Eclampsia

Disease Description (Causes and Symptoms)

• Definition: Eclampsia refers to a condition in which preeclampsia—hypertension occurring after 20 weeks of pregnancy (systolic ≥140 mmHg or diastolic ≥90 mmHg) with proteinuria (or other signs of preeclampsia)—causes generalized convulsions (epileptic seizures) or loss of consciousness during pregnancy or before or after delivery.
• Causes and pathophysiology: The exact cause is unknown, but placental, vascular, and immunological abnormalities are thought to be involved in combination. In severe cases, loss of cerebral blood-flow autoregulation causes hyperperfusion and increased vascular permeability, leading to findings resembling cerebral edema/reversible posterior encephalopathy syndrome (PRES).
• Major risk factors: Family history (gestational hypertension), multiple pregnancy, polyhydramnios, diabetes mellitus, chronic hypertension or chronic kidney disease, autoimmune disease, advanced maternal age, obesity, anemia, first pregnancy (no history of miscarriage), and, in some reports, an association with nonsmoking.
• Major symptoms: Headache, visual disturbances (blurred vision, photopsia), upper abdominal (right upper quadrant) pain, hypertension, generalized edema, proteinuria, and convulsions (accompanied by loss of consciousness). If the condition worsens rapidly, placental abruption and multiorgan dysfunction may occur.

Treatment Methods

• Definitive treatment: Delivery (childbirth) is the final and decisive treatment. The timing of delivery is determined by considering gestational age and the condition of the mother and fetus.
• Control/prevention of convulsions: Intravenous magnesium sulfate (MgSO4) administration (e.g., a loading dose followed by maintenance therapy) is standard for the treatment and prevention of convulsions. Calcium gluconate (intravenous) is used in cases of magnesium toxicity.
• Treatment of hypertension: Immediate antihypertensive treatment is required for severe hypertension (generally ≥160/110 mmHg). Commonly used medications include intravenous labetalol, hydralazine, and immediate-release oral nifedipine (not amlodipine). Example target blood pressure: systolic 140–155 mmHg and diastolic 90–100 mmHg (may vary by institution).
• Conservative (exceptional) treatment: If the fetus is immature and the condition of the mother and fetus is stable, expectant management may be performed in the hospital with close observation (admission), including monitoring blood pressure and proteinuria, blood tests (CBC, platelets, AST/ALT, creatinine, electrolytes), and fetal monitoring (NST, ultrasound).
• Critical care management: Fluid management (with caution regarding excessive fluid volume), respiratory and neurological monitoring, preparation for hemostasis and transfusion (when thrombocytopenia or HELLP syndrome is suspected), and, when necessary, a multidisciplinary approach in the intensive care unit and delivery room.
• Precautions (during self-care and hospital treatment)
  • If convulsions occur, secure the airway, do not restrain the mother’s hands or feet, administer magnesium sulfate immediately, and consider emergency delivery.
  • During magnesium administration, if respiratory depression (respiratory rate <12/min), decreased heart rate or reflexes (patellar tendon reflex), or urinary retention occurs, perform an immediate evaluation and prepare calcium gluconate.
  • If the platelet count is very low or a coagulation disorder is present, discuss the delivery and anesthesia strategy in advance (including contraindications to spinal/epidural anesthesia).
• Prognosis: Symptoms usually improve after delivery, but complications (renal failure, liver injury, cerebral hemorrhage, DIC, fetal death, etc.) may occur. In some cases, persistent neurological sequelae or postpartum hypertension may remain.

Checkpoints Before an Outpatient Visit (Including Preparations, Items to Review, and Sample Questions)

• Items to bring to the hospital
  • Recently measured blood pressure records (BP log: including date/time and position)
  • Urinalysis results (proteinuria testing) and recent test reports (blood tests, platelet count, liver function, kidney function)
  • List of medications currently being taken (including prescription drugs, OTC drugs, herbal medicines, and supplements)
  • Records of when changes in fetal movement or symptoms (headache, visual disturbances, abdominal pain, edema) began, as well as their frequency and severity
  • Previous obstetric history (pregnancy history) and history of chronic diseases (hypertension, kidney disease, autoimmune disease, etc.)
• Tests and records to request for submission to the doctor during the outpatient visit
  • 24-hour urine protein (if possible), CBC, platelet count, AST/ALT, creatinine, electrolytes, and urinalysis
  • Fetal heart-rate monitoring (NST) or ultrasound (growth assessment)
• Criteria for immediate hospital visit (emergency signs)
  • Persistent or severe headache, loss or blurring of vision, repeated vomiting, altered consciousness or convulsions, sudden severe abdominal pain (right upper quadrant), or markedly decreased fetal movement.
• Sample questions (questions the patient should prepare to answer)
  • When did your recent symptoms begin, and what were they like (headache, visual changes, abdominal pain, edema, etc.)?
  • Do you have records of blood pressure measurements? Are you taking any medications?
  • When was your last prenatal examination/test, and what were the results?

General Sample Questions to Ask the Doctor

• When do you recommend delivery in this condition? What are the criteria for deciding between labor induction and cesarean section?
• What are the expected effects and side effects of the prescribed medications (e.g., labetalol and magnesium)?
• What is the significance of the current test results (such as decreased platelets or elevated liver enzymes), and are additional tests needed?
• What is the basis for determining whether hospitalization or intensive care treatment is needed, or whether outpatient follow-up is possible?
• How should blood pressure be managed going forward, and until when after delivery should medication be taken?

Disease-Specific Sample Questions

• I am planning a future pregnancy. What is the risk of recurrence, and what recommendations are available for prevention or early detection (special tests or early prenatal care)?
• Considering my current gestational age and the condition of the fetus (ultrasound growth assessment and NST results), do you recommend immediate delivery (induction or cesarean section), or is conservative management possible? Please explain.