Eclampsia in pregnant women, what is it
From the moment of conception the female body creates the conditions most favorable for the development of the fetus. All systems are trying to adapt to the new state. But not always. If the mother’s body adapts to gestation, develops preeclampsia – specific complication of pregnancy that occurs in the period after 20 weeks.
Eclampsia is the most dangerous form of preeclampsia that represents a real threat to the life of the mother and child. This pathology requires continuous monitoring of the pregnancy and postpartum period with a readiness to provide emergency assistance at any time.
The etiology of the disease
Eclampsia is a suddenly appearing disease during pregnancy, labor and puerperium. Outside of pregnancy, the abnormality does not occur. Eclampsia is characterized by a sudden increase in blood pressure to such indicators, in which there is a real threat to the life of the mother and child. As the highest form of manifestation of preeclampsia, eclampsia is a complex of certain symptoms indicating the violation of vital activity of all organs and systems of the body. The most dangerous symptom of the disease is the occurrence of convulsions followed by loss of consciousness.
The beginning of eclampsia is preceded by a condition in which noted the intermittent increase in blood pressure. In the analysis of the urine detect the presence of protein in high concentrations. Functional disorders of the Central nervous system in cerebral blood flow, increase swelling, headaches in the occipital and temporal lobe, as well as disorders of visual function from retinal detachment and hemorrhage in the fundus of the eye is preeclamptics condition.
Preeclampsia is also characterized by pain in the epigastric region, dysfunction of kidneys, liver, total excitability of the nervous system, disruption of metabolic processes in tissues. This is an extremely dangerous condition that can go into eclampsia and hit vital organs.
By diagnosing the woman has severe preeclampsia, she put at risk, and from that moment she is under the scrutiny of the attending physician. Emergency measures to continue until the patient’s condition does not improve. A regular fence of urine for analysis for the presence of protein, the biochemical analysis of blood contain valuable information for gynecologist. Preeclampsia is a danger, however, than eclampsia. Necessarily controlled by the status of the fetus using CTG.
The greatest number of cases is fixed at the time of labor (up to 50% of cases). Second place goes to the third trimester of pregnancy (30%). Slightly lower percentage after delivery. Cardiovascular, endocrine, mental disorders, kidney and liver failure, diagnosed in a pregnant woman, are the precipitating factor for the development of the pathological state.
Symptoms of the disease
Despite advances in modern medicine in obstetrics and gynecology to date, there is no single method that allows us to predict the probability of occurrence of eclampsia in a pregnant woman. However, the list of specific symptoms can indicate the probability of occurrence of eclampsia. These include:
- increase in blood pressure above normal values (more than 15 mm Hg from baseline);
- edema in different parts of the body (face, torso, limbs);
- the decrease of urine secretion;
- emotional instability;
- disorder of visual function (partial loss of vision, blurred objects);
- upon delivery of the analysis revealed the protein in a high concentration;
- the appearance of pain in the kidneys and the epigastric of the Department;
- sleep disturbance (insomnia, superficial sleep);
- rapid weight gain (more than 500 g per week);
- the emergence of a convulsive contraction of the facial muscles and extremities.
Eclamptic coma , rapidly developing disease that requires emergency assistance and a skilled approach to his treatment. A coma can last from 1 – 2 minutes to several hours. In some cases, the time interval can be greatly increased. To determine in advance the duration of the eclamptic coma is impossible.
Eclampsia goes through the following stages of development:
- predatorily period (characterized by the appearance of a nervous TIC of facial muscles, rolling of the eyeballs);
- tonic spasmodic contraction of the muscles of the body on the background of respiratory failure with subsequent appearance of lividity of the skin;
- clonic spasmodic contraction of all muscle groups with the appearance of wheezing and foam from the mouth;
- stay in a coma with a gradual exit.
A quick exit from the coma — prognosis. The number of eclamptic seizures can be several during the day. Sometimes the background of increase of arterial pressure observed rise in body temperature. Despite the severity of this condition is much more complicated course of the disease in the absence of convulsive contractions. In this case, see a heavy defeat of the Central nervous system on the background of cerebral edema. Oxygen deprivation provokes functional disorders in the liver, kidney, digestive organs, violates the metabolic processes in tissues.
Coma causes complications not only for mother but for the fetus (can cause irreversible processes in the period of intrauterine development). The severity of the effect the number of attacks, duration of coma, degree of damage to the Central nervous system, the presence of systemic diseases.
Every attack of eclampsia lead to complications in the form of:
- dystrophic changes in the internal organs (necrosis);
- accumulation of oxidized products of metabolism;
- heart attack;
- oliguria (decreased production of urine in the body);
- placental abruption and bleeding;
- premature onset of labour;
- pulmonary edema;
- aspiration pneumonia;
- retinal detachment with short-term loss of vision;
- short memory loss;
- damage to the language as a result of procosa;
- of injury at the time of falling;
- psycho-emotional instability;
- acute hypoxia of fetus;
- deaths (for mother and child).
The longer the attack, the more unfavorable the prognosis.
Eclampsia is considered as a result preeclampsia status and severe preeclampsia. Modern medical science has a number of theories of this disease (about 30), but the exact cause has not yet been identified. The most common aggravating factors is considered to be the following:
- fetoplacental insufficiency, manifested in dysfunction of the placental barrier;
- infectious diseases of different etiology;
- genetic diseases, gene mutations, in which the mother’s body reacts to the embryo as a foreign body;
- endocrine diseases (obesity, diabetes, thyroid disease and others);
- antiphospholipid syndrome;
- the presence of chronic hypertension in the anamnesis;
- cases of pre-eclampsia (eclampsia) in previous births;
- genetic predisposition (maternal);
- late age (after 40 years);
- multiple pregnancy;
- a stress factor.
If a woman is at risk, it should be under the supervision of a doctor. The planned consultation at the gynecologist that pregnant women regularly in the antenatal clinic, are somewhat different from standard procedures. The complex of diagnostic measures includes the following points:
- identification and assessment of swelling (severity of disease);
- control measurement of blood pressure at rest;
- blood analysis (determination of creatinine, urea, bilirubin);
- urine (total and Nechiporenko);
- gemostaziogramma (the study of blood clotting);
- ultrasound diagnostics of the fetus and pelvic organs of women;
- CTG of a fetus at least 1 times a week.
On the basis of anamnesis and complaints of the patient, the doctor determines the severity of the condition. Preeclampsia does not always translate into eclampsia. But leave this fact without attention is impossible. Self-medication in this case is unacceptable.
Obstetrician-gynecologists klassificeret 2 forms of eclampsia:
- A mild form. Characterized by high blood pressure (140 mm Hg. century), the presence of protein in urine, swelling in the limbs (not always).
- A severe form. Has a more pronounced clinical manifestations: increase in pressure of 160 mm Hg. art. and above, a higher content of protein in the urine, migraines, dyspepsia, pain in the epigastric region, a violation of urination.
If signs of eclampsia a pregnant woman should be required to arrive in inpatient obstetric Department to provide skilled assistance. Eclampsia is a direct indication for emergency caesarean section in pregnancy.
At diagnosis it is important to exclude diseases with similar symptoms:
- brain tumor;
- diabetic coma;
Treatment and prevention
Several decades ago, preeclampsia, and eclampsia, treated by the standard procedure. She assumed the application of the following measures:
- the use of diuretics and diaphoretic remedies;
- the use of narcotic pain medications;
- activities aimed at the speedy delivery (natural childbirth or cesarean section).
Long-term experience of observations proved the ineffectiveness of this technique. Diuretics do not have the desired effect, and drugs have a negative impact on how a woman’s body and on the developing fetus. Bloodletting increases the risk of spazmirovannah vessels.
Modern method of treatment based on the observance of absolute rest and symptomatic treatment:
- The adherence of silence. Stay in hospital in a special ward under constant supervision of qualified staff. The absence of external stimuli in the form of noise, light, tactile contact helps prevent new attacks. The necessary procedures for testing performed under light anesthesia.
- Intramuscular magnesium sulphate (25%) every 6 hours for the first day with subsequent dose reduction on an individual scheme. Effectively the purpose of drugs phenothiazine series (Chlorpromazine) to provide anticonvulsant, hypotensive and sedative effect.
- Control blood pressure with antihypertensive drugs (Corinfar, Atenolol, Dopegit).
- The use of anxiolytic and neuroleptic drugs (Droperidol, Diazepam), oxygen and nitrogen inhalation.
- The use of dehydration tools to enhance diuresis and relieve edema (Lasix, Furosemide, Mannitol).
- Supportive therapy in the form of Seduksen, Pulsed, the use of protein products (protein, albumin).
- Intravenous glucose-novocaine mixture to improve blood circulation, Reosorbilact and saline to relieve intoxication.
- Replenishment of blood volume with solutions of plasma (Infacol, isotonic solution).
- The use of drugs with sedative effect (Diphenhydramine, Glycoled).
Preeclampsia, and eclampsia requires a comprehensive approach with the use of moderate-dose appointed drugs. In the case of ineffectiveness of the therapy, in the presence of clinical manifestations with the defeat of the brain shows an emergency cesarean delivery.
Preventive measures aimed at preventing eclamptic syndrome include the following activities:
- timely detection and correction of nephropathy;
- the use of calcium or aspirin to reduce blood viscosity;
- rest day nutrition, limitation of physical activity;
- recreation (night sleep at least 6 hours);
- eliminate stressful situations;
- regular consultation with the attending physician in compliance with its recommendations.
In case of attack you must perform the following emergency measures:
- To call an ambulance. Prior to her arrival, to follow the recommendations of the doctor on duty.
- To lay the woman on one side for free flow of foam and vomit at the time of the attack.
- To create the most comfortable conditions for the prevention of injury (it is possible to build soft cushions from scrap vehicles that are placed on the sides).
- Between attacks it is necessary to remove vomit to avoid aspiration into the respiratory system.
Preeclampsia and rapidly developing eclampsia require emergency care. Only competent approach and adequate treatment help to prevent potential negative consequences for the female body and child.