#68 Another Look at Eclampsia

I’ve written and talked about eclampsia in many places, but it is an important enough topic to talk about often. Pre-eclampsia and eclampsia are diseases found only in  pregnancy. Let’s have another look at eclampsia.  Eclampsia is a serious and deadly pregnancy complication. It is essentially pre-eclampsia with the added complication of seizures. Once you start seizing with pre-eclampsia, the only way to save you and your baby is an immediate C-section.

In pregnancy, unmanaged or mismanaged pre-eclampsia often turns into eclampsia. Think of preeclampsia on a continuum or like steps on a ladder, becoming gradually worse until a seizure occurs.

Managing and preventing pre-eclampsia is the best and only way to prevent eclampsia. Usually high blood pressure is the first sign of pre-eclampsia. Decreasing work, having regular office visits to watch blood pressure fluctuations, and timely hospitalization and possibly taking medications to reduce your blood pressure are just some of the ways to effectively prevent pre-eclampsia from becoming eclampsia.

All pregnancy prenatal care is designed to look for pre-eclampsia. So we check blood pressure, weight, urine for protein, fetal heart rate, and reflexes. The problems arise from ignoring or dismissing one or more of these signs. Sometimes one blood pressure will be elevated slightly, say 140/85. It is the habit of nurses to recheck the BP until they get a lower one which is then recorded. While this approach works well in some situations, it does not work well with pre-eclampsia. It has been my experience that the one high BP is the crucial value, not the lowest ones you get after repeated testing. I always watched the blood pressure of my patients, paying careful attention to the smallest variation from normal.

With pre-eclampsia, the cause of the increase in blood pressure isn’t known. However, studies suggest that if your mother or other family members had pre-eclampsia during pregnancy, you may be at risk for developing the condition as well. If you know other family members developed pre-eclampsia during their pregnancies, be sure to tell your obstetrician.

For reasons we don’t understand, black women have more trouble with preeclampsia and eclampsia. There are mostly likely many contributing factors. If you read about some of the deaths or serious injury associated with preeclampsia and eclampsia, some women have brought concerns to their doctors or labor and delivery nurses, but their concerns have been dismissed. This amounts to denial of access to needed care.

Many of the stories about pregnancy complications start with blood pressure that was not properly monitored, was ignored, or was misunderstood. This is why it is important for you and your doctor to monitor your blood pressure from the start of your pregnancy. In fact, if you are trying to get pregnant, take your blood pressure so you have a baseline value for going into your pregnancy.

Even after you return home with your new baby, you need to monitor your blood pressure and watch for the signs of pre-eclampsia several weeks. Some countries maintain women’s health clinics which follow the recovery of women from deliveries for up to a year. New mothers may need to take anti-hypertensives for weeks, months, or even for the rest of her life. This doesn’t fix preeclampsia or prevent eclampsia, but it does help prevent hypertensive strokes.

To summarize, pre-eclampsia is a complication that doctors can treat with proper care. With early detection, you and your doctor can make the best choices for your pregnancy and for your baby.