Pre-eclampsia & Eclampsia: Causes, Risk Factors, Prevention & Treatment

Table of Contents

What is Pre-eclampsia?

Pre-eclampsia is a condition when a pregnant woman has high blood pressure and protein in urine.
A complication during pregnancy characterized by high blood pressure that damages another organ system, especially the liver and kidneys.
Pre-eclampsia normally begins after 20 weeks of pregnancy in women whose blood pressure was normal before pregnancy.
Pre-eclampsia is similar to gestational hypertension.
Pre-eclampsia is also a leading cause of pre-term birth.
According to the World Health Organization, pre-eclampsia and eclampsia cause 14% of maternal deaths each year, or about 50,000 to 75,000 women worldwide.

What is Eclampsia?

Eclampsia is a severe progression/complication of pre-eclampsia.
Eclampsia is a rare but serious condition in which high blood pressure results in seizures or coma, usually in late pregnancy.
If preeclampsia is severe enough to affect brain function, causing seizures or coma, it is called/known as eclampsia.
It is a rare condition, affecting one in every 2000-3000 pregnancies every year.
If pre-eclampsia is left untreated then it develops into eclampsia and creates additional problems during delivery or pregnancy.

Who are at Risk?

Women are regarded as being at high risk of developing pre-eclampsia if they have one or more of the following risk factors:

Previous pre-eclampsia
Diabetes
Chronic hypertension
Renal disease
Autoimmune disease; and
Multiple pregnancies.

Causes of Pre-eclampsia & Eclampsia:

The actual cause of pre-eclampsia/ eclampsia is still not clearly understood. However, according to experts, some of the causes of Pre-eclampsia and eclampsia are:

Imperfect vascularization of the placenta
Genetic factors
Blood vessel problems
Auto immune disorders
Poor nutrition and high body fat
Lack of blood flow to the uterus

Factors Contributing to Pre-eclampsia & Eclampsia:

Family history of hypertension.
Chronic hypertension
Family history of diabetes mellitus
In vitro fertilization
Race
Multiple pregnancies
Interval between pregnancies
Patient age
Obesity
Pregnancy history
Renal disease
Gestational diabetes
Lupus
Rheumatoid arthritis
Carrying more than one baby

Risks Associated with Pre-eclampsia and Eclampsia:

Problems with pre-eclampsia and eclampsia pose risks to the fetus and mother such as:

Lack of oxygen and nutrients, which can impair fetal growth
Preterm birth
Infants born preterm due to pre-eclampsia face a higher risk of some long-term health issues, mostly related to being born early, including learning disorders, cerebral palsy, epilepsy, deafness, and blindness.
Infants born preterm may also have to be hospitalized for a long time after birth and may be smaller than infants born full term.
Infants who experienced poor growth in the uterus may later be at higher risk of diabetes, congestive heart failure, and high blood pressure
Stillbirth, if placental abruption (separation of the placenta from the uterine wall) leads to heavy bleeding in the mother.
Stillbirths are more likely to occur when the mother has a more severe form of preeclampsia, including HELLP syndrome.
Infant death
Risk for damage to the kidneys, liver, brain, and other organ and blood systems.
Organ failure or stroke
In severe cases, pre-eclampsia can develop into eclampsia, which includes seizures. Seizures in eclampsia may cause a woman to lose consciousness. If the fetus is not delivered, these conditions can cause the death of the mother and/or the fetus.

Evidence-based Recommendations for Prevention/Treatment of Pre-eclampsia & Eclampsia:

World Health Organization highlights following evidence-based recommendations prevention and treatment of Pre-eclampsia and Eclampsia:

Calcium supplementation during pregnancy to prevent pre-eclampsia and its complications (in areas where dietary calcium intake is low)
Low-dose acetylsalicylic acid (aspirin, 75 mg/day) is recommended for the prevention of pre-eclampsia in women at high risk of developing the condition.
Antihypertensive drugs for women with severe hypertension during pregnancy.
Magnesium sulphate for prevention and treatment of eclampsia in women with severe pre-eclampsia.
Induction of labor for women with severe pre-eclampsia.
Policy of early delivery is recommended for women with severe pre-eclampsia at term.
Prevention and treatment of postpartum hypertension through antihypertensive drugs (in women who were treated with antihypertensive drugs antenatally).

Source: (https://apps.who.int/iris/bitstream/handle/10665/44703/9789241548335_eng.pdf?sequence=1)

Additional Recommendation & Measures for Prevention & Treatment of Pre-eclampsia & Eclampsia:

Calcium supplements, especially to women who have calcium deficiency before pregnancy. Supplements should also be given in areas where calcium intake is <900mg/day.
- Adequate parental care to recommend lots of water and fluid intake or reduction of salt intake.
Special attention to high risk groups.
Maintain normal body weight.
No intake of medications, vitamins supplements without consulting to the doctor.
Revise national guidelines and protocols according to evidence-based practices
Adopt participatory processes to change health care providers behavior in align with the evidence-based practices.

Differences between Pre-Eclampsia and Eclampsia:

Difference based on	Pre-eclampsia	Eclampsia
Process	High blood pressure and protein in the urine during pregnancy causes pre-eclampsia.	Eclampsia is more serious complications of pregnancy, comprised of repeated seizures, followed by exhausted state or in a coma state.
Criteria for diagnosis	Onset of a new episode of hypertension during pregnancy, characterized by: • Persistent hypertension (diastolic blood pressure ≥ 90 mm Hg) and • Substantial proteinuria (> 0.3 g/24 hours).	Generalized seizures, generally in addition to pre-eclampsia criteria.
Results	High blood pressure, increased albuminuria, persistent headache, edema, oliguria, fatigue, drowsiness and vomiting along with multiple symptoms.	High blood pressure results into pre-eclampsia, seizure in late pregnancy, conditions like edema, pulmonary edema, headache, and gestational diabetes.
Occurrence	Usually, pre-eclampsia occurs after 20 weeks pregnancy.	Usually, eclampsia occurs in the last trimester of pregnancy but might appear before, after or during pregnancy.
Signs and symptoms	May be asymptomatic but if symptoms are seen then, the noticeable ones are: Swelling Rapid weight gain due to edema Hypertension Presence of proteins in the urine Tachycardia Visual changes	High blood pressure Brain hemorrhage Convulsions Severe headache Abdominal pain Blurred vision Coma
Treatment	Take low-dose aspirin daily after 12 weeks of pregnancy	Full intravenous or intramuscular magnesium sulphate regimens/loading dose of magnesium sulphate Delivery of the baby