What is eclampsia

Eclampsia is the new onset of seizures or coma in a pregnant woman with preeclampsia. These seizures are not related to an existing brain condition. Eclampsia describes a type of convulsion or fit (involuntary contraction of the muscles) that pregnant women can experience, usually from week 20 of the pregnancy or immediately after the birth. Although eclampsia may occur sooner with multiple pregnancies or molar pregnancies, and may additionally occur up to 6-weeks after delivery (delayed postpartum eclampsia) ¹. Approximately 60% of the eclampsia cases occur before childbirth (antepartum) and 20% occur intrapartum (during labor), and finally, 20% of the cases occur after delivery (postpartum). Approximately 90% of the after delivery (postpartum) seizures occur within one week of delivery ¹.

Eclampsia represents the severe end of the preeclampsia spectrum. Preeclampsia spectrum includes symptoms of the central nervous system (CNS), for example, severe headaches or vision changes, and may involve hepatic abnormalities (such as elevated liver transaminases with right upper quadrant/epigastric discomfort), elevated blood pressures, and also may include thrombocytopenia (low platelet count), kidney abnormalities, and pulmonary edema.

Eclampsia is quite rare in the US, with an estimated 1 case for every 4,000 pregnancies.

At least 20% of women with eclampsia will go on to develop hypertension in subsequent pregnancies and another 2-5% will develop eclampsia in a future pregnancy. Overall, multiparous females are not only likely to develop hypertension but also have a higher mortality compared to primiparous women. Because there is no reliable test to predict who will develop pre-eclampsia, all high risk women are urged to take a low dose aspirin (75mg dose of aspirin or baby aspirin) during pregnancy.

During an eclamptic fit, the mother’s arms, legs, neck or jaw will twitch involuntarily in repetitive, jerky movements.

She may lose consciousness and may wet herself. The fits usually last less than a minute.

While most women make a full recovery after having eclampsia, there’s a small risk of permanent disability or brain damage if the fits are severe.

Of those who have eclampsia, around 1 in 50 will die from the condition. In developed countries, resultant maternal mortality may be as high as 1.8%, and in the developing countries, it may be as high as 14% ². Unborn babies can suffocate during a seizure and 1 in 14 may die.

Research has found that a medication called magnesium sulfate can halve the risk of eclampsia and reduce the risk of the mother dying.

It’s now widely used to treat eclampsia after it’s occurred and treat women who may be at risk of developing it.

Preeclampsia vs Eclampsia

Preeclampsia and eclampsia are pregnancy-related high blood pressure disorders. In preeclampsia, the mother’s high blood pressure reduces the blood supply to the fetus, which may get less oxygen and fewer nutrients. Eclampsia is when pregnant women with preeclampsia develop seizures or coma.

Pre-eclampsia is a condition that affects some pregnant women, usually during the second half of pregnancy (from around 20 weeks) or soon after their baby is delivered. Preeclampsia rarely happens before the 20th week of pregnancy. Most preeclampsia cases occur after 24 to 26 weeks, and usually towards the end of pregnancy.

Although less common, preeclampsia can also develop for the first time in the first 6 weeks after birth.

Most people only experience mild symptoms, but it’s important to manage preeclampsia in case severe symptoms or complications develop.

Generally, the earlier preeclampsia develops, the more severe the condition will be.

Early signs of preeclampsia include having high blood pressure (hypertension) and protein in your urine (proteinuria).

It’s unlikely that you’ll notice these signs, but they should be picked up during your routine antenatal appointments.

In some cases, further preeclampsia symptoms can develop, including:

• swelling of the feet, ankles, face and hands caused by fluid retention (edema)
• severe headache
• vision problems
• pain just below the ribs

If you notice any symptoms of pre-eclampsia, seek medical advice immediately by calling your midwife or doctor.

Although many cases preeclampsia are mild, preeclampsia can lead to serious complications for both mother and baby if it’s not monitored and treated.

The earlier pre-eclampsia is diagnosed and monitored, the better the outlook for mother and baby.

Who’s affected with preeclampsia?

Mild preeclampsia affects up to 6% of pregnancies, and severe cases develop in about 1 to 2% of pregnancies.

There are a number of things that can increase your chances of developing preeclampsia, such as:

• having diabetes, high blood pressure or kidney disease before starting pregnancy
• having another condition, such as lupus or antiphospholipid syndrome
• having developed the condition during a previous pregnancy

Other things that can slightly increase your chances of developing preeclampsia include:

• having a family history of the condition
• being over 40 years old
• it having been at least 10 years since your last pregnancy
• expecting multiple babies (twins or triplets)
• having a body mass index (BMI) of 35 or over

If you have 2 or more of these together, your chances are higher.

If you’re thought to be at a high risk of developing pre-eclampsia, you may be advised to take a daily dose of low-dose aspirin from the 12th week of pregnancy until your baby is delivered.

Early signs and symptoms of preeclampsia

Initially, preeclampsia causes:

• high blood pressure (hypertension)
• protein in urine (proteinuria)

You probably won’t notice any symptoms of either of these, but your doctor or midwife should pick them up during your routine antenatal appointments.

High blood pressure affects 10 to 15% of all pregnant women, so this alone doesn’t suggest preeclampsia.

But if protein in the urine is found at the same time as high blood pressure, it’s a good indicator of the condition.

Further symptoms

As preeclampsia progresses, it may cause:

• severe headaches
• vision problems, such as blurring or seeing flashing lights
• severe heartburn
• pain just below the ribs
• nausea or vomiting
• excessive weight gain caused by fluid retention
• feeling very unwell
• sudden increase in edema – swelling of the feet, ankles, face and hands

If you notice any symptoms of pre-eclampsia, get medical advice immediately by calling your doctor.

Without immediate treatment, pre-eclampsia may lead to a number of serious complications, including:

• convulsions (eclampsia)
• HELLP syndrome (a combined liver and blood clotting disorder)
• stroke

The letters in the name HELLP stand for each part of the condition:

• “H” is for hemolysis – this is where the red blood cells in the blood break down
• “EL” is for elevated liver enzymes (proteins) – a high number of enzymes in the liver is a sign of liver damage
• “LP” is for low platelet count – platelets are substances in the blood that help it clot

But these complications are rare.

Preeclampsia complications

Although they’re rare, a number of complications can develop if pre-eclampsia isn’t diagnosed and monitored.

These problems can affect both the mother and her baby.

Problems affecting the mother

Eclampsia (fits or seizures and coma)

HELLP syndrome

HELLP syndrome is a rare liver and blood clotting disorder that can affect pregnant women.

It’s most likely to occur immediately after the baby is delivered, but can appear any time after 20 weeks of pregnancy, and in rare cases before 20 weeks.

The letters in the name HELLP stand for each part of the condition:

• “H” is for hemolysis – this is where the red blood cells in the blood break down
• “EL” is for elevated liver enzymes (proteins) – a high number of enzymes in the liver is a sign of liver damage
• “LP” is for low platelet count – platelets are substances in the blood that help it clot

HELLP syndrome is potentially as dangerous as eclampsia, and is slightly more common.

The only way to treat the condition is to deliver the baby as soon as possible.

Once the mother is in hospital and receiving treatment, it’s possible for her to make a full recovery.

Stroke

The blood supply to the brain can be disturbed as a result of high blood pressure. This is known as a cerebral hemorrhage, or stroke.

If the brain doesn’t get enough oxygen and nutrients from the blood, brain cells will start to die, causing brain damage and possibly death.

Organ problems

• pulmonary edema – where fluid builds up in and around the lungs. This stops the lungs working properly by preventing them absorbing oxygen.
• kidney failure – when the kidneys can’t filter waste products from the blood. This causes toxins and fluids to build up in the body.
• liver failure – disruption to the functions of the liver. The liver has many functions, including digesting proteins and fats, producing bile and removing toxins. Any damage that disrupts these functions could be fatal.

Blood clotting disorder

The mother’s blood clotting system can break down. This is known medically as disseminated intravascular coagulation (DIC).

This can either result in too much bleeding because there aren’t enough proteins in the blood to make it clot, or blood clots developing throughout the body because the proteins that control blood clotting become abnormally active.

These blood clots can reduce or block blood flow through the blood vessels and possibly damage the organs.

Problems affecting the baby

Babies of some women with pre-eclampsia may grow more slowly in the womb than normal. This is because the condition reduces the amount of nutrients and oxygen passed from the mother to her baby. These babies are often smaller than usual, particularly if the preeclampsia occurs before 37 weeks.

If pre-eclampsia is severe, a baby may need to be delivered before they’re fully developed. This can lead to serious complications, such as breathing difficulties caused by the lungs not being fully developed (neonatal respiratory distress syndrome). In these cases, a baby usually needs to stay in a neonatal intensive care unit so they can be monitored and treated.

Some babies of women with pre-eclampsia can even die in the womb and be stillborn. It’s estimated around 1,000 babies die each year because of preeclampsia. Most of these babies die because of complications related to early delivery.

Preeclampsia causes

Preeclampsia is thought to be caused by the placenta not developing properly due to a problem with the blood vessels supplying it. The exact cause isn’t fully understood.

Placenta

The placenta is the organ that links the mother’s blood supply to her unborn baby’s blood supply. Food and oxygen pass through the placenta from mother to baby. Waste products can pass from the baby back into the mother.

To support the growing baby, the placenta needs a large and constant supply of blood from the mother.

In preeclampsia, the placenta doesn’t get enough blood. This could be because the placenta didn’t develop properly as it was forming during the first half of the pregnancy.

The problem with the placenta means the blood supply between mother and baby is disrupted.

Signals or substances from the damaged placenta affect the mother’s blood vessels, causing high blood pressure (hypertension).

At the same time, problems in the kidneys may cause important proteins that should remain in the mother’s blood to leak into her urine, resulting in protein in the urine (proteinuria).

What causes problems with the placenta?

In the initial stages of pregnancy, the fertilized egg implants itself into the wall of the womb (uterus). The womb is the organ a baby grows inside during pregnancy. The fertilized egg produces root-like growths called villi, which help to anchor it to the lining of the womb.

The villi are fed nutrients through blood vessels in the womb and eventually grow into the placenta.

During the early stages of pregnancy, these blood vessels change shape and become wider.

If the blood vessels don’t fully transform, it’s likely that the placenta won’t develop properly because it won’t get enough nutrients. This may lead to pre-eclampsia.

It’s still unclear why the blood vessels don’t transform as they should. It’s likely that inherited changes in your genes have some sort of role, as the condition often runs in families. But this only explains some cases.

Risk factors for preeclampsia

Some factors have been identified that could increase your chances of developing pre-eclampsia.

These include:

• having an existing medical problem – such as diabetes, kidney disease, high blood pressure, lupus or antiphospholipid syndrome
• previously having pre-eclampsia – there’s an approximately 16% chance you’ll develop the condition again in later pregnancies

Some factors also increase your chances by a small amount.

If you have 2 or more of these together, your chances are higher:

• it’s your first pregnancy – pre-eclampsia is more likely to happen during the first pregnancy than during any subsequent pregnancies
• it’s been at least 10 years since your last pregnancy
• you have a family history of the condition – for example, your mother or sister has had pre-eclampsia
• you’re over the age of 40
• you were obese at the start of your pregnancy – meaning you had a body mass index (BMI) of 35 or more
• you’re expecting multiple babies, such as twins or triplets

If you’re considered to be at a high risk of developing preeclampsia, you may be advised to take a 75mg dose of aspirin (baby aspirin or low-dose aspirin) every day during your pregnancy from when you’re 12 weeks pregnant until your baby is born.

Evidence suggests this can lower your chances of developing the condition.

Pre-eclampsia diagnosis

Preeclampsia is easily diagnosed during the routine checks you have while you’re pregnant. During these antenatal appointments, your blood pressure is regularly checked for signs of high blood pressure and a urine sample is tested to see if it contains protein.

If you notice any of the symptoms of pre-eclampsia between your antenatal appointments, see your midwife or doctor for advice.

Blood pressure

Blood pressure is a measure of the force of blood on artery walls (main blood vessels) as it flows through them.

It’s measured in millimeters of mercury (mmHg) and recorded as 2 figures:

• systolic pressure – the pressure when the heart beats and squeezes blood out
• diastolic pressure – the pressure when the heart rests in between beats

Your doctor will use a device with an inflatable cuff and a scale as a pressure gauge (a sphygmomanometer) to measure your blood pressure.

The systolic reading is taken first, followed by the diastolic reading.

If, for example, the systolic blood pressure is 120mmHg and the diastolic blood pressure is 80mmHg, the overall blood pressure will be 120 over 80, which is commonly written as 120/80.

High blood pressure during pregnancy is usually defined as 140/90 or higher – a systolic reading of 140mmHg or more, or a diastolic reading of 90mmHg or more.

The American College of Obstetricians and Gynecologists provides the following criteria for a diagnosis of gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome.

Gestational hypertension is diagnosed if a pregnant woman has high blood pressure but no protein in the urine. Gestational hypertension occurs when women whose blood pressure levels were normal before pregnancy develop high blood pressure after 20 weeks of pregnancy. Gestational hypertension can progress into preeclampsia ³.

Mild preeclampsia is diagnosed when a pregnant woman has ⁴:

• Systolic blood pressure (top number) of 140 mmHg or higher or diastolic blood pressure (bottom number) of 90 mmHg or higher and either
  • Urine with 0.3 or more grams of protein in a 24-hour specimen (a collection of every drop of urine within 24 hours) or a protein-to-creatinine ratio greater than 0.3
    Or
  • Blood tests that show kidney or liver dysfunction
  • Fluid in the lungs and difficulty breathing
  • Visual impairments

Severe preeclampsia occurs when a pregnant woman has any of the following:

• Systolic blood pressure of 160 mmHg or higher or diastolic blood pressure of 110 mmHg or higher on two occasions at least 4 hours apart while the patient is on bed rest
• Urine with 5 or more grams of protein in a 24-hour specimen or 3 or more grams of protein on 2 random urine samples collected at least 4 hours apart
• Test results suggesting kidney or liver damage—for example, blood tests that reveal low numbers of platelets or high liver enzymes
• Severe, unexplained stomach pain that does not respond to medication
• Symptoms that include visual disturbances, difficulty breathing, or fluid buildup ⁵

Urine tests

A urine sample is usually requested at every antenatal appointment. This can easily be tested for protein using a dipstick. A dipstick is a strip of paper that’s been treated with chemicals so it reacts to protein, usually by changing color.

If the dipstick tests positive for protein, your doctor or midwife may ask for another urine sample to send to a laboratory for further tests. This could be a single sample of urine, or you may be asked to provide several samples over a 24-hour period. These can be used to determine exactly how much protein is being lost through your urine.

Blood test

If you’re between 20 weeks and 34 weeks plus 6 days pregnant and your doctors think you may have preeclampsia, they may offer you a blood test to help rule out pre-eclampsia.

It measures levels of a protein called placental growth factor (PIGF). If your PIGF (placental growth factor) levels are high, it’s highly likely that you don’t have pre-eclampsia.

If your PIGF (placental growth factor) levels are low, it could be a sign of pre-eclampsia, but further tests would be needed to confirm the diagnosis.

Further tests in hospital

If you’re diagnosed with pre-eclampsia, you should be referred to a specialist in hospital for further tests and more frequent monitoring. Depending on the severity of your condition, you may be able to go home after an initial assessment and have frequent outpatient appointments.

In severe cases, you may need to stay in hospital for closer observation.

Preeclampsia treatment

Pre-eclampsia can only be cured by delivering the baby. If you have pre-eclampsia, you’ll be closely monitored until it’s possible to deliver the baby.

Once diagnosed, you’ll be referred to a hospital specialist for further assessment and any necessary treatment.

If you only have high blood pressure without any signs of pre-eclampsia, you can usually return home afterwards and attend regular (possibly daily) follow-up appointments.

If pre-eclampsia is confirmed, you’ll usually need to stay in hospital until your baby can be delivered.

Monitoring in hospital

While you’re in hospital, you and your baby will be monitored by:

• having regular blood pressure checks to identify any abnormal increases
• having regular urine samples taken to measure protein levels
• having various blood tests – for example, to check your kidney and liver health
• having ultrasound scans to check blood flow through the placenta, measure the growth of the baby, and observe the baby’s breathing and movements
• electronically monitoring the baby’s heart rate using a process called cardiotocography, which can detect any stress or distress in the baby

Medication for high blood pressure

Medication is recommended to help lower your blood pressure. These medications reduce the likelihood of serious complications, such as stroke.

Some of the medications used regularly include labetalol, nifedipine or methyldopa.

Of these medications, only labetalol is specifically licensed for use in pregnant women with high blood pressure.

This means the medication has undergone clinical trials that have found it to be safe and effective for this purpose.

But while methyldopa and nifedipine aren’t licensed for use in pregnancy, they can be used “off-label” (outside their licence) if it’s felt the benefits of treatment are likely to outweigh the risks of harm to you or your baby.

These medications have been used by doctors for many years to treat pregnant women with high blood pressure.

They’re recommended as possible alternatives to labetalol in guidelines produced by the National Institute for Health and Care Excellence (NICE).

Your doctors may recommend one of them if they think it’s the most suitable medication for you.

If your doctors recommend treatment with one of these medications, you should be made aware that the medication is unlicensed in pregnancy and any risks should be explained before you agree to treatment, unless immediate treatment is needed in an emergency.

Other medications

Anticonvulsant medication may be prescribed to prevent fits if you have severe pre-eclampsia and your baby is due within 24 hours, or if you have had convulsions (fits).

They can also be used to treat fits if they occur.

Delivering your baby

In most cases of pre-eclampsia, having your baby at about the 37th to 38th week of pregnancy is recommended. This may mean that labor needs to be started artificially (known as induced labor) or you may need to have a caesarean section.

This is recommended because research suggests there’s no benefit in waiting for labor to start by itself after this point. Delivering the baby early can also reduce the risk of complications from pre-eclampsia.

If your condition becomes more severe before 37 weeks and there are serious concerns about the health of you or your baby, earlier delivery may be necessary.

Deliveries before 37 weeks are known as premature births and babies born before this point may not be fully developed.

You should be given information about the risks of both premature birth and pre-eclampsia so the best decision can be made about your treatment.

After the delivery

Although pre-eclampsia usually improves soon after your baby is born, complications can sometimes develop a few days later.

You may need to stay in hospital after the delivery so you can be monitored.

Your baby may also need to be monitored and stay in a hospital neonatal intensive care unit if they’re born prematurely.

These units have facilities that can replicate the functions of the womb and allow your baby to develop fully.

Once it’s safe to do so, you’ll be able to take your baby home.

You’ll usually need to have your blood pressure checked regularly after leaving hospital, and you may need to continue taking medication to lower your blood pressure for several weeks.

You should be offered a postnatal appointment 6 to 8 weeks after your baby is born to check your progress and decide if any treatment needs to continue. This appointment will usually be with your doctor.

What causes eclampsia

The exact cause of eclampsia is not known ¹. The placenta seems to have a prime role in the causes of eclampsia. An increase in placental mass, as in multiple pregnancies, increases the risk for the preeclampsia-eclampsia spectrum, as does placental edema that occurs in pregnancies complicated by fetal hydrops. Molar pregnancies that impact placental architecture also have a higher risk of the complication ⁶.

The risk factors of eclampsia are similar to those of preeclampsia and include nulliparity (never having given birth), non-white, low socioeconomic backgrounds, plural pregnancies, and extremes of maternal age ¹. Additionally, eclampsia is associated with and an array of maternal medical conditions such as chronic hypertension, chronic renal disease, and autoimmune disorders. Obesity and maternal diabetes are also recognized as increasingly important factors. Fetal conditions such as fetal hydrops have been associated with preeclampsia ⁷.

Some scientists have suggested hypertension causes breakdown of the autoregulatory mechanisms of cerebral circulation inducing endothelial dysfunction that concludes in cytotoxic edema and expression of a generalized seizure ¹. Inflammation of the cerebrum seems to play a role in the pathophysiology. In some scenarios, it may be associated with posterior reversible encephalopathy syndrome due to posterior circulation’s inability to autoregulate itself in response to acute hypertension ⁸.

In a 1973 report, findings at autopsy include more than 50% of women who died within 2 days of seizures had evidence of cerebral hemorrhages ¹. It also described brain histopathology. Occipital lobe petechial hemorrhages were a common finding. Cerebral venous thrombosis was also frequently observed. Since then some studies have used free radical stains to demonstrate endothelial, histiocytic, and platelet markers suggestive of capillary injury in otherwise intact brain parenchyma.

Factors that may play a role include:

• Blood vessel problems
• Brain and nervous system (neurological) factors
• Diet
• Genes

Eclampsia follows a condition called preeclampsia. This is a complication of pregnancy in which a woman has high blood pressure and other findings.

Most women with preeclampsia do not go on to have seizures. It is hard to predict which women will. Women at high risk of seizures often have severe preeclampsia with findings such as:

• Abnormal blood tests
• Headaches
• Very high blood pressure
• Vision changes
• Abdominal pain

Your chances of getting preeclampsia increase when:

• You are 35 or older.
• You are African American.
• This is your first pregnancy.
• You have diabetes, high blood pressure, or kidney disease.
• You are having more than 1 baby (such as twins or triplets).
• You are a teen.

Eclampsia prevention

Getting medical care during your entire pregnancy is important in preventing complications. This allows problems such as preeclampsia to be detected and treated early.

Getting treatment for preeclampsia may prevent eclampsia.

Eclampsia signs and symptoms

Symptoms of eclampsia include:

• Seizures
• Severe agitation
• Unconsciousness

Most women will have these symptoms of preeclampsia before the seizure:

• Headaches
• Nausea and vomiting
• Stomach pain
• Swelling of the hands and face
• Vision problems, such as loss of vision, blurred vision, double vision, or missing areas in the visual field

Eclampsia possible complications

Women with eclampsia or preeclampsia have a higher risk for:

• Separation of the placenta (placenta abruptio)
• Premature delivery that leads to complications in the baby
• Blood clotting problems
• Stroke
• Cortical blindness
• Neurological deficits
• Coronary event
• Renal failure
• Liver dysfunction
• DIC (disseminated intravascular coagulation)
• Death
• Intrauterine growth retardation

Eclampsia diagnosis

Eclampsia is a clinical diagnosis that is described by the occurrence of new-onset generalized tonic-clonic seizures in a woman with preeclampsia; however, on occasion, it may be the first presentation of preeclampsia. Clinical findings may include posterior reversible encephalopathy syndrome (due to vasogenic edema predominantly localized in the posterior cerebral hemispheres), which include a headache, confusion, visual symptoms, and seizure.

Your doctor will do a physical exam to look for causes of seizures. Your blood pressure and breathing rate will be checked regularly.

Blood and urine tests may be done to check:

• Blood clotting factors
• Creatinine
• Hematocrit
• Uric acid
• Liver function
• Platelet count
• Protein in the urine

Eclampsia treatment

The main treatment to prevent severe preeclampsia from progressing to eclampsia is giving birth to the baby. Letting the pregnancy go on can be dangerous for you and the baby.

You may be given medicine to prevent seizures. These medicines are called anticonvulsants.

Your provider may give medicine to lower high blood pressure. If your blood pressure stays high, delivery may be needed, even if it is before the baby is due.

Magnesium sulfate is a treatment of choice to prevent recurrent seizures; however, approximately 10% of will have a repeat a seizure despite magnesium sulfate therapy ¹. Recurrent seizures require surveillance for rhabdomyolysis, metabolic acidosis, aspiration pneumonia, and neurogenic pulmonary edema. Magnesium sulfate remains superior for recurrent seizure activity (an additional 2 gm bolus can be considered in those already on magnesium sulfate therapy), but the addition of intravenous lorazepam 2 mg intravenously over 3 to 5 minutes may also be considered. The initial loading bolus of magnesium sulfate is 4 gm to 6 gm intravenously over 15 to 20 minutes with a maintenance dose of 1 gm to 3 gm an hour, depending on renal function. Blood levels of magnesium are monitored every four hours and targeted at four mEq/L to -7 mEq/L or 5 mg/dl to 9 mg/dl. Urine output is closely monitored. Should magnesium sulfate toxicity occur calcium, gluconate 1 gm intravenously can be administered ¹.

Management of severe hypertension is the next focus of patient care. A preferred agent for the treatment of severe hypertension is intravenous labetalol (initial dose of 20 mg and for recalcitrant severe hypertension follow-up dose of 40 mg and 80 mg every 15 minutes). Maintaining systolic blood pressure between 140 mm Hg to 160 mmHg and diastolic blood pressure between 90 mmHg to 105 mmHg are targeted treatment goals.

Fetal bradycardia lasting 3 to 5 minutes is a common finding during and immediately after the seizure and does not indicate emergency cesarean delivery. Stabilization of the mother by stabilizing the seizure activity and correction of maternal hypertension if present and oxygen to treat hypoxemia and hypercarbia is the mainstay of initial supportive therapies are part of fetal intrauterine fetal resuscitation. However, if the fetal heart rate strip does not improve after 15 minutes of maternal and fetal resuscitative interventions then a differential diagnosis of occult abruption should be considered, and emergent cesarean delivery may be indicated. Eclampsia represents an absolute contraindication to expectant management. Once the maternal-fetal condition is stabilized, delivery should be accomplished labor induction. This is a particularly reasonable option after 32 weeks of gestation. It may be an option at early gestations with a favorable Bishop score; however, long induction-delivery intervals are best avoided with a clear end-point for delivery to be concluded within 24 hours.

After delivery treatments

Some women develop preeclampsia or eclampsia after they deliver their babies. The American College of Obstetricians and Gynecologists recommends that healthcare providers closely monitor women who had high blood pressure or preeclampsia during pregnancy for 72 hours after delivery, either at home or in the hospital ⁹. Because postpartum preeclampsia and eclampsia can progress quickly and can have serious effects, it is important to get treatment immediately.

Depending on a woman’s specific health situation, treatment may include medications to prevent blood pressure from reaching dangerously high levels and causing stroke or other problems associated with extremely high blood pressure. It may also include medications to treat or prevent seizures.

One study looked at women who came to the emergency room with a diagnosis of postpartum preeclampsia. The most common warning symptoms in these cases were headache, vision changes, and nausea or abdominal pain. Nearly all of these women had high blood pressure when admitted, and some had already had seizures at home before coming to the hospital. Treatment for postpartum preeclampsia follows the guidelines used to treat preeclampsia during pregnancy. The women in the study received magnesium sulfate to treat or prevent seizure and, if needed, additional treatment for their high blood pressure ¹⁰.

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