Eclampsia

Eclampsia is late toxicosis of pregnancy, characterized by seizures, followed coma.
Etiology eclampsia, and dropsy and nephropathy pregnant is common. Eclampsia is the most severe form of late toxicosis of pregnancy (see). In eclampsia, as with nephropathy pregnant, there is a characteristic triad of clinical symptoms - swelling, albuminuria , and hypertension; they are joined symptoms of Central nervous system lesions - cramps (see), coma (see).
Pathological changes in eclampsia in the brain, liver, kidneys; changes from the Central nervous system are the most severe. Characteristic: swelling of the brain, often point bleeding; bleeding large size are observed usually in eclampsia on the background of pre-existing hypertension. In the liver, on the grounds of thrombosis are bleeding under its capsule, decompensated liver cells. In the kidneys have significant degenerative changes are less frequent necrotic lesions of the cortical layer of the kidneys.
Over and symptoms. Seizures eclampsia is usually preceded by symptoms of pre-eclampsia: a few hours before Atlanticheskogo seizure pregnant complains of headache, sudden pain in the epigastric region, may receive vomiting. There are many changes from the side view: in some instances, the pregnant sees everything ' as if in a fog", in other - the glimpses of spots before the eyes; rarely may occur temporary full blindness.
Fit eclampsia contains three successive phases. It begins by loss of consciousness; a look pregnant fixed on one point, her head tilting to the side; appear fibrillar twitching facial muscles. This introductory phase lasts up to 30 sec.; it is followed by a phase of tonic convulsions, in which the whole body bent, his head tipped back, jaw clenched, breathing is delayed. This phase lasts 20-25 seconds. Next, longer phase - emergence clonic seizures - messy contraction of the muscles of the body and limbs. The seizure ends with a deep whistling breath, mouth appears foam is recovered breath. After a seizure, the woman is in a coma. There are cases of eclampsia in which a woman during the day remains in a coma, there may be up to 10-15 or more seizures (atlanticheskii status).
There are eclampsia during pregnancy, childbirth and postpartum eclampsia. In eclampsia in childbirth usually after delivery women seizures are not repeated. If eclampsia has evolved in the last months of pregnancy, in connection with seizures can occur premature birth, birth activities, despite the use of drugs is increasing.
Often after knocking eclampsia of pregnancy can continue, but if the symptoms of late toxicosis (especially albuminuria, hypertension) remain, indicating severe toxicosis, in the next few days should be wary of repeating eclampsia (return eclampsia). A particularly severe form is non-convulsive eclampsia; in this form pregnant runs into severe coma, often leading to death. Adverse signs in eclampsia are: small yellowness, tachycardia, a sharp decline in blood pressure (hypotension).
Observed and atypical forms of eclampsia, often with more than a mild case; can be eclampsia without severe hypertension; in other cases there is no albuminuria.
In puerperas who underwent eclampsia in the postpartum period, you may experience a severe complication in the form of acute renal failure. As a result of cortical necrosis of renal develops anuria; the amount of urine a day less than 100 ml urine has a kind of coffee grounds.

Eclampsia (eclampsia; from the Greek. eklampsis - flash, a sudden appearance) - severe toxemia second half of pregnancy, characterized by convulsions.
In developing eclampsia distinguish four periods: 1) eclampsia, characterized by edema, albuminuria and hypertension; 2) pre-eclampsia, in which the phenomena of eclampsia join the symptoms of increased intracranial pressure (headache, blurred vision, agitation, vomiting); 3) convulsive period; 4) the period of recovery.
Typical eclampsia is characterized by the sudden onset seizures, which sometimes precede epigastric pain - solar symptom of irritation.
At the beginning of seizure, there are small fibrillar twitching, mainly the muscles of the face, passed further on the upper extremities (this period lasts from a few seconds to a minute). Then comes the most dangerous for the mother and fetus period, which lasts from 20 to 25 sec.,- appear tonic contraction of skeletal muscles, loss of consciousness, respiratory failure, sudden cyanotic skin and mucous membranes, dilated pupils, sometimes a woman bites his tongue. After this period appear clonic convulsions, covering the trunk, upper and lower limbs. Breathing becomes difficult, the mouth speaks foam (in the case of the bite language is mixed with blood). Further convulsions, gradually weakening, disappear. The duration of this condition - 40 sec. up to 1.5-2 minutes
After the attack the patient falls into a coma: motionless, consciousness, it has no, breathing noisy, raucous. Coma may be replaced by a new attack. If this does not occur, the patient gradually regains consciousness, restored normal breathing and sensitivity; usually remain General fatigue and headache. The duration of coma is different, sometimes it can last for hours, which of course affects the prognosis. After the attack the patient remembers nothing of the incident. In the most severe cases of eclampsia convulsive phase may fall entirely (eclampsia without convulsions).
The differential diagnosis is first necessary to distinguish seizures eclampsia from epilepsy. Recognition of the latter help anamnesis data (seizures before pregnancy, no change in the fundus, fast recovery of consciousness after the attack).
Sometimes it is not easy to differentiate eclampsia from acute hypertensive encephalopathy, which also causes sudden attacks tonic and clonic convulsions followed by a deep coma, similar to those in eclampsia. In these cases, the diagnosis can help knowledge of clinical hypertension (see). Coma in eclampsia should be distinguished from diabetes and uremic Cola (see). Finally, we must bear in mind the possibility of a brain hemorrhage.
Cause cramps in eclampsia is increasing reflex excitability of the cortex of the brain. So anything that could cause irritation (generic pain, gross external or internal investigation, surgery without anesthesia, catheterization, etc.), reflex may cause convulsions.
Forecast in eclampsia depends on its clinical forms and characteristics of the course eclampsia, as well as from the time of its occurrence.
Eclampsia occurs during pregnancy (eclampsia gravidarum), childbirth (eclampsia sub partu) and after (eclampsia puerperalis). Having begun during pregnancy, eclampsia can cause birth and end with them. May occur the so-called intercurrent form eclampsia, when started during pregnancy seizures under the influence of treatment cropped, pregnancy persists, then come urgent childbirth, and seizures eclampsia are not repeated. In some cases, eclampsia during pregnancy kopirovaniya first seizures after some time appear again (recurrent form of eclampsia in pregnant women). Beginning in pregnancy, seizures may continue in childbirth and the postpartum period. Eclampsia sub partu may spread to the postnatal period.


There are three clinical forms eclampsia.
1. The typical form. Is more common in pregnant gipertonicescomu type, accompanied by a large swelling and subcutaneous tissues of internal organs, and increased intracranial pressure, severe hypertensive; at the same time have hypertension.
2. Not quite typical form. More common in protracted childbirth mostly in women with unstable nervous system; usually observed only swelling of the brain, swelling of subcutaneous tissue does not happen. In such cases, there are only symptoms of increased intracranial pressure with moderate and changing hypertension; albuminuria, especially in the beginning, none.
3. Uraemic form eclampsia, which is based on jade, former before pregnancy or developed during pregnancy. More common in pregnant asthenic physique. In this form subcutaneous edema and tissues of internal organs are missing or are poorly expressed that says about the lack of barrier functions of the connective tissue. This may accumulate free fluid in the abdominal and chest cavities, as well as in the fetal bladder.
In the liver have severe degenerative changes to necrosis and hemorrhage inclusive. This renal and hepatic failure and caused severe intoxication, oppression CNS, high blood pressure, and sometimes and jaundice.
Eclampsia is a life-threatening maternal and fetal disease. Causes of death of the mother, if it can be: asphyxiation and smothering during seizures; intoxication; bleeding in the brain; the infection, to which the body of a pregnant with eclampsia are particularly susceptible; pulmonary edema. Eclampsia occurs the harder, the more time passes from the beginning of seizures before the birth; therefore, the earlier in pregnancy develop atlanticheskii convulsions, the worse the prognosis for the mother and fetus. Especially dangerous recurrent form of eclampsia in pregnant; a more favorable prognosis gives intercurrent its form, which began close to the period of the expulsion of the fetus.
The most favorable prognosis with a typical, but not quite developed eclampsia in cases when the process is limited only by the scope of the Central nervous system. More often such "brain" form eclampsia occurs in childbirth; her seizures are reduced immediately after birth. Mortality in it, as a rule, is not observed. Heavier flows typical, quite developed eclampsia. If it develops during pregnancy, with correct and rational therapy can be cured, pregnancy will develop further and eclampsia will take place on the type of "intercurrent" form. In more rare cases of recurrent eclampsia (pregnancy), which runs extremely difficult.
Common causes of death in typical eclampsia are pulmonary edema and developing, on this basis, lobar pneumonia, and postnatal septic processes. Due to the protracted stage of convulsions may occur asphyxia and a cardiac arrest (whooping stage eclampsia goes into paralytic).
If typical eclampsia occurs cure, changes caused by swelling and blood circulation, resp. hypertension, soon disappear, functional condition of organs after some time returned to normal. Thus, the prognosis for typical eclampsia relatively favourable. Except in the cases of eclampsia, which developed in the early stages of pregnancy and shortly after birth.
Less favorable prognosis with atypical uremic form eclampsia, in which there is heavy defeat parenchymatous organs, especially the kidneys and liver. During this same form eclampsia are more frequently observed a brain hemorrhage leading to death, and "eclampsia without convulsions", when the convulsive stage falls and immediately there comes a stage of paralysis. Changes in the bodies arising from uremic form eclampsia (jade, retinitis, and others), almost defy reverse development, functional state of organs for a long time remains broken. So uremic form eclampsia often gives relapse as this, and during the next pregnancy. Relapsing forms eclampsia extremely difficult. The severity is determined also by the number of seizures, the length of the intervals between them and the state of the patient at this time. Under other equal conditions eclampsia heavier in cases where the number of seizures is becoming more when they are longer intervals between them shorter, and the patient out of the seizures is unconscious.
To characterise the condition of the patient is of great importance assessment tone of the cardiovascular system. Frequent weak filling pulse is a sign of the onset of paralytic stage. Often this increases the temperature.