eclampsia

Eclampsia is a life-threatening obstetric complication defined by the occurrence of new-onset generalized seizures in a pregnant or postpartum woman with preeclampsia or with signs suggesting severe hypertension during pregnancy. It represents the progression of hypertensive disorders of pregnancy and requires urgent medical attention to protect both mother and fetus. Preeclampsia commonly presents with raised blood pressure and proteinuria, but eclampsia may occur with rupture of membranes or in the absence of prior symptoms.

Pathophysiology is not fully understood, but abnormal placentation leading to widespread endothelial dysfunction, cerebral edema, and vasospasm is thought to contribute. Risk factors include first pregnancy, preexisting hypertension or diabetes, obesity, multiple gestation, and a history of preeclampsia.

Clinical features include sudden seizures, altered consciousness, or coma. Seizures may be preceded by signs such as severe headache, visual changes, or epigastric pain. Diagnosis is based on clinical presentation in the appropriate obstetric context, with laboratory tests and fetal monitoring used to assess severity and guide management.

Management focuses on stabilization and prevention of further seizures, control of blood pressure, and delivery when feasible. Intravenous magnesium sulfate is the standard treatment to prevent and stop seizures, with monitoring for signs of magnesium toxicity. Antihypertensive therapy may include labetalol, hydralazine, or nifedipine. The definitive treatment is delivery, timed to maternal stabilization and fetal status. Postpartum care includes continued monitoring for complications such as cerebral edema, liver or kidney dysfunction, coagulopathy, and HELLP syndrome.

Prognosis improves with prompt recognition and evidence-based management; without timely treatment, eclampsia carries significant maternal and fetal risk.