Eclampsia is the most severe stage of late toxicosis (preeclampsia). Unlike early toxicosis, eclampsia syndrome poses a huge danger not only to the health of the fetus and the expectant mother, but also to the lives of both of them.

The pathology is spontaneous and sudden, develops very quickly, so it is very difficult to predict its consequences. The occurrence of eclampsia is preceded by the appearance of edema, the presence of protein in the urine, and an increase in blood pressure.

The condition does not belong to an independent disease and occurs only during pregnancy, during delivery, and in the postpartum period. It is usually associated with severe disturbances in the pregnant woman - placenta - fetus system and is a combination of severe damage to the central nervous system, which in the most severe cases is manifested by the development of seizures and coma.

In more than 90% of cases, eclampsia occurs after the 28th week of pregnancy, very rarely (no more than 1%) before the 20th week. Diagnosis is not difficult, so modern medicine rarely reports severe complications after an attack.

Causes

It is impossible to unambiguously determine why eclampsia occurs in pregnant women. There are many theories, but none of them are 100% reliable. Doctors identify a number of predisposing factors, ignoring which can lead to the development of pathology. These include:

• hypertensive conditions;
• the presence of similar attacks in previous pregnancies;
• chronic diseases of internal organs (severe kidney damage, pathologies of the heart and blood vessels, diabetes mellitus, severe obesity);
• first birth at an early (before 18 years) or late (after 35 years) age;
• poor uterine blood flow;
• disturbances in the placenta;
• eclampsia in close relatives.

The risk of developing a pathological condition increases if the time interval between pregnancies exceeds ten years. Eclampsia is most often observed during pregnancy (up to 70% of cases). During childbirth, the rate is about 25%, after childbirth - no more than 2-3%.

Symptoms

The occurrence of pathology is preceded by a condition. It is characterized by the following symptoms: protein in the urine, hypertension, edema. Eclampsia syndrome can develop in the presence of even one or two of the above factors.

The most common manifestation of late toxicosis is edema. They usually occur on the legs and arms, subsequently spreading to the face and neck, as well as the entire body. Edema is pathological in nature; it not only does not decrease after a night's rest, but also leads to rapid weight gain (more than 500 g per week).

Normally, a person does not have protein in their urine. In pregnant women, the acceptable level may be 0.333 g/l per day. If the indicators exceed this norm, we are talking about proteinuria; in this case, the woman should be under the strict supervision of a doctor.

Protein is present in the urine in more than half of women with symptoms of preeclampsia. However, in 14% of pregnant women, the urine test results are normal.

The risk of developing pathology increases with blood pressure 140/90 mm. rt. Art. (moderate form of the disease), 160/110 mm. rt. Art. (severe form).

Other threatening factors are:

• severe headache, dizziness;
• nausea and vomiting;
• pain in the stomach and liver;
• problems with urination;
• severe swelling of the whole body;
• blurred vision, appearance of spots before the eyes

There is a pathological change in the composition of the blood - a decrease in the number of platelets, destruction of red blood cells. The presence of edema, high blood pressure and increased protein concentration in the urine allows a diagnosis of “moderate eclampsia”. In severe cases, convulsive seizures and fetal death may develop.

The main symptoms are convulsive seizures, which end in fainting and, in severe cases, coma. Eclampsia is characterized by increased headaches, chronic sleep disturbances, and a sharp jump in blood pressure. Deep lesions of the nervous system organs increase the excitability of the brain. External stimuli of varying intensity can trigger seizures: bright light, sudden movements, loud noise.

There are several stages in a seizure:

1. Tension and slight trembling of the facial muscles, the general condition deteriorates sharply.
2. Stretching of the entire torso, unnatural curvature of the spine, contraction of muscles. Convulsions, eye rolling, changes in pulse, and breathing problems are noted. This stage of a seizure is the most dangerous because it leads to the risk of complete respiratory arrest, brain hemorrhage and possible death.
3. The pregnant woman's body is subjected to strong convulsions that replace each other. A seizure lasts about a minute. Characterized by sudden disturbances in breathing and pulse, the appearance of foam at the mouth, and bleeding from biting the tongue. Gradually, the cramps weaken, breathing normalizes, and the skin acquires its natural color.
4. Return of consciousness. Within a few minutes, the woman comes to her senses, her pulse and breathing normalize, and her pupils narrow. Memories of the experience are not retained.

After a seizure, the condition gradually stabilizes, but there are often cases when seizures end in coma. This condition can last from several hours to several days. It poses a real threat to the health of the mother and fetus.

Classification of the disease depending on the main symptoms and their severity includes:

1. The typical form is characterized by high blood pressure, swelling of the skin, and a high amount of protein in the urine.
2. Atypical form - symptoms most often appear during prolonged labor. In this form of the disease, cerebral edema is diagnosed, while other symptoms are mild or absent.
3. Renal form - occurs with severe kidney pathologies.

With glomerulonephritis, an acute inflammatory process in the kidneys, swelling of the skin may be insignificant with excessive accumulation of fluid in the abdominal cavity and fetal bladder.

Diagnosis and treatment

As already noted, the disease is pronounced in nature, so its diagnosis does not present much difficulty. The situation is often aggravated by the fact that a seizure occurs suddenly and does not leave time for a gynecological examination or ultrasound. Typical signs help distinguish eclampsia from an epileptic seizure, as well as from a diabetic coma.

Doctors are faced with the task of identifying the precursors of late toxicosis in time and preventing their transition to the most severe form.

Preliminary diagnostic and preventive measures include:

• asking the patient about the time of onset of the first symptoms, such as swelling, headache, pressure surges;
• analysis of possible diseases of internal organs that arose both before and during pregnancy;
• general blood and urine tests;
• fetus and condition of internal organs;
• regular blood pressure monitoring;
• identifying edema, assessing its severity and location;
• electrocardiogram.

Timely implementation of diagnostic measures at the stage of preeclampsia will not allow the condition of the expectant mother to develop into eclampsia itself. Failure to do this increases the risk of complications such as severe heart failure, stroke or paralysis, mental disorders, coma and sudden death.

Very often, an attack of eclampsia occurs when a woman is away from a medical facility where she will receive immediate help. First of all, you must immediately call an ambulance. While waiting for doctors, first aid should be provided.

Pre-hospital and emergency care

The pregnant woman should be placed on her left side to prevent ingestion of vomit and blood. It is better if it is on a soft surface, which will help avoid additional injuries. There is no need to restrain the patient during convulsions.

After a seizure, it is necessary to clear your mouth and nose of mucus, foam, vomit and blood. When the woman comes to her senses, every effort will be made to calm her down and prevent additional emotional stress.

Emergency care for eclampsia is, first of all, anticonvulsant therapy. The patient is given intravenous magnesium sulfate (magnesia). After the first main dose, a maintenance dosage is prescribed in the form of a solution of magnesia and saline. Such therapy is necessary as long as the risk of eclampsia remains.

Therapy

Treatment of eclampsia should be aimed at normalizing blood pressure, correcting brain function, restoring blood circulation and clotting. Drug therapy is prescribed, the purpose of which is to normalize blood pressure. The drugs Nifedipine, Sodium Nitroprusside, Dopegit are indicated. The exact dosage is determined by the doctor.

Drugs used in the treatment of eclampsia

To relieve severe edema, diuretics are prescribed, and glucose is prescribed to improve brain metabolism. Since after an attack the patient may experience a severe psychological state, she is prescribed sedatives (calming) drugs. Treatment of eclampsia involves the involvement of a neurologist and neurosurgeon.

A convulsive state is also dangerous for the unborn child. There is a risk of premature placental abruption and lack of oxygen supply to the fetus. The prognosis of the disease is not always favorable and depends on several factors: the severity of the seizure, the duration of pregnancy, and the timeliness of providing qualified medical care.

Delivery

After the convulsions end, doctors decide on delivery. With a moderate form of pathology, it is possible to maintain pregnancy until 37 weeks. Severe forms pose a threat to the life of the woman and child, so delivery is carried out regardless of the period during the day.

There is a misconception that eclampsia syndrome requires exclusively delivery with the help. However, unless the condition is complicated by certain other medical conditions, there is no need for a caesarean section. On the contrary, natural childbirth in this condition is more preferable. It is necessary to accelerate labor by using gentle methods: opening the amniotic sac, rotating the fetus.

Although the typical period for the development of eclampsia is during pregnancy, rapid eclampsia is sometimes observed during childbirth. This condition occurs with prolonged contractions, inadequate pain relief, strong labor, when the process of dilation of the cervix and expulsion of the fetus occur too quickly. The symptoms of the syndrome are similar to those that occur during pregnancy.

Eclampsia after childbirth develops, as a rule, in the first two days after the birth of the child (there are cases of late eclampsia that occurred several weeks after birth) and is quite rare. Treatment of the pathological condition is carried out using the same therapeutic methods as during pregnancy.

Treatment according to Stroganov

For successful treatment of eclampsia, Stroganov’s principles are used. Thanks to the use of these methods, mortality decreased by 5-6 times.

Stroganov's principles include the following measures:

1. Placing the woman in a darkened room where all noise or visual stimuli are absent. Treatment (injections, catheterization) is carried out under inhalation anesthesia.
2. Relief from seizures with the help of morphine hydrochloride and chloral hydrate, the administration of which was carried out according to a specially developed scheme.
3. Delivery using obstetric forceps, rupture of membranes.
4. Drug therapy aimed at maintaining normal functioning of the lungs, heart and kidneys.
5. Performing bloodletting 300-400 ml.

Over time, some of Stroganov's principles underwent certain changes. Thus, the drugs morphine and chloral hydrate, which have a depressant effect on the central nervous system, were replaced with magnesium sulfate and oxygen ether. In order to prevent oxygen starvation of the mother and child, oxygen inhalations are performed.

Bloodletting reduces vascular spasm, which allows you to normalize blood pressure and improve the functioning of the kidneys and lungs. Bloodletting is not performed if emergency delivery is planned.

Thanks to the optimal combination of traditional and modern treatment methods, the condition is now classified as a rare pathology, and maternal mortality and fetal death occur only in the most extreme cases.

Women who have experienced eclampsia during pregnancy or childbirth should be under close medical supervision throughout the postpartum period. Regular blood pressure measurements and a urinalysis every two to three days are necessary to monitor the presence of protein. Particular attention is paid to monitoring the activities of the cardiovascular system, respiratory system and reproductive system.

Children also need very careful care. Such babies are prone to infectious and viral diseases, allergic reactions, diseases of the nervous system and other pathologies.

Prevention

Preventive measures aimed at minimizing the risk of developing pathology are as follows:

1. Registration for pregnancy no later than 12 weeks.
2. Regular observation by a gynecologist, visiting a consultation monthly in the first half of pregnancy and every two weeks in the second.
3. Treatment of chronic diseases of internal organs at the stage of pregnancy planning.
4. Monitoring your blood pressure.
5. Taking a general urine test at least once a month in the first 20 weeks of pregnancy and twice a month thereafter.
6. Timely identification and elimination of the first signs, fight against edema.
7. Compliance with the principles of proper nutrition (inclusion in the diet of non-spicy foods rich in vitamins, fresh vegetables, fruits and herbs, limiting fatty foods and salt).
8. Elimination of excessive physical activity, psychological peace.
9. Sufficient stay in the fresh air, regular walks in the fresh air, moderate sports activity, sleep at least 8-9 hours a day.

Preventing the development of eclampsia is helped by taking small doses of Aspirin from the moment of detection until the 20th week of gestation and calcium supplements throughout the entire period of gestation. Taking these medications should become the norm for those women who are at risk. Iron supplements, folic acid, magnesium, vitamins E and C are also recommended for prevention.

The algorithm for severe preeclampsia is used for timely assistance when symptoms of damage to the nervous system appear, indicating severe preeclampsia in the presence of hypertension above 140 and 90 mmHg. with protein in the urine. These include headache, pain in the epigastrium, nausea, vomiting or a combination thereof, visual disturbances such as the flickering of “flies” or “veils” before the eyes, sometimes its complete disappearance. If a pregnant woman is in a hospital, then first of all it is necessary:

• call for help from all available staff in the department and the anesthesiologist-resuscitator and team
• lay the patient on a flat surface with her head turned to one side and prevent injury to the woman by protecting her from blows with available things
• It is recommended to administer a bolus of 25% magnesium sulfate solution 20 ml over 10 minutes, and then switch to maintenance therapy, depending on the level of systolic blood pressure, the dose and rate of administration will change.
• antihypertensive drugs are indicated at pressures of 160 and 100 mm Hg. and above and it is best to use nifedipine 10 mg sublingually and after 30 minutes repeat the dose under pressure control or corinfar, since it does not penetrate the blood-brain barrier.
• further observation and treatment is carried out in the intensive care ward, during which the woman is prepared for delivery.

Emergency care for preeclampsia is discussed above, but as for delivery, we will try to analyze the main points. One of the main tasks when identifying a woman with severe preeclampsia is preparing the pregnant woman for delivery. If the birth canal is not ready, the use of folliculin or prostaglandins locally is indicated. If this condition occurs before 37 weeks of pregnancy, prevent RDS syndrome, and if after 37 weeks and the birth canal is ready, vaginal spontaneous birth is indicated against the background of adequate pain relief. Caesarean section is performed when the preparation of the birth canal is ineffective and the condition of the fetus deteriorates. For the third stage of labor, curettage of the uterine cavity is mandatory.

Preeclampsia: Emergency care is provided for moderate to severe preeclampsia, and is aimed at lowering blood pressure, sedation, the use of antispasmodics, the prevention of seizures and oxygen therapy.

Preeclampsia - the algorithm for providing assistance is discussed above, and now let's move on to eclampsia, as the most severe form of preeclampsia.

Emergency care for eclampsia. The algorithm consists of providing assistance on the spot, regardless of where the woman is, laying her down on a flat surface, turning her head to the side, emptying the oral cavity and protecting her from injury and damage. After a seizure, a woman is taken to the intensive care unit or intensive care unit, and if a seizure occurs at home, then an ambulance should be called immediately. In the hospital, oxygen therapy and anticonvulsant therapy are provided as for severe preeclampsia. To monitor the function of vital organs and systems, catheterization of the main vessels, bladder and placement of a nasogastric tube are performed. If a woman is in a coma or seizures continue, transferring the woman to mechanical ventilation is indicated. In the absence of venous access, short-term intravenous anesthesia with sodium thiopental or masked fluorotane anesthesia is used. In case of insufficient hypotension against the background of magnesium, vasodilators are used to eliminate vascular spasm. Treatment is also carried out after delivery, which is carried out depending on the obstetric situation.

First aid for eclampsia in pregnant women is carried out in a strict manner, since it has very serious consequences and a threat to life not only for the fetus, but also for the mother. Therefore, if signs of eclampsia appear, you need to:

• Lay on a flat surface, on your left side, with your head turned to the side, and place blankets and pillows around your body.
• Insert a mouth dilator and a tongue holder into the mouth, and if they are missing, a spoon wrapped in a rag - to prevent tongue retraction and asphyxia
• Clear the oral cavity of mucus, foam and vomit.
• In case of respiratory arrest, perform indirect cardiac massage.

Eclampsia: emergency care - algorithm for providing care at the prehospital stage:

• Call an ambulance
• Provide protection for women from blows
• Ensure airway patency by positioning on the left side and turning the head to the side, while inserting a spoon into the mouth
• Don't hold a woman by force
• After cramps, clean the mouth

Eclampsia - the emergency care algorithm after the ambulance arrives is based on maintaining the therapeutic and protective regime and promptly transporting it to intensive care, where the room should be soundproof, with dim light and closed windows.

Eclampsia: first aid is primarily aimed at maintaining and restoring the function of all organs and systems, and it is necessary to monitor pressure, pulse, respiration and kidney and liver function.

So, first aid for preeclampsia and eclampsia should consist of hospitalization of all pregnant women in the obstetric and physiological department. Convulsive readiness is stopped at the point of care, before transportation to a medical institution.
For this purpose, use rausedil, sibazon 0.5%, droperidol 0.025% or 2% promedol. For high blood pressure, ganglion blockers are used to provide emergency care. In case of high convulsive readiness and the need for emergency manipulations, oxygen-nitrous oxide anesthesia is used.

From the above material, we understand how relevant it is to implement clinical recommendations for the provision of emergency care for preeclampsia and such a terrible complication as eclampsia, since untimely diagnosis and improper provision of care increase the risk of maternal and prenatal mortality.

Video: Preeclampsia, eclampsia part 1

From the earliest stages of pregnancy, a special system of interaction between the mother’s body and the fetus is formed. In gynecology, it is called the “mother-placenta-fetus system.” Thanks to it, the woman’s body does not reject the embryo, but on the contrary: it contributes to its preservation and development.

However, some pregnant women may experience a disruption in the functioning of this system, which leads to eclampsia, a condition in which there is dysfunction of the mother’s vital organs, which poses a direct threat to both the life of the woman and the life of the fetus.

To date, there is no consensus on why this disease begins, but it is reliably known that its appearance is typical only for pregnant women, women in labor and postpartum women. In obstetric practice, two conditions of late gestosis are distinguished: preeclampsia and eclampsia, but what is this in simple terms?

Preeclampsia– this is a condition in which damage to the nervous system, liver, kidneys occurs, and arterial hypertension develops.

is a condition that requires emergency hospitalization; it can develop in patients with preeclampsia, and also exist as an independent form of a serious disease.

Causes of eclampsia in pregnant women

Since eclampsia is a dysfunction of the “mother-placenta-fetus” system, the causes are diseases that the woman already had before conceiving the child. During pregnancy, these pathologies can be a trigger for the onset of severe gestosis. Among the causes of eclampsia are the following:

1. Fetoplacental insufficiency (FPI) is a condition in which the blood flow of the placenta begins to function poorly. Only a doctor can assess the condition of the arteries using a Doppler examination.
2. Thrombophilia is a genetic disease that involves a special mutation of genes that provoke thrombus formation. During pregnancy, thrombophilia becomes active and in later stages is the cause of the development of FPN.
3. Mutations of the eNOS gene affect the functioning of blood vessels. If there is a genetic defect, a woman’s body may perceive the fetus as a foreign body and try to get rid of it.
4. Defects in the attachment of the placenta to the walls of the uterus cause deterioration in fetal nutrition and provoke the appearance of FPN. With this pathology, blood flow disturbances can develop either gradually or suddenly.

In addition to the causes, there are risk factors for eclampsia and preeclampsia. At the very beginning of pregnancy, when registering, the gynecologist should pay attention to their presence and prescribe the patient appropriate therapy so that risk factors do not provoke the onset of severe gestosis.

• Chronic hypertension;
• Multiple pregnancy;
• Presence of eclampsia or preeclampsia in obstetric history;
• The presence of eclampsia or preeclampsia in the obstetric history of the mother, grandmother, aunt or sister;
• Old-time women (over 40 years of age at the time of pregnancy).

Particularly close attention to the patient’s condition should be paid if one or more risk factors for the development of gestosis are combined with the fact that the woman is carrying her first pregnancy.

Types of disease

In general, eclampsia can be divided into two types: according to the severity of the disease and the time of its onset. Depending on this, the treatment regimen will be determined and the risk to the health of the mother and fetus will be assessed.

The Russian classification of the stages of development of gestosis is somewhat different from that adopted in European countries. According to domestic experts, preeclampsia is the initial stage of eclampsia.

Severity of the disease

• Mild preeclampsia – involves blood pressure in the range of 140 – 170/90 – 110 mmHg. Art. In this case, proteinuria (more than 0.3 g/l) will be determined in a urine test.
• Severe preeclampsia - involves blood pressure above the limit of 170/110 mmHg. Art. Proteinuria is pronounced.

Time of onset of illness

• Eclampsia during pregnancy is the most common and poses a threat to the life of mother and child. Treatment is complicated by the fact that the fetus may not tolerate certain medications to relieve attacks.
• Eclampsia during childbirth - occurs in approximately 20% of all cases and poses a threat to the life of the woman and child. In this case, the provocateur of the attacks is labor.
• Eclampsia after childbirth occurs very rarely and develops within 24 hours after the baby is born.

Signs of eclampsia and symptoms

Despite the variety of species, the signs of eclampsia have a certain similarity, so they can be divided into a general list:

• Increased blood pressure - depending on the level to which it has increased, the doctor will determine the severity of the disease.
• Edema - the more severe the patient’s condition, the stronger the fluid retention in her body. The swelling is mainly in the upper body (face, arms).
• A series of convulsive seizures are numerous, lasting 1-2 minutes. The intervals between seizures are small. Loss of consciousness is short-term.
• Eclamptic status is a series of convulsive seizures in which the patient is in a coma and does not regain consciousness.

Characteristics of a seizure

The attack begins with involuntary contractions of the facial muscles. After a short period of time, the entire musculature of the body is involved in the process. The woman loses consciousness and limb clonus appears. After a series of clonus, coma occurs.

Diagnostics

Making a diagnosis is complicated by the fact that eclampsia does not have specific symptoms that would correspond only to it. Cramps, edema and proteinuria may be symptoms of other diseases that have nothing to do with gestosis.

Currently, the problem of determining eclampsia is being actively studied, and to make a diagnosis, doctors use special examinations and tests that reveal the initial stage of the disease - preeclampsia:

• Systematic blood pressure measurement. Moreover, to confirm eclampsia, it is necessary to monitor the state of blood pressure over time.
• Urine analysis to determine the amount of protein. The daily test () is important here.

If the indicators indicate the presence of preeclampsia, then subsequent convulsive seizures will indicate that the pathological processes in the woman’s body have entered the most severe stage of their development - eclampsia.

Since severe degrees of gestosis suggest the presence of convulsive seizures, self-medication must be completely avoided. First aid for eclampsia will consist of the following:

1. Call an ambulance (most likely they will send an ambulance).
2. Lay the woman on her left side and build rolls of blankets around her. This precaution will help the patient avoid injury until doctors arrive. In addition, this position will ensure the free flow of foam released during an attack.
3. Fix the tongue to prevent it from falling into the pharyngeal cavity.
4. In between attacks, remove vomit and foam from the mouth.

A repeated series of seizures can be stopped by intravenous administration of magnesium (20 ml of a 25% solution over 30 minutes).

It is important to remember - in emergency cases, you can call 03 and ask the doctor on duty to give you instructions on the actions that need to be taken while the ambulance team is on the way.

Treatment of eclampsia in pregnant women

Therapy for severe gestosis consists of two stages. First you need to stop the seizures, and then lower your blood pressure. At the same time, it is necessary to eliminate swelling in order to alleviate the woman’s condition.

However, this is only an auxiliary measure in the treatment of eclampsia. The main actions should be normalization of blood pressure and anticonvulsant therapy. It is important to adhere to a certain sequence in prescribing treatment.

Thus, reducing blood pressure without eliminating seizures will not give the expected effect and will generally be difficult, since a pregnant woman will not be able to take pills or medicine due to the high muscle tone that occurs during seizures.

Anticonvulsant therapy

All medications intended to relieve seizures can be divided into three categories:

1. Drugs intended for emergency use: 25% magnesia solution, Droperidol, Diazepam.
2. Drugs intended for maintenance therapy: 25% magnesium solution at a dosage of 2 g per hour, Fulsed, Seduxen, Andaxin.
3. Drugs that enhance the sedative effect: Diphenhydramine, Glycine.

The dosage must be prescribed by a doctor. All anticonvulsants tend to significantly relax muscles and cause excessive drowsiness. If attacks of eclampsia were stopped and delivery did not take place, then therapy should be repeated throughout the entire pregnancy to avoid new manifestations of gestosis.

Antihypertensive therapy

It is carried out after stopping the seizures. It is important not just to reduce high blood pressure one-time, but also to keep it within normal limits - this can be difficult if, with eclampsia, a decision was made not to do an emergency delivery.

• Drugs intended for emergency use: Nifediline, Sodium nitroprusside (intravenously, maximum - 5 mcg per 1 kg of body weight per minute.)
• Drugs intended for maintenance therapy: Methyldopa.

Anti-high blood pressure medications should be taken until the end of pregnancy to prevent attacks from recurring. Antihypertensive therapy should be carried out primarily only if the patient is at risk of cerebral hemorrhage.

In severe cases of eclampsia, delivery is indicated as treatment, regardless of the gestational age and condition of the fetus. In this case, the mother’s life is at stake, so all possible measures must be taken to save her. However, when organizing childbirth, the following conditions must be met:

• Convulsions must be stopped. Delivery procedures should begin only a few hours after the attack has stopped.
• If possible, childbirth should be done through natural means. Caesarean section involves general anesthesia, which can provoke a new wave of seizures after recovery from anesthesia.
• Labor must be stimulated artificially. It is important to meet the period when the attack has subsided - when it resumes, the muscles of the whole body will become toned again and the birth of a child will become difficult.

Prevention

Preventive measures to prevent eclampsia are prescribed either to those patients who have a history of this condition during previous pregnancies, or to those who have already had attacks and there is a need to prevent new ones.

The gynecologist may prescribe calcium supplements or aspirin. Depending on the condition of the woman and the fetus, these drugs are prescribed for the entire term, or for a certain period of time, until the doctor is convinced that the patient is out of danger.

Treatment of eclampsia in a pregnant woman requires the immediate intervention of a specialist, so all actions of her relatives should be limited to providing first aid until the medical team arrives.

Preeclampsia, eclampsia- a severe complication of pregnancy and childbirth, manifested by multiple organ failure syndrome - hepatorenal, pulmonary, uteroplacental, cerebral, with the development of convulsive attacks (eclampsia). It is a syndrome of maladaptation of an organism that has one or another background pathology (pyelonephritis, diabetes, chronic psychogenic stress, nutritional disorders, etc.) in response to a developing pregnancy. The following stages of the disease are distinguished: mild preeclampsia, severe preeclampsia, eclampsia.
Mild preeclampsia is characterized by moderate arterial hypertension (up to 135-140/85-90 mm Hg), a slight decrease in the daily volume of urine, edema, pathological (more than 400 g per week) weight gain, a decrease in the relative density of urine, and a mild degree of proteinuria (no more than 0.1 g/day).
Severe preeclampsia is characterized by a more pronounced degree of hypertension (150-160/95-100 mm Hg or more), the addition of subjective symptoms: “stuffy” nose, ears, hoarseness, dizziness, headache, pain in the epigastric region, blurred vision
Eclampsia most often occurs against the background of symptoms of severe preeclampsia, but can develop with erased, mild symptoms of this complication. An attack of eclampsia lasts 15-2 minutes and is characterized by a sequential change of the following periods:
Pre-convulsive period - fibrillary twitching of the muscles of the face, neck, upper limbs. The eyelids close, the eyes “roll up” - only the whites of the eyes are visible, consciousness is lost; duration 30 s.
The period of tonic convulsions consists of a general convulsive status, reminiscent of the state of opisthotonus:
1. the body is stretched, the head is tense, the head is thrown back (tonic spasm),
2. breathing stops, pulse is barely noticeable, general cyanosis; duration 30-40 s.

3. The period of clonic convulsions - strong convulsive contractions of all muscle groups of the trunk and limbs, which by the end of this period (30-40 s) weaken and stop. Hoarse convulsive breathing, tachypne, is restored, foam is separated from the mouth, often stained with blood due to biting the tongue , mucous membranes of the lips during an attack.
4. The period of resolution of the attack is the complete cessation of convulsions, sometimes consciousness is restored, but more often there is a transition to a coma or to the next convulsive attack.
The most dangerous for the mother and fetus are the 3rd and especially the 2nd periods of the attack, which is associated with apnea, the possibility of cerebral hemorrhagic stroke, and cardiac arrest. In some cases, a coma develops in pregnant women with preeclampsia without an episode of convulsive attack. This condition is mistakenly interpreted as “nonconvulsive eclampsia.”
Symptoms. Reeclampsia is characterized by edema, arterial hypertension, uneven weight gain, and changes in urine, which makes the diagnosis of the complication quite simple. It should be remembered that for correct orientation in the severity of the disease, especially when it is erased, asymptomatic, it is important to assess its duration, background pathology, signs of intrauterine growth retardation (lag in fetal size from gestational age).
Urgent Care. At the prehospital stage, sedatives, narcotics, neuroleptics are used: 10-20 mg of sibazone (seduxen, relanium) in the form of a 0.5% solution - 2-4 ml intravenously (intramuscular), 4 ml of 0.25% solution of droperidol intravenously, nitrous oxide with oxygen in a ratio of 1:2. In case of high convulsive readiness or attacks of eclampsia, a 25% solution of magnesium sulfate (6 g of dry matter) is administered intramuscularly; if there is contact with a vein, part of the dose (10-12 ml of a 25% solution) can be administered intravenously in a 5% glucose solution or isotonic sodium solution chloride For high arterial hypertension (180-200/100-120 mm Hg or more), clonidine 0.01% is administered over 3-5 minutes, 0.3-1 ml intravenously or intramuscularly. You can also administer papaverine intramuscularly, but-shpu - 2% solution, 2 ml each.
In case of eclampsia or coma, the medical tactics are the same, but at the moment of arrival to the patient, it is imperative to urgently establish reliable contact with the vein. Infusion solutions can be 5% glucose solution, rheopolyglucin, isotonic salt solutions. Poliglyukin is categorically not indicated. In this case, antispasmodics, antipsychotics, antihypertensive drugs are immediately administered intravenously, and magnesium therapy is prescribed (see above). During an attack of eclampsia, a mouth dilator is inserted (you can use a spoon wrapped in gauze or cotton wool). At the end of the attack, mask anesthesia with nitrous oxide and oxygen in a ratio of 1:1 or 1:2 is required immediately. If it is impossible to provide inhalation anesthesia during transportation, and blood pressure does not exceed 160 mm Hg. Art., you can use sodium hydroxybutyrate intravenously - 20-40 ml of a 20% solution. Transported under narcotic sleep conditions.

Hospitalization. In all cases of diagnosis of this complication, regardless of its severity (mild severe preeclampsia), immediate hospitalization of the patient in the pregnancy pathology department (intensive care unit) of the maternity hospital is indicated. It is advisable to inform the maternity hospital staff in advance about the upcoming delivery of a pregnant woman with severe preeclampsia or eclampsia; transportation in a specialized resuscitation vehicle is preferable; transportation on a stretcher is mandatory

Eclampsia is a disease that occurs in pregnant women, in which blood pressure rises so much that the health of the child and mother is threatened. Typically, eclampsia in pregnant women occurs in the third trimester or within 24 hours after birth.

Most often, eclampsia during pregnancy and postpartum eclampsia occurs in primiparous young girls and primiparous women over 40 years of age.

Eclampsia in pregnancy occurs in women with acute kidney disease. Renal eclampsia is observed with nephropathy, acute nephritis and in rare cases with chronic nephritis

The main cause of the disease is an increase in blood pressure, which causes spasm of cerebral vessels. Spasms lead to disruption of the blood supply to the brain and its swelling.

Risk factors

Eclampsia during pregnancy and postpartum eclampsia can develop under the influence of the following factors:

• maternal eclampsia;
• eclampsia in previous pregnancies from one partner;
• young age;
• first birth;
• multiple pregnancy;
• systemic lupus erythematosus;
• kidney diseases

Symptoms of eclampsia

Symptoms of eclampsia

Renal eclampsia in pregnant women is accompanied by a seizure. Convulsions develop in a certain sequence: first the facial muscles begin to contract, then the upper limbs undergo contraction. After this, cramps cover all the muscles of the skeletal muscles. Breathing is impaired or completely absent. The patient loses consciousness, the pupils dilate.

Convulsive symptoms of eclampsia may be accompanied by foam at the mouth, often with blood. The patient may bite her tongue. After convulsions, the pregnant woman falls into an eclamptic coma.

Before the attack, the patient feels a headache, general weakness, dizziness, vision is impaired, and pain occurs in the right hypochondrium and epigastric region.