Eclampsia is a life threatening complication of pregnancy. It is manifested by very high blood pressure associated with generalized convulsions and at times loss of consciousness. There is also proteinuria, i.e. passing of proteins in the urine. This condition is different from convulsions or coma due to infection or other causes during pregnancy. A woman may have nausea, vomiting, headache and photophobia prior to the onset of florid eclampsia. There may be feeling of restlessness and or muscle twitching also in the preceding phase. This is followed by generalized involuntary contractions of the limbs, which usually last for 15 to 20 seconds. The entire body becomes rigid during this phase and tongue may be bitten between the teeth. The patient may lapse into coma after this. After awakening, she may have no memory of the preceding events. Some patients may develop renal and hepatic dysfunction acutely along with eclampsia. Eclampsia is more common during the first pregnancy of an individual. It is known to occur in first degree relatives, i.e., a woman having eclampsia may have her mother or sister also suffering from it. This suggests a hereditary cause for the same. Women with pre existing hypertension or diabetes or kidney diseases are more prone to develop eclampsia. Obesity and having first baby late in life are other risk factors. Some conditions like large placenta or vesicular mole predispose a woman to develop eclampsia of pregnancy. Women having pre eclampsia or eclampsia during first pregnancy are at risk of developing the same during subsequent pregnancies. Pre eclampsia is a condition in which women develop high blood pressure and proteins in the urine usually around 20th week of pregnancy. If not treated at this stage, it can pass on to eclampsia of pregnancy. Exact cause of eclampsia is not known up to now and various theories have been postulated for it. One thing is certain, it occurs due to the presence of placenta and its removal cures it. One hypothesis states that there is increased sensitivity of maternal blood vessels to the pressor agents (chemical agents which regulate pulse and blood pressure). Reduced perfusion to the placenta is said to be the key factor causing eclampsia as per one researcher. It is also seen as direct manifestation of effect of very high blood pressure on the brain. Diagnosis of eclampsia is based on excluding other ailments which can cause seizures during pregnancy. A very high blood pressure and presence of proteins in the urine usually help in diagnosing eclampsia. If the pre eclampsia is managed adequately, eclampsia can be avoided. Usually prompt intervention to deliver the baby helps in improving the condition. If eclampsia has already developed and one is having convulsions, she should be put in a lateral position immediately to avoid choking on secretions. A harmless smooth object can be put between lips to avoid tongue biting. Anticonvulsant drugs especially magnesium sulphate is used to control convulsions. Drugs are given to reduce the blood pressure immediately. But drastic reduction of blood pressure is avoided as it could reduce perfusion to the vital parts of the mother’s body and also to the foetus. If the patient has dehydration, or renal or hepatic damage, appropriate management is done. In most of the cases the baby is lost by the time other management is done, which is distressful. Thus it is wise to avoid pre eclampsia and eclampsia. If hypertensive one should keep blood pressure well under control. Regular antenatal check up of the pregnant woman helps in detecting pre eclampsia at its onset. Thus it can be managed before it progresses to eclampsia and causes harm to the mother and baby both. A woman having pre eclampsia or eclampsia during first pregnancy should be very careful during the subsequent pregnancy to prevent its recurrence. Awareness regarding eclampsia should be generated among women so that if they have any of the risk factors or symptoms, they can seek timely medical advice and avoid this complication. E-mail-rachna212002@yahoo.co.uk
