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Eclampsia and pre-eclampsia: causes, types, first aid and treatment

From the earliest time of pregnancy a special system of interaction of the mother's organism with the embryo is formed. In gynecology, it was called the "mother-placenta-fetus system." Thanks to her, the body of a woman does not reject the embryo, but on the contrary: it helps to preserve and develop it.

However, some of the pregnant women may experience a disruption in the functioning of this system, which leads to eclampsia, a condition in which dysfunction of the vital organs of the mother is observed, which directly threatens both the life of the woman and the life of the fetus.

Until now, there is no consensus on why this ailment begins, but it is reliably known that its appearance is characteristic only of pregnant women, parturients and puerperas. In obstetrical practice, there are two states of late gestosis: preeclampsia and eclampsia, but what is this in plain language?

Pre - eclampsia is a condition in which the nervous system, liver, kidneys are affected, arterial hypertension develops.

Eclampsia is a condition requiring urgent hospitalization, it can develop in patients with preeclampsia, and also exist as an independent form of severe disease.

Content

Causes of eclampsia in pregnant women

Eclampsia

Since eclampsia is a malfunction of the mother-placenta-fetus system, the causes are diseases that the woman already had before the conception of the child. During pregnancy these pathologies can be a trigger mechanism to the onset of severe gestosis. Among the causes of eclampsia are the following:

  1. Fetoplacental insufficiency (FPN) - a condition in which the blood flow of the placenta begins to function poorly. Evaluate the condition of the arteries can only doctor with Doppler studies.
  2. Thrombophilia is a genetic disease involving a special mutation of genes that provoke thrombus formation. During pregnancy, thrombophilia becomes active and in later terms is the cause of the development of FPN.
  3. Mutations of the gene eNOS - affect the operation of blood vessels. In the presence of a genetic defect, a woman's body can 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 the deterioration of fetal nutrition, provoke the appearance of FPN. With this pathology, blood flow disorders can form either gradually or suddenly.

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

  • Chronic hypertension;
  • Multiple pregnancy;
  • The presence of eclampsia or preeclampsia in the obstetrical anamnesis;
  • The presence of eclampsia or preeclampsia in the obstetrical anamnesis of a mother, grandmother, aunt or sister;
  • Old women (over 40 years old at the time of pregnancy).

Particular attention should be paid to the patient's condition if one or more of the risk factors for the development of gestosis is combined with the fact that the woman is pregnant with the first pregnancy.

Types of disease

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

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

Degree of severity of the disease

  • Easy pre-eclampsia - presupposes arterial pressure in the range 140 - 170/90 - 110 mm Hg. Art. In this case, proteinuria will be determined in the urine analysis - an increased protein content (more than 0, 3 g / l).
  • Severe preeclampsia - involves blood pressure above the border of 170/110 mm Hg. Art. Proteinuria is clearly pronounced.

Time of occurrence of the disease

  • Eclampsia in pregnancy - occurs most often, carries a threat to the life of the mother and child. Treatment is complicated by the fact that the fetus may not transfer certain drugs to stop the attacks.
  • Eclampsia in childbirth - occurs in about 20% of all cases, poses a threat to the life of a woman and a child. In this case, the provocateur of attacks is labor activity.
  • Eclampsia after childbirth - occurs very rarely, develops within 24 hours after the birth of the baby.

Symptoms of eclampsia and symptomatology

Symptoms of eclampsia

Despite the diversity of species, the signs of eclampsia have a certain similarity, so they can be identified in a general list:

  • Increase in blood pressure - depending on the extent to which it has increased, the doctor will determine the severity of the disease.
  • Edema - the heavier the patient's condition, the stronger is the fluid retention in her body. The upper part of the trunk (face, hands) is swollen.
  • A series of convulsive seizures are numerous, lasting 1-2 minutes. The gaps between the cramps are small. Loss of consciousness is short-lived.
  • Eclampsic status is a series of convulsive seizures, in which the patient is in a coma and does not regain consciousness.

Characteristic of convulsive seizure

The attack begins with involuntary contractions of the facial muscles of the face. After a short period of time, the entire musculature of the body is involved in the process. The woman loses consciousness, clones of extremities appear. After a series of clones, coma sets in.

Diagnostics

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

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

  • Systematic measurement of blood pressure. Moreover, for confirmation of eclampsia it is necessary to monitor the condition of blood pressure in dynamics.
  • Urine analysis for the determination of the amount of protein. The daily sample is important here (a sample according to Zimnitsky ).

If the indicators indicate the presence of pre-eclampsia, subsequent convulsive seizures will indicate that the pathological processes in the body of a woman have entered the most difficult stage of their development - eclampsia.

First aid for eclampsia

First aid for eclampsia

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

  1. Call an ambulance (most likely to send a reanemobile).
  2. The woman lay on her left side, around her build rolls of blankets. This precautionary measure will help the patient avoid injuries before the arrival of doctors. In addition, this position will ensure a free outflow of foam, which is released during an attack.
  3. The tongue is fixed in order to avoid its sinking into the pharyngeal cavity.
  4. In the intervals between attacks, remove from the mouth vomit and foam.

To suppress a repeated series of seizures, it is possible by intravenous administration of magnesia (20 ml of 25% solution for 30 minutes).

— в экстренных случаях можно позвонить по номеру 03 и попросить дежурного врача дать вам указания к действиям, которые нужно предпринять до тех пор, пока бригада скорой помощи находится в пути. It is important to remember - in emergency cases, you can call at number 03 and ask the doctor on duty to give you instructions for actions that need to be taken as long as the ambulance crew is on the way.

Treatment of eclampsia in pregnant women

Therapy for severe gestosis consists of two stages. First it is necessary to stop the cramps, and then - to lower blood pressure. At the same time, it is necessary to eliminate swelling to relieve the condition of the woman.

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

Thus, reducing the pressure without eliminating the cramps will not give the expected effect and in general it will be difficult, since the pregnant woman will not be able to take the pill or medicine because of the high muscle tone that occurs with convulsive seizures.

Anticonvulsant therapy

All medicines intended for arresting seizures can be divided into three categories:

  1. Drugs intended for emergency exposure: 25% magnesia solution, Droperidol, Diazepam.
  2. Drugs intended for maintenance therapy: 25% magnesia solution in a dosage of 2 g per hour, Fulsed, Seduxen, Andaxin.
  3. Drugs that enhance sedation: Diphenhydramine, Glycine.

. Dosage should appoint a doctor . All anticonvulsants have the ability to significantly relax the muscles and cause excessive drowsiness. If the eclampsia episodes were managed to stop and the delivery did not take place, then the therapy should be repeated throughout the gestation period in order to avoid new manifestations of gestosis.

Hypotensive therapy

It is carried out after arresting seizures. It is important not just to lower one time high blood pressure, but keep it within normal limits - it can be difficult if eclampsia decided not to do emergency delivery.

  • Drugs intended for emergency treatment: Nifediline, sodium nitroprusside (intravenously, maximal - 5 μg per 1 kg of weight per minute.)
  • Preparations intended for maintenance therapy: Methyldopa.

Means against high blood pressure should be taken until the end of pregnancy, so that the seizures do not recur. Hypotensive therapy should be carried out first of all only if the patient has a threat of hemorrhage to the brain.

In severe cases of eclampsia, treatment is indicated for delivery regardless of the gestation period and fetal condition. In this case, the life of the mother is at stake, therefore, every possible measure should be taken to save it. However, the following conditions must be met in the organization of labor:

  • Cramps should be stopped. It is necessary to begin delivery procedures only a few hours after stopping the attack.
  • Where possible, births need to be done through natural ways. Cesarean delivery involves general anesthesia, which can provoke a new wave of cramps after exiting anesthesia.
  • Generic activity must be stimulated artificially. It is important to keep within the period when the attack receded - when it is renewed, the muscles of the whole body will again come into tonus and the birth of the child will become difficult.

Prevention

Preventive measures for the prevention of eclampsia are prescribed either to those patients who had this condition in the anamnesis, with the carrying of previous pregnancies, or to those who had already had seizures and the need to prevent new ones.

A gynecologist can prescribe a calcium supplement, or aspirin. Depending on the condition of the woman and the fetus, these drugs are prescribed for the entire period, or for a certain period of time, until the doctor is satisfied that the patient is out of danger.

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

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