Eclampsia

Aka: Eclampsia, Toxemia of Pregnancy, Eclamptic Seizure

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II. Definitions

  1. Eclampsia ("sudden flash" or "shining forth")
    1. Most severe form of PIH characterized by Seizures
  2. Also referred to as Toxemia or "toxin present"

III. Epidemiology

  1. Rare <20 weeks gestation (except in hydatiform mole)
  2. Most episodes occur prior to delivery
    1. Antepartum Seizure: 53% of cases
    2. Intrapartum Seizure: 19% of cases
    3. Postpartum Seizure: 28% of cases
      1. Majority (79%) of postpartum Seizures are late postpartum (>48 hours after delivery)

IV. Pathophysiology

  1. Results from focal cerebral edema
  2. Associated with transient Vasoconstriction and ischemia
  3. Usually results from progressive Severe Preeclampsia
  4. May also occur with little warning
    1. Mild Preeclampsia may precede Eclamptic Seizure
  5. Blood Pressure is only mildly increased in 30-60% of patients
    1. Up to 15% of cases have diastolic BP <90 mmHg

V. Signs

  1. See Preeclampsia
  2. Phase 0: Preceding symptoms
    1. Headache (80%)
    2. Visual changes (45%)
  3. Phase 1: Prodrome (brief)
    1. Twitching
    2. Facial congestion
    3. Mouth foaming
    4. Altered Level of Consciousness
  4. Phase 2: Tonic
    1. Muscle rigidity
  5. Phase 3: GTCS activity for 1 to 1.5 minutes
    1. Rhythmic muscle contractions and relaxation
    2. Generalized Tonic Clonic Seizure
    3. Loss of respiratory activity
    4. Fetal Bradycardia
  6. Phase 4: Comatose
    1. Respiratory effort, but otherwise comatose
  7. Phase 5: Post-ictal
    1. Confused and agitated, combative

VI. Management

  1. See Eclamptic Seizure Management

VII. References

  1. Fontaine (2000) in ALSO, B:1-36
  2. Sibai in Gabbe (2002) Obstetrics, p. 945-74
  3. (2000) Am J Obstet Gynecol 183(1):S1-22 [PubMed]
  4. Leeman (2016) Am Fam Physician 93(2):121-7 [PubMed]
  5. Zamorski (2001) Clin Fam Pract 3:329-47 [PubMed]

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Ontology: Eclampsia (C0013537)

Definition (NCI) A potentially life-threatening pregnancy-related disorder characterized by tonic-clonic seizures in association with hypertension after the twentieth week of gestation and up to six weeks postpartum and in the absence of other potential causes of seizures.(NICHD)
Definition (MSH) Onset of HYPERREFLEXIA; SEIZURES; or COMA in a previously diagnosed pre-eclamptic patient (PRE-ECLAMPSIA).
Definition (CSP) convulsions and coma occurring in pregnant or puerperal women, associated with hypertension, edema, and proteinuria.
Concepts Disease or Syndrome (T047)
MSH D004461
ICD10 O15 , O15.9
SnomedCT 156111007, 198996001, 198989003, 198988006, 15938005
English Eclampsia, Eclampsias, ECLAMPSIA, Eclampsia unspecified, Eclampsia, unspecified as to time period, eclampsia (diagnosis), eclampsia, Eclampsia NOS, Eclampsia [Disease/Finding], Eclampsia unspecified (disorder), Eclampsia NOS (disorder), Eclamptic toxemia, Toxemia with convulsions, Eclamptic toxaemia, Toxaemia with convulsions, Eclampsia (disorder), eclamptic; toxemia, toxemia; eclamptic
French ECLAMPSIE, Eclampsie, Éclampsie
Portuguese ECLAMPSIA, Eclampsia
Spanish ECLAMPSIA, eclampsia, SAI (trastorno), eclampsia, no especificada, eclampsia, SAI, eclampsia, no especificada (trastorno), eclampsia (trastorno), eclampsia, toxemia con convulsiones, toxemia eclámpsica, Eclampsia
German EKLAMPSIE, Eklampsie, bei der der zeitliche Bezug nicht angegeben ist, Eklampsie
Japanese 子癇, ｼｶﾝ
Swedish Graviditetskramp
Czech eklampsie, Eklampsie
Finnish Eklampsia
Russian EKLAMPSIIA, ЭКЛАМПСИЯ
Korean 자간증, 시기 상세불명의 자간증
Croatian EKLAMPSIJA
Polish Drgawki rzucawkowe, Rzucawka porodowa
Hungarian Eclampsia
Norwegian Svangerskapskrampe, Eclampsia gravidarum, Eklampsi
Dutch eclamptisch; toxemie, toxemie; eclamptisch, Eclampsie, niet gespecificeerd naar tijdperk, eclampsie, Eclampsie
Italian Eclampsia
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Eclamptic seizure (C0743381)

Concepts Disease or Syndrome (T047)
SnomedCT 426634003
English Eclamptic seizure (finding), Eclamptic fit, Eclamptic seizure
Spanish convulsión eclámptica (hallazgo), convulsión eclámptica
Derived from the NIH UMLS (Unified Medical Language System)

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