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Eclampsia

Eclampsia is a serious complication of pregnancy and is characterised by convulsions. Usually eclampsia occurs after the onset of pre-eclampsia though sometimes no pre-eclamptic symptoms are recognisable. The convulsions may appear before, during or after labour, though cases of eclampsia after just 20 weeks of pregnancy have been recorded. more...

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Signs and symptoms

The majority of cases are heralded by pregnancy-induced hypertension and proteinuria but the only true sign of eclampsia is an eclamptic convulsion, of which there are four stages. Patients with edema and oliguria may develop renal failure or pulmonary oedema.

  • Premonitory stage - this stage is usually missed unless constantly monitored, the woman rolls her eyes while her facial and hand muscles twitch slightly.
  • Tonic stage - soon after the premonitory stage the twitching turns into clenching. Sometimes the woman may bite her tongue as she clenches her teeth, while the arms and legs go rigid. The respiratory muscles also spasm, causing the woman to stop breathing. This stage continues for around 30 seconds.
  • Clonic stage - the spasm stops but the muscles start to jerk violently. Frothy, slightly bloodied saliva appears on the lips and can sometimes be inhaled. After around two minutes the convulsions stop, leading into a coma, but some cases lead to heart failure.
  • Comatose stage - the woman falls deeply unconscious, breathing noisily. This can last only a few minutes or may persist for hours.

Epidemiology

It can be fatal to both mother and fetus, with just under one in 50 women dying and one in 14 of their babies also not surviving, despite best-available medical care.

Bibliography

  • Mayes, M., Sweet, B. R. & Tiran, D. (1997). Mayes' Midwifery - A Textbook for Midwives 12th Edition, pp. 533–545. Baillière Tindall. ISBN 0-7020-1757-4

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Women's health, breast and pelvic disorders: pre-eclampsia and stress
From Townsend Letter for Doctors and Patients, 11/1/04 by Robert A. Anderson

Preeclampsia occurred in 180 of 3,321 working, pregnant Norwegian women who completed a questionnaire sorting them into a cohort reporting a highly stressful and hectic work pace vs. those who never or rarely worked at a hectic pace. RR for preeclampsia in those working at a stressful pace was 1.4 vs. those who had jobs in which they did not face hectic stress (p<0.05). Those lifting loads of 22-44 pounds were almost twice as likely to develop preeclampsia vs. women who never or rarely lifted these amounts. Those drinking >4 cups of coffee/d were 60% more likely to develop preeclampsia vs. those drinking <4 cups/d (p<0.01).

Wergehad E, Strand K. Workplace Conditions and Preeclampsia and Prevalence, Norway, 1989. Int J Gynaecol Obstet 1997 Aug; 58(2):189-96

COMMENT: Knowing that stress and caffeine both raise catecholamine levels and that catecholamine metabolites increase oxidative stress, and that preeclampsia is at least in part a free-radical related problem, this stress/eclampsia relationship makes sense. The stress can be physical or psychosocial. The toxemia of pregnancy involved here may be a metaphor for the toxic nature of stress when it is not well managed.

COPYRIGHT 2004 The Townsend Letter Group
COPYRIGHT 2004 Gale Group

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