Eclampsia 291471 222208756 2008-06-28T02:37:03Z Davidruben 101637 rv - remove forum per [[WP:EL]] {{DiseaseDisorder infobox | Name = Eclampsia | ICD10 = {{ICD10|O|15||o|10}} | ICD9 = {{ICD9|642.6}} | ICDO = Image = | Caption = | OMIM = | OMIM_mult = | MedlinePlus = 000899 | eMedicineSubj = med | eMedicineTopic = 633 | DiseasesDB = 4068 | }} '''Eclampsia''' is a serious complication of [[pregnancy]] and is characterised by [[seizure|convulsions]]. Usually eclampsia occurs after the onset of [[pre-eclampsia]] though sometimes no pre-eclamptic symptoms are recognisable. The convulsions may appear before, during or after [[childbirth|labour]], though cases of eclampsia after just 20 weeks of pregnancy have been recorded. ==Pathophysiology== The pathogenesis of eclampsia is poorly understood. ==Signs and symptoms== The majority of cases are heralded by [[pregnancy-induced hypertension]] and [[proteinuria]] but the only true sign of eclampsia is an eclamptic convulsion, of which there are four stages{{Fact|date=June 2008}}. Patients with [[edema]] and [[oliguria]] may develop [[renal failure]] or [[pulmonary edema]]. ;Premonitory stage: this stage is usually missed unless constantly monitored, the woman rolls her eyes{{Fact|date=June 2008}} while her facial and hand muscles twitch slightly{{Fact|date=June 2008}}. ;Tonic stage: soon after the premonitory stage the twitching turns into clenching. Sometimes the woman may bite her tongue as she clenches her teeth, while the arms and legs go rigid. The [[respiration (physiology)|respiratory]] muscles also spasm, causing the woman to stop breathing, leading to cyanosis. This stage continues for around 30 seconds. ;Clonic stage: the spasm stops but the muscles start to jerk violently. Frothy, slightly bloodied{{Fact|date=June 2008}} saliva appears on the lips and can sometimes be inhaled. After around two minutes{{Fact|date=June 2008}} the convulsions stop, leading into a temporary unconscious stage. ;Comatose stage: the woman falls deeply unconscious and need [[airway management]] to allow breathing and prevent [[hypoxia]]. This can last only a few minutes or may persist for hours. ==Epidemiology== Eclampsia is usually treated well in the majority of cases with just under one in 50 affected women{{Fact|date=June 2008}} and one in 14{{Fact|date=June 2008}} fetuses of affected women developing complications. ==Treatment== The treatment of eclampsia consists of preventing further convulsions, controling elevated blood pressure and delivering the fetus. Prevention of convulsion is usually done using [[magnesium sulfate]] with a loading of Magnesium sulfate 20% solution, 4g IV over 5 minutes, followed by 1g of magnesium sulfate an hour. The blood pressure may be controlled by [[hydralazine]] 5mg IV slowly every 5 minutes until blood pressure is lowered <!-- to around ???/??? -->. In less well resourced healthcare settings hydralazine 12.5 mg IM every 2 can be given as needed. Delivery should take place as soon as the woman’s condition has stabilized. Delaying delivery to increase fetal maturity is unsafe for both the woman and the fetus{{Fact|date=June 2008}}, after delivery the woman's health will begin to improve. Delivery should occur regardless of the gestational age{{Fact|date=June 2008}}. In severe pre-eclampsia, delivery should occur within 24 hours of the onset of symptoms{{Fact|date=June 2008}}. In eclampsia, delivery should occur within 12 hours of the onset of convulsions{{Fact|date=June 2008}}. If vaginal delivery is not anticipated within 12 hours (for eclampsia) or 24 hours (for severe pre-eclampsia), deliver by [[caesarean section]]{{Fact|date=June 2008}}. ==Bibliography== * Mayes, M., Sweet, B. R. & Tiran, D. (1997). Mayes' Midwifery - A Textbook for Midwives 12th Edition, pp. 533–545. Baillière Tindall. ISBN 0-7020-1757-4 [[Category:Obstetrics]] [[Category:Medical emergencies]] {{med-stub}} {{Pathology of pregnancy, childbirth and the puerperium}} [[de:Eklampsie]] [[es:Eclampsia]] [[fr:Éclampsie]] [[it:Eclampsia]] [[ur:ارتِعاج]] [[he:אקלמפסיה (כלבות)]] [[new:इक्लेम्प्सिया]] [[ja:子癇]] [[pt:Eclampsia]] [[sv:Graviditetskramp]] [[uk:Еклампсія]]