Eclampsia

Eclampsia [ ɛklampsi ː, also: eklampsi ː ] (Greek ἐκλάμπειν eklámpein " shine forth, shine forth " here in the sense of " suddenly appear ") is a sudden, serious illness, especially in the last trimester of pregnancy, which is associated with seizures. You can also occur shortly after birth or in the postpartum period. The precursor is referred to as pre-eclampsia.

Occurrence

It affects approximately 1 in 2000-3500 pregnant women. 80 % of all first-time mothers Eklampsiefälle concern. In multiple pregnancies, it is six times more frequently than in singleton pregnancies. Even diabetes during pregnancy and especially obesity are risk factors for pre-eclampsia and / or eclampsia.

Symptoms

Usually does not occur on the eclampsia without appropriate history. The patients usually have been pre-eclampsia caused by fluid retention (edema), protein excretion in the urine (proteinuria ) and high blood pressure ( hypertension ) is characterized.

Against this background, it is in eclampsia to the appearance of tonic- clonic seizures with or without loss of consciousness ( 44% postpartum, antepartal 38%, 18% intrapartum ). Harbingers of such a seizure can be a rapid increase in blood pressure with severe (usually frontal ) headaches, flickering before the eyes, foggy double or blurred vision, neurological symptoms: confusion, possibly blindness, coma, focal motor deficits, liver and kidney failure, and possibly nausea and be vomiting.

Pathogenesis

• Vasoactive, α - adrenergic substances lead to vasospasm
• Fibrin thrombi
• Liver cell necrosis
• Maternal mortality rate: 3-5 %; child mortality: 30-50 %

Fetal monitoring

• Determination of estriol, HPL, SP 1
• Ultrasonic fetometry ( Wachstumsretardierung! )
• Cardiotocography: Nonstress or stress CTG

Complications

A eclampsia requires intensive medical monitoring of the patient. It can lead to complications such as acute renal failure, cerebral edema, thrombosis, retinal damage, bleeding and placental insufficiency with danger to the child.

Risks

Renal failure, intra-abdominal or intracranial hemorrhage, acute fatty liver of pregnancy, pulmonary edema, placental abruption, intrauterine asphyxia, intrauterine death.

Therapy

The seizure is treated with anticonvulsants such as diazepam or clonazepam. Magnesium can be given intravenously, it has a hypotensive and anticonvulsant (anti-spasmodic ).

Undesirable side effect of intravenous magnesium is the cessation of breathing. He heralded mostly by failure of tendon reflexes at ( areflexia ); for early detection of this complication is therefore advisable to check the Patellarsehnenreflexes that should be good always triggered. Therefore, magnesium should i.v. only very slowly be injected.

If necessary, the pregnancy must be prematurely terminated by induction of labor or caesarean section, so that improves the metabolic status of the mother.

General measures

• Monitoring of the patient (heart rate, respiratory rate ), the recovery position, maintaining an airway, O2 Delivery, set venous access. Shielding against external stimuli, accounting for the hydration. CTG controls of the child ( see above)
• Attack treatment / prophylaxis: Anticonvulsant drugs, diazepam 10 mg iv about 2 min
• Anticonvulsant therapy: magnesium sulfate ( Cave overdose: continuous monitoring of heart and respiratory rate of the patient, review of the Patellarsehnenreflexes, in overdose symptoms: 1 g calcium gluconate )
• Antihypertensive therapy: see pre-eclampsia! ( constant RR controls! fundus! )
• Fluid balance ( balance sheet, adequate fluid replacement: 80 ml / kg / h or: amount of urine output for the last hour plus 30 ml! )
• Treatment of acute renal failure: diuretics and human albumin after CVP monitoring
• Low-dose heparin

Prevention

Pregnant women should regularly perform checkups, which can be completely taken over by both a gynecologist and a midwife. In the case of a medical abnormalities idea is unavoidable. Thus, precursors eclampsia usually can be recognized early and if necessary treat with medication. Thanks to a simple blood test can the relationship between sFlt-1/PlGF (soluble fms -like tyrosine kinase-1/placental growth factor) determine what is preventing the precursor of eclampsia can be detected early.

Follow-up

• Post partum: Intensive monitoring for 24 h, RR - setting, magnesium sulfate for 24 h, fluid balance
• Postpartum clarification at peripartalem Seizure: anamnesis, EEG, CT / M, clinic (RR, proteinuria, edema), laboratory parameters
• After pregnancy accurate to test for preliminary damage and neurological late effects

Differential Diagnosis

Epilepsy, tetany, uremia, diabetic coma, apoplexy