Eclampsia still kills

Detecting and managing imminent eclampsia are important skills for practitioners even though eclampsia rarely is a complication of pregnancy. Eclampsia exhibits grand mal convulsions preeclampsia does not. In Britain the incidence of eclampsia is estimated at less than 1/1000 deliveries; in the Western world (including the US) the Nordic countries and England and Wales eclampsia and preeclampsia are the most important obstetric causes of maternal mortality. Cerebral hemorrhage is the lethal result in 50-60% of cases. Eclampsia usually occurs in the 2nd half of pregnancy toward the end of term; the convulsions in half the cases begin before labor. The cause is unknown. Clinical features include proteinuria renal impairment and disseminated intravascular coagulation. It probably is a form of hypertensive encephalopathy an acute or subacute syndrome of diffuse cerebral dysfunction that is not from uremia and that is reversed by treating the raised arterial pressure. Eclampsia and hypertensive encephalopathy have the common features of headaches vomiting and convulsions and the complication of cortical blindness. Cerebral edema is seen inconsistently. Those who die have significantly higher blood pressures than those who survive but not more proteinuria or worse renal function. Equal numbers of deaths occur from eclampsia and preeclampsia. It is a disease of young women having 1st babies but the older and parous women die. Consider any woman to have the disease if she has a blood pressure of 140/90 or more and proteinuria of 1+ or more (dipstick) or if she has headaches and vomiting in 2nd half of pregnancy. Immediate admittance to the hospital is recommended for renal function (plasma urea creatinine) studies platelet count and hepatic function (plasma aspartate aminotransferase activity) studies. Cure depends on elective delivery.