregnancy closely re: high risk of superimposed preeclampsia (> 20%) and likely need for antihypertensives later in pregnancy

Why should we treat hypertension during pregnancy? • Will BP control prevent preeclampsia? • Will BP control improve neonatal outcome? • Will BP control decrease maternal morbidity?

Not just dangerous for the fetus * • BP of 170 systolic or 110 diastolic can lead to cerebrovascular catastrophe in pregnancy • Uncontrolled hypertension often leads to hospital admission and early delivery to preserve maternal safety *Retrospective studies suggest increased cerebral accidents when systolic levels >150 mm Hg

Prevent: No (definitive trial needed) • Improve neonatal outcome: Probably…Maybe (definitive trial needed • Decrease maternal morbidity: Yes • Morbidity in 2 & 3 primarily severe hypertension

Regardless of drug class, BP control does not prevent proteinuria or preeclampsiaAbalos et al, Cochrane 2002

Pregnancy-specific multi-organ syndrome • Hypertension + proteinuria • Over 60,000 maternal deaths worldwide per year • 30% of premature deliveries are consequence of PE • Two-fold increased riskof CVD later in life

Preeclampsia: Definition, Diagnosis and Impact • De novo hypertension and proteinuria presenting after mid-pregnancy (exceptions exist) • Accounts for most, but not all, of the morbidity of hypertension in pregnancy • May be superimposed on chronic hypertension or renal disease, (such scenarios often severe) • Unique to human gestation, resolves with delivery • A systemic disease with multiorgan involvement • May progress to convulsive phase: eclampsia • A leading cause of maternal mortality • A leading cause of of preterm births (~15%)

Why are preeclamptic women hypertensive? • AII sensitivity increases even before overt preeclampsia, and despite decreased AII, PRA and aldosterone levels (Role of Ang I receptor autoantibodies?) • Invasive hemodynamic studies in preeclamptic women reveal high SVRs and decreased COs • Renal vasoconstriction with greater fall in GFR than in ERPF, suggesting afferent vasoconstriction • Sympathetic activity is increased, in parallel with BP; whether causal or compensatory unknown • Endothelial dysfunction related (enormous literature) • Pathogenetic roles for increased AII action and impaired VEGF signaling perhaps secondary to sFlt-1 & sEndoglin

Goravic et al, AJOG, April, 07: Preeclampsia is also a podocyte disorder (podocyturia present)

Longitudinal changes in cardiac output and SVR in normal pregnancy and in women with preeclampsia or gestational hypertensionBosio et al, 1999(Vascular compliance decreased in superimposed preeclampsia independent of increase in blood pressures)Hibbard et al 2005

Endoglin - overview • Endoglin or CD105 is a TGF -b1 and b3 co-receptor on endothelial • cells and syncytotrophoblasts of the placenta • Endoglin mutations underlie Hereditary Hemorrhagic Telangiectasia-1, • characterized by AV malformations and focal loss of capillaries • Endoglin null mice die at mid-gestation due to defective angiogenesis • and cardiovascular development • Endoglin may be involved in the regulation of endothelial nitric oxide • synthase (eNOS) activity and the local regulation of vascular tone

An Animal Model for “severe” Preeclampsia The simultaneous introduction of adenoviruses encoding both sFlt1 and soluble endoglin produced severe hypertension, heavy proteinuria, elevated liver enzymes, and circulating schistocytes, in essence creating a powerful model that simulates most of the protean manifestations of preeclampsia in humans and has obvious implications for the study of mechanisms or therapy of the disease.

Preeclampsia: Maternal Factors: Diagnosis, Risk, Recurrence • Increased in women with hypertension, diabetes mellitus, renal disease, multiple fetuses, obesity, previous preeclampsia, insulin resistance, hyperhomocysteinemia, or Thrombophilias • Difficult to diagnose with underlying hypertension, renal disease, collagen vascular disease… err in favor of diagnosis • Considerably less common in parous women unless they have underlying risk factors • Recurrent preeclampsia predicts later cardiovascular disease • By contrast, cardiovascular risk is lowest in women who have been pregnant, but never preeclamptic

WHO systematic review of screening to predict preeclampsia Conde-Agudelo A, et al Obstet and Gynecol 2004;104:1367-1391 87 of 7,191 articles (211,369) women met criteria. CRITERIA Population adequately described (by age, parity, risk) Cut off levels; clear definitions of + or - test Adequate blinding + results from >90% of participants RESULTS • No clinically useful screening test to predict PE • Promising and being investigated: Combinations of tests: e.g., Anti and pro-angiogenic factors (sFlt-1, sEng, PlGF) (see Obstet Gynecol 109:168.07)

Levine et al N Engl J Med 9/06

Preeclampsia >37 weeks Preterm Preeclampsia Levine et al N Engl J Med 9/06

Preeclampsia prevention/intervention trials • Aspirin: Initially very effective in small trials, but little effect in large subsequent trials. Meta analyses galore ! Latest (Paris collaboration) suggests small effect. • Calcium supplementation: Minimal (if any) effect on preeclampsia, but decreases disease severity in populations with low Ca intake (<600 mg/d). • Blood pressure control, per se: no decrease in preeclampsia regardless of agent (diuretic, β blocker, other) more definitive trials needed. • Fish oil, Mg supplementation appear without benefit, • Vitamin C+E: Major trials negative to-date and possibly harmful.

Remember the Objectives of Treating Preeclampsia • Prevent convulsions • Deliver a surviving child • Prevent mortality and residual pathology in mother and child

“Conservative Management” in Severe Preeclampsia • While there are studies suggesting prolongation of pregnancy, fetal outcome is improved minimally, if at all, while maternal morbidity increases substantially. • Temporize only as long as BP control is acceptable, and in the absence of ominous symptoms and signs (i.e., headache, visual disturbance, epigastric pain, coagulopathy or thrombocytopenia, microangiopathy, abnormal LFTs, renal dysfunction, or fetal jeopardy) and preferably in a tertiary care setting.

HELLP SyndromeHemolysisElevated Liver-EnzymesLow Platelet Count

Eclampsia: Pathophysiology and Prevention in 2006 • Noninvasive techniques suggest elevated CPP in eclampsia, lowered by magnesium or labetalol. Possible role for drug effects on autoregulation in addition to systemic BP • Magnesium is drug of choice to prevent recurrent seizures (RCTs: Mg vs diazepam or phenytoin) • 24 h of Magnesium prevents seizures (without monitoring!) in Magpie trial (>15,000 women) • Magnesium prevents seizures better than selective cerebral vasodilator • Can occur days to weeks postpartum (Hirshfeld-Cytron et al Obstet Gynecol Survey 61:471, 2006)

Principles of management of hypertension in pregnancy • Most do not treat mild to moderate hypertension < BP 150-160/100-110 (except if underlying disease or target organ damage present). All should treat BP >150-160/100-110, 170/110 is a medical emergency • We have no randomized trials to guide BP targets! • Aim for vaginal delivery close to term if possible • Monitor maternal and fetal welfare closely in these very high risk pregnancies • renal, hepatic, coagulation status • fluid balance • fetal growth, activity, cardiac reactivity

Drugs for Chronic Hypertension in Pregnancy • Methyldopa-B: 0.5-3 g/d 2-4 divided doses (preferred drug of NHBPEP Working Group) • Labetalol-C: 200-1200 mg/d 2-3 divided doses • Hydralazine-C: 50-300 mg/d 2-4 divided doses (useful only with sympatholytic agent) • β receptor blockers-C: (dose depends on agent); those with ISA preferred by Australasian group • Nifedipine-C: 30-120 mg/d of sustained release preparation, other CCBs seem similarly effective • Thiazide Diuretics-C: (dose depends on agent) can cause volume depletion and electrolyte disorders, but effective in chronic hypertensives (?salt sensitive?) as adjunct therapy.

Drugs for Urgent Control of Severe Hypertension • Hydralazine-C: 5mg iv/im, then 5-10 mg q 15-40 min (or infusion of 0.5-10 mg/h) • Labetalol-C: 20 mg iv, then 20-80 mg q 20-40 min up to max of 300 mg (or infusion of 1-2 mg/min) • Nifedipine-C: 5-10 mg po, repeat in 30 min prn, then 10-20 mg q 2-4h (noted by NHBEP working group, but not approved by FDA for treatment of hypertension) • Nitroprusside-C: 10 µg/kg/min, agent of last resort due to possible toxicity • Some newer (designer) ones: untested in gravid women

Antihypertensive Selection in Nursing Mothers • Key pharmacokinetic principles governing drug transfer to milk include: small maternal Vd, low plasma protein binding, high lipid solubility. Of additional importance are neonatal oral bioavailability and safety. Well-designed studies are pitifully few, if at all. • Atenolol and metoprolol are concentrated in milk • Diuretics can decrease milk production • CCBs and methyldopa transfer to milk, apparently with no adverse effects • Few data on ACE inhibitors or ARBs except for captopril which appears safe in nursing

Key Issues in Antihypertensive Selection • In spite of recent small series, there remains NO justification for use of ACE inhibitors or ARBs due to possible congenital malformations and definitive fetal toxicity • Data remain inadequate and contradictory to choose between drug classes for maternal/fetal risk/benefit • (controversy re: early β blockers vs methlydopa) • Choose the drugs you know best from among those commonly used in pregnancy

Summary • Pregnancy is normally a vasodilated state which can be complicated by several hypertensive disorders, potentially threatening mother and fetus • Specific diagnosis may matter • Goals of antihypertensive therapy differ from those in nonpregnant women • Choice of drugs depends more on established clinical experience than on well-designed and adequately-powered trials in pregnant women, which remain shamefully lacking

Hypertension in Pregnancy: Reviews, Guidelines, Consensus NHBEP Working Group on Hypertension in Pregnancy: AJOG 183:S1-S22, 2000 AHRQ Evidence Report on Management of Mild Chronic Hypertension in Pregnancy: Obstet Gynecol 96:849-60, 2000 Cochrane Pregnancy and Childbirth Group: Cochrane Database of Systematic Reviews New Developments in Preeclampsia. Semin Nephrol 24:537-625 , 2004 (issue edited by Davison JM & Lindheimer MD) Karumanchi S et al. Kidney Itl 67:12001-13, 2005 Redman CW, Sargent Il: Science 308:1592-4, 2004 Karumanchi SA,Lindheimer MD. Advances in the understanding of eclampsia. Curr Hypertens Rep;10:305-12, 2008. Lindheimer MD, Taler SJ, Cunningham FG . Hypertension in pregnancy (invited Am Soc Hypertension position paper) Journal of the American Society of Hypertension, (in press Nov-Dec 2008)

Special Thanks are due to: • Professor Marshall Lindheimer, M.D. for guidance and help in preparing this lecture • My residents and fellows for academic assistance • My children for technological assistance

Novel Therapies for Preeclampsia • Antibodies to dioxin (digibind) or to marinobufogenin (endogenous ouabain) • Relaxin • VEGF- 121

VEGF-121 therapy in experimental preeclampsia Li et al. Hypertension 50:686. 07 Body Weight of Fetus Systolic BP 200 0.7 0.6 160 0.5 120 0.4 SBP(mmHg) 0.3 80 0.2 0.1 40 0.0 Naive Null Vehicle VEGF121 0 Adv-sFlt Naive Null Vehicle VEGF121 Adv-sFlt Urine Albumin/Creatinine 20000 16000 12000 UA (ug)/Ucrea (mg) 8000 4000 0 Null Vehicle VEGF121 Naive Adv-sFlt Adv-sFlt+Vehicle Adv-sFlt+VEGF121 Body Weight per Fetus (g/Fetus)

Severe morbidity and mortality according to treatment group

Cumulative risk of neonatal mortality, by treatment group Cox regression model p =0.02* Villar et al. 2006 Adjusted for clustering on centre

Do not Forget! • Blood pressure decreases early in pregnancy; thus mild chronic hypertension can be missed and then misdiagnosed as preeclampsia or gestational hypertension near term • Most women with mild to moderate hypertension require little or no drug therapy until later in pregnancy • As most young women are not hypertensive, we must be aggressive in searching for secondary causes, especially renovascular hypertension and pheochromocytoma

• More by User

Pathogenesis, diagnosis and management of pneumorrhachis

Pathogenesis, diagnosis and management of pneumorrhachis Eur Spine L (2006) 15 (Suppl. 5):S636-S643 - Int 溫聖辰 Introduction Pneumorrhachis (PR) Phenomenon of intraspinal air, is an exceptional imaging finding Various etiologies mainly traumatic and iatrogenic

961 views • 27 slides

Anaesthetic management of obstetric emergencies

Anaesthetic management of obstetric emergencies. Dr M Booyens Mb,chb ( ufs ), da ( sa ) Medical officer – anaesthesia – RMS Hospital. Content. Umbilical cord prolapse Antepartum Hemorrhage (APH) Postpartum Hemorrhage (PPH) Hypertensive disorders HELLP syndrome

1.78k views • 41 slides

Metabolic Anomalies and Nutritional Management for Short Bowel Syndrome

Goals and Objectives. Define short bowel syndromeReview anatomy and physiology of the gastrointestinal tractDiscuss underlying etiologies of short bowel syndromeDiscuss metabolic complicationsReview surgical management for short bowel syndromeReview medical treatment modalities. What is short b

812 views • 52 slides

Cerebrospinal Fluid Leaks

Introduction. Cerebrospinal fluid surrounds and cushions brainPathologic communication with outside world can lead to problemsMultiple etiologies of CSF fistulaeMultiple diagnostic modalitiesTreatment varies and depends on etiologies. History. 2nd Century -- described by GalenMiddle Ages -- ass

836 views • 24 slides

IMPACT OF PREECLAMPSIA ON BIRTH OUTCOMES

IMPACT OF PREECLAMPSIA ON BIRTH OUTCOMES. Xu Xiong, MD, DrPH Department of Obstetrics and Gynecology Université de Montréal, Quebec, Canada. Preeclampsia. A syndrome characterized mainly by hypertension and proteinuria after 20 weeks of gestation.

400 views • 15 slides

Hypertension and Preeclampsia Intervention Trial At Term: The HYPITAT-trial

Hypertension and Preeclampsia Intervention Trial At Term: The HYPITAT-trial. Corine M Koopmans, Ben W J Mol, Jan G Aarnoudse, Paul P Van Den Berg Henk Groen, Christine Willekes, Anneke Kwee, Kitty WM Bloemenkamp, Joris AM Van Der Post, Hubertina CJ Scheepers and Maria MG Van Pampus,

2.11k views • 43 slides

Angiogenic factors in preeclampsia

274 views • 5 slides

The Ecliptic Patient and Management : local and international practices

The Ecliptic Patient and Management : local and international practices. Dr. Chisale Mhango FRCOG. NPC Training in MNH. Definition of Eclampsia. New onset of grand mal seizure activity and/or unexplained coma during pregnancy or postpartum in a woman with signs or symptoms of preeclampsia

360 views • 24 slides

Etiologies of Bulimia

Etiologies of Bulimia. Analyse etiologies, in terms of biological, cognitive and/or sociocultural factors, of Bulimia Nervosa.’ . Predictions?. Biological? Cognitive? Socio-Cultural?. Answer the following questions in your notes.

304 views • 10 slides

Update on Prediction &amp; prevention of Preeclampsia

Assist. Prof. S. Rouholamin. Update on Prediction &amp; prevention of Preeclampsia. Hypertension in Pregnancy. Etiology &amp; Definition. Complicates 10-20% of pregnancies Elevation of BP ≥140 mmHg systolic and/or ≥90 mmHg diastolic, on two occasions at least 6 hours apart. Categories.

2.33k views • 117 slides

Nursing Management of DI and SIADH April 24, 2012

Nursing Management of DI and SIADH April 24, 2012. Lauren Walker RN, BSN, CCRN. Objectives. Describe the normal function of ADH in water and electrolyte regulation. Compare and contrast the etiologies of SIADH and DI. Describe the assessment findings of SIADH and DI.

1.1k views • 32 slides

Preeclampsia and Eclampsia: Anesthetic Management

Preeclampsia and Eclampsia: Anesthetic Management. Anita M. Backus, MD Assistant Clinical Professor Director of Obstetric Anesthesia UCLA Medical Center Los Angeles, California. www.anaesthesia.co.in [email protected]. Preeclampsia: Epidemiology. Incidence widely quoted at 5-7%

1.69k views • 39 slides

CASE PRESENTATION PREECLAMPSIA

CASE PRESENTATION PREECLAMPSIA. PRESENTED BY : Avneep Aggarwal MODERATOR : Anjan Trikha. www.anaesthesia.co.in [email protected]. HISTORY. Name: Savita Age: 27 yrs Resident of New delhi Date of admission 11/08/08 Presenting complaint : Missed periods for 8 months.

4.99k views • 44 slides

CHRONIC PAIN MANAGEMENT

CHRONIC PAIN MANAGEMENT. Michael Marschke, MD Medical Director of Horizon Hospice. COMMON ETIOLOGIES OF CHRONIC PAIN . Episodic pain syndromes: Headaches – migraine, tension, cluster… Ischemic episodes – claudication, angina, sickle cell disease

585 views • 24 slides

SINDROME PREECLAMPSIA-ECLAMPSIA -CONTROVERSIAS-

Jornadas Tocoginecológicas SOGIU Centro Regional Trinidad Setiembre 2014. SINDROME PREECLAMPSIA-ECLAMPSIA -CONTROVERSIAS-. Asist . Dra. María Eugenia Verde-Prof. Agdo . Dr. Fabián Rodríguez Clínica Ginecotocológica C Facultad de Medicina Universidad de la Republica.

469 views • 10 slides

Got any suggestions?

We want to hear from you! Send us a message and help improve Slidesgo

Top searches

Trending searches

101 templates

39 templates

art portfolio

100 templates

24 templates

43 templates

9 templates

Preeclampsia Clinical Case

It seems that you like this template, preeclampsia clinical case presentation, free google slides theme, powerpoint template, and canva presentation template.

Preeclampsia is a condition that affects people who are pregnant. It causes high blood pressure, kidney damage and even other signs of organ damage. When should you expect it? You should be looking for these symptoms around the 20th week of pregnancy. Now you might be worried about how this can affect your baby, but thanks to medical advances, new treatments offer a hopeful prospect for the pregnancy. Speak about your last patient with this clinical case template and share your findings with the medical community. Knowledge equals health!

Features of this template

• 100% editable and easy to modify
• 28 different slides to impress your audience
• Contains easy-to-edit graphics such as graphs, maps, tables, timelines and mockups
• Includes 500+ icons and Flaticon’s extension for customizing your slides
• Designed to be used in Google Slides, Canva, and Microsoft PowerPoint
• 16:9 widescreen format suitable for all types of screens
• Includes information about fonts, colors, and credits of the resources used

How can I use the template?

Am I free to use the templates?

How to attribute?

Attribution required If you are a free user, you must attribute Slidesgo by keeping the slide where the credits appear. How to attribute?

Register for free and start downloading now

Related posts on our blog.

How to Add, Duplicate, Move, Delete or Hide Slides in Google Slides

How to Change Layouts in PowerPoint

How to Change the Slide Size in Google Slides

Related presentations.

Premium template

Unlock this template and gain unlimited access

• • Rare but serious complication of pregnancy that can result in injury or death of the pregnant person and/or baby
• • Symptoms include seizures, facial twitching, body-wide muscle contractions and relaxations, foam at the mouth
• • Treatment includes medication, vaginal or cesarean delivery of the baby
• • Involves Maternal-Fetal Medicine, High-Risk Pregnancy Program, Obstetrics, Gynecology & Reproductive Sciences
• Maternal Seizure Disorder
• Preeclampsia
• Hypertensive Disorders of Pregnancy
• Gestational Hypertension
• HELLP Syndrome

What is eclampsia?

What causes eclampsia, what are the symptoms of eclampsia, what are the risk factors for eclampsia, how is eclampsia diagnosed, how is eclampsia treated, what is the outlook for people with eclampsia, what makes yale unique in its treatment of eclampsia.

Eclampsia, a rare condition in which a pregnant or postpartum person suddenly experiences seizures, is a medical emergency. It is a serious complication of pregnancy that can lead to injury or death of the pregnant person and/or baby. Eclampsia usually occurs in people with preeclampsia , a condition of high blood pressure and protein in the urine that can develop during pregnancy or in the postpartum period. However, in some cases, eclampsia may arise in a pregnant or postpartum person not previously diagnosed with preeclampsia.

The hallmark symptom of eclampsia is seizures, which can lead to dangerous complications, including difficulty breathing, blood clots, stroke , coma, heart failure , premature birth , and maternal and fetal death.

Eclampsia typically occurs during the final trimester (weeks 28–40) of pregnancy, but it can arise any time after 20 weeks of pregnancy and until 6 weeks after delivery. It can even occur during labor and delivery.

Eclampsia is rare, affecting fewer than 1% of pregnant women with high blood pressure during pregnancy, which includes women with preeclampsia. In the U.S., this means that between 1 and 10 pregnant women out of every 10,000 are affected.

The most effective treatment is to stabilize the person having a seizure and then prepare to deliver the baby, as the condition typically begins to resolve after childbirth. Importantly, treatments for eclampsia are available to help stop seizures, safely lower blood pressure, and deliver the baby safely. Complications, which may lead to injury or death of the mother and/or baby, occur in 5.6% to 14% of women with eclampsia, highlighting the importance of proper diagnosis and treatment.

Eclampsia typically occurs when a pregnant person with preeclampsia (a condition marked by high blood pressure and protein in the urine) begins having seizures. The condition is a life-threatening emergency.

In healthy pregnant persons, blood pressure levels remain normal throughout pregnancy and postpartum. However, in pregnant and postpartum persons who develop high blood pressure and protein in their urine, the diagnosis is a condition called preeclampsia. Preeclampsia may be mild or severe, either of which may advance to eclampsia.

Because doctors cannot predict which patients with preeclampsia will advance to eclampsia, anticonvulsant (anti-seizure) medication may be given to pregnant and postpartum persons with severe preeclampsia to reduce their risk of seizures.

Doctors aren’t sure what causes eclampsia. It may be related to problems related to the development of the placenta or poor blood flow to the placenta. Genetic factors, inflammatory changes in the body, blood clotting abnormalities, brain inflammation, or hormone imbalances may also be factors.

Seizures are the most notable symptom of eclampsia. Pregnant or postpartum persons may experience seizures that last 1 to 2 minutes. During the seizure, they typically:

• Experience facial twitching
• Have a series of rapid, body-wide muscle contractions and relaxations
• Foam at the mouth
• Become unconscious for a short period after the seizure
• Act confused or agitated after regaining consciousness
• Hyperventilate during seizure recovery
• Have no memory of the seizure

Some experience seizure-related complications, such as biting their tongues, hitting their heads on the floor (causing head trauma), and breaking bones due to falls.

Pregnant persons are at increased risk of eclampsia if they:

• Have never been pregnant before
• Are pregnant with twins or other multiples
• Have a personal or family history of preeclampsia/eclampsia
• Are teenagers
• Are age 35 or older
• Experienced fetal growth restriction or stillbirth in a previous pregnancy
• Had placental abruption (the placenta detaching from the uterus) in a previous pregnancy
• Have a pregnancy affected by fetal growth restriction
• Have obesity
• Have pregestational diabetes
• Have lupus or other autoimmune diseases
• Have kidney disease
• Had hypertension before becoming pregnant
• Have vascular conditions
• Had in-vitro fertilization (IVF)

As soon as a pregnant person with preeclampsia begins experiencing seizures, they may be diagnosed with eclampsia. The seizures may arise suddenly and should be treated immediately.

Doctors may not rely on an extensive medical history, although it’s helpful for them to know that a patient was diagnosed with preeclampsia, has a personal or family history of preeclampsia/eclampsia, or has a known seizure disorder not related to pregnancy or preeclampsia.

It is important to note that many pregnant people who develop eclampsia were previously diagnosed with preeclampsia because they had high blood pressure readings (140/90 mmHg or higher) and protein in their urine, a sign that the kidneys are malfunctioning. Some patients with severe preeclampsia (with blood pressure readings of 160/110 mmHg or higher) may have been prescribed anti-seizure medication to prevent eclampsia, but the treatment is not always effective.

Diagnostic testing may be used to confirm high blood pressure and protein in the urine, check liver function, blood cell count, and look for blood clotting abnormalities, particularly among those not previously diagnosed with preeclampsia. Imaging studies, such as cranial tomography (CT), may be used to rule out other conditions, such as a brain hemorrhage. Other testing may be performed to rule out infection, trauma, or ingestion of a toxic substance.

When a pregnant person with eclampsia begins having seizures, they will be treated immediately with magnesium sulfate, an intravenous anticonvulsant medication used to stop or prevent seizures. The patient should also be placed on her side to reduce the risk of aspiration (inhaling food, vomit, or bodily fluids). If magnesium sulfate is not effective, another anticonvulsant medication may be given intravenously, such as a benzodiazepine like diazepam or lorazepam.

In addition, intravenous medication to lower their blood pressure, such as hydralazine or labetalol, and supplemental oxygen to help the patient and baby maintain adequate oxygen levels may also be given.

Ultimately, delivery is usually the most effective way to treat or “cure” eclampsia. Once a person with eclampsia has been stabilized and is not actively having seizures, doctors typically recommend delivering the baby. After an eclamptic seizure, a woman can have a vaginal birth or a Cesarean birth, but in many cases a Cesarean delivery is preferred because it is often quicker than vaginal delivery—the speed of a delivery may minimize potential complications. In some cases, if the patient and the baby have stabilized after the seizure, doctors may give oxytocin to speed labor and vaginal delivery.

After delivery, the patient should continue to receive magnesium sulfate or another anticonvulsant medication for 24 hours. She should be observed closely during this time frame to help avoid complications, such as very high blood pressure, difficulty breathing or additional seizures.

Some patients with eclampsia are given medication to lower their blood pressure when they’re discharged from the hospital. They may need to follow up with their doctors earlier and more frequently, than the typical 6-week post-pregnancy appointment.

Most people with eclampsia recover and safely deliver their babies. Others may have serious health complications, such as stroke, and their babies may experience severe complications, such as prematurity, brain injury, or neonatal respiratory distress syndrome. In a minority of cases, people and/or babies die from eclampsia.

Some people who develop eclampsia during pregnancy continue to have high blood pressure for 6 to 8 weeks after pregnancy.

People with eclamptic seizures are at increased risk of eclampsia in later pregnancies. Their doctors may prescribe low-dose (baby) aspirin during future pregnancies to reduce this risk. People who have had eclampsia are also at an increased risk of cardiovascular disease, seizures, and cognitive impairment later in life, highlighting the importance of proper diagnosis and treatment.

”Yale Maternal-Fetal Medicine is a regional center with expertise in management of preeclampsia, eclampsia, and other hypertensive disorders that may complicate a current or past pregnancy,” says Katherine Campbell, MD, MPH , a Yale Medicine specialist in maternal-fetal medicine and medical director of Labor & Birth and the Maternal Special Care Unit at Yale New Haven Hospital . “Yale offers 24 hour-7 days a week Maternal-Fetal Medicine coverage of our inpatient Labor and Birth Unit at Yale-New Haven Hospital and we collaborate closely with our neonatal colleagues to help care for our patients and their babies. We provide state of the art care, incorporating multidisciplinary, team-based care in both the outpatient and inpatient setting to manage patients with preeclampsia or eclampsia. We have active research studies to help advance our understanding of the mechanisms underlying this disease, identify novel therapeutics, and provide optimal clinical care at the bedside and after discharge home.”