Eclampsia

What to do if someone has a seizure in pregnancy

1. Call 911 or your local emergency number.
2. Keep them safe: move hard or sharp objects away. Do not hold them down.
3. Turn them onto their left side as soon as the jerking allows, to protect the airway and improve blood flow to the uterus.
4. Do not put anything in their mouth.
5. Time the seizure and note when it started.
6. Stay with them until help arrives. Most eclamptic seizures last about 1 minute, but a second seizure can follow.

Eclampsia vs preeclampsia

Most people with preeclampsia never develop eclampsia, and some people have a seizure before high blood pressure is noticed.

Symptoms and warning signs

Seizures are typically generalized (tonic-clonic): stiffening and jerking of the whole body, loss of consciousness, and confusion afterward. They are often preceded by:

• severe, persistent headache, often at the front or back of the head
• vision changes: blurring, flashing lights, spots or temporary vision loss
• upper right belly or under-the-ribs pain, nausea and vomiting
• confusion or changes in mental state
• swelling of the face and hands
• very high blood pressure

Causes and risk factors

Eclampsia is thought to arise when the abnormal placental development of preeclampsia triggers widespread blood vessel dysfunction, leading to brain swelling and disrupted blood flow, often resembling posterior reversible encephalopathy syndrome on brain scans.

Risk factors for preeclampsia and eclampsia:

• First pregnancy
• Previous preeclampsia
• Chronic high blood pressure, kidney disease, diabetes, lupus or antiphospholipid syndrome
• Twins or more
• Age under 20 or over 35
• Obesity
• IVF pregnancy
• Family history of preeclampsia

Diagnosis

Eclampsia is diagnosed when a person with signs of preeclampsia has a new seizure without another cause. Tests include:

• Blood pressure monitoring
• Urine protein testing
• Blood tests: platelets, liver enzymes, kidney function, to check for HELLP syndrome
• Fetal monitoring and ultrasound
• Brain imaging (CT or MRI) if seizures are atypical, there are focal neurological signs, or seizures continue despite treatment, to look for stroke, bleeding or other causes

Treatment

• Stabilize: protect the airway, give oxygen, and position on the left side.
• Magnesium sulfate: given by IV or injection to stop the seizure and prevent further seizures. It is more effective than standard anti-seizure medicines in eclampsia. It is continued for about 24 hours after delivery or the last seizure, with monitoring for side effects.
• Blood pressure control: IV labetalol or hydralazine, or oral nifedipine, to bring severe high blood pressure down to a safer range and reduce the risk of stroke.
• Delivery: the definitive treatment once the mother is stabilized, regardless of how far along the pregnancy is. Vaginal birth may be possible, but cesarean is often needed.
• Close monitoring after birth for further seizures, high blood pressure, kidney problems and fluid in the lungs.

Complications

For the mother: stroke, brain bleeding, placental abruption, HELLP syndrome, kidney failure, fluid in the lungs, aspiration pneumonia and, rarely, death. For the baby: lack of oxygen, premature birth and its complications, growth restriction and stillbirth.

Postpartum eclampsia

Eclampsia can occur after delivery, most often within the first 48 hours, but cases occur up to 6 weeks postpartum, even in people who had normal blood pressure during pregnancy. A severe headache, vision changes or high blood pressure after birth needs immediate care. Tell any emergency team that you recently gave birth.

Outlook and future health

Most people recover fully with prompt treatment, and brain changes usually reverse. Future pregnancies carry a higher risk of preeclampsia, so early prenatal care and preventive aspirin are usually recommended. Preeclampsia and eclampsia also increase the long-term risk of high blood pressure, heart disease and stroke, so yearly blood pressure checks and heart-healthy habits are important.

Prevention

• Attend all prenatal visits for blood pressure and urine checks.
• Low-dose aspirin, started between 12 and 28 weeks (ideally before 16 weeks), is recommended for people at high risk of preeclampsia. Take it only as advised by your clinician.
• Monitor blood pressure at home if advised, including after birth.
• Know the warning signs and act quickly.

Frequently asked questions

What is the difference between preeclampsia and eclampsia?

Preeclampsia is high blood pressure in pregnancy, usually after 20 weeks, with protein in the urine or signs of organ strain. Eclampsia is when someone with preeclampsia has a seizure. Eclampsia is always an emergency, while preeclampsia ranges from mild to severe.

What are the warning signs of eclampsia?

Warning signs include a severe headache that does not go away, vision changes such as flashing lights or blurring, pain under the right ribs or in the upper belly, nausea or vomiting in later pregnancy, sudden swelling, confusion and very high blood pressure. Seek emergency care immediately.

Can eclampsia happen after giving birth?

Yes. Postpartum eclampsia usually occurs within 48 hours of delivery but can happen up to 6 weeks after birth, sometimes in people who had normal blood pressure in pregnancy. A severe headache, vision changes or high blood pressure after birth need emergency assessment.

How is eclampsia treated?

Eclampsia is treated with magnesium sulfate to stop and prevent seizures, medicines to lower dangerously high blood pressure, and delivery of the baby once the mother is stable. Monitoring continues for at least 24 hours after delivery or the last seizure.

Can eclampsia be prevented?

The risk can be lowered. Regular prenatal checks catch preeclampsia early, and low-dose aspirin started before 16 weeks lowers the risk in high-risk pregnancies. Magnesium sulfate given to people with severe preeclampsia greatly reduces the chance of seizures.