Introduction

Pregnancy-induced hypertension is new onset of hypertension after 20 weeks of pregnancy. It must fulfill following criteria :

1. Blood pressure >= 140/90
2. Previously normal BP
3. No protein in urine
4. No signs/ symptoms of preeclampsia or eclampsia

Pre-eclampsia- It is a multiorgan disease, due to unknown cause, characterized by hypertension and protein in urine after 20 weeks of pregnancy.

Eclampsia- It is development of seizures in a pre-existing pre-eclampsia patient or it may occur unexpectedly in a person who is previously normal or have mild elevated BP or no protein in urine.

Prevalence of  Eclampsia

In developed countries incidence is 1.6 to 10 per 10,000 deliveries. In developing countries this rate ranges from 50 to 151 per 10,000 deliveries. This major difference among the countries is  due to gaps in access to care, lack of awareness among people, inappropriate surveillance and  management protocols. Hypertension disorder in pregnancy  features among the top six causes of maternal mortality in US. And 14% of all maternal deaths worldwide. However, the rate of eclampsia and maternal deaths due to hypertensive disorder is decreasing. But it still remains the major health concern. According to WHO, prevalence of preeclampsia is 4.6% and that of eclampsia is 0.3%. The incidence rate in low income countries is 0.5%. According to a study in 2016, in India,  incidence of eclampsia varies from 0.179 to 3.7%. And maternal mortality varies from 2.2 to 23% of all eclamptic women.

What causes eclampsia?

Abnormal development and function of placenta lead to impaired blood flow and neurological issues.

What are the risk factors?

1. Age more than 35
2. Interval between two pregnancy more than 10 yrs
3. Twin or multiple pregnancy
4. Family history of eclampsia or preeclampsia
5. Previous history of preeclampsia or eclampsia.
6. Any abnormality in placenta
7. Obesity
8. Hypertension
9. Pregestational diabetes
10. Any preexisting kidney disease, autoimmune disease
11. Low socio-economic status
12. Insufficient prenatal care

Signs and Symptoms

Eclampsia is a condition where you have seizures or coma with or without pre-eclampsia. The symptoms you can observe are:

1. Severe headache
2. Abdominal pain
3. Nausea, vomiting
4. Blurring of vision
5. Swelling of face, feet,  hands
6. Alter mental status
7. Bleeding
8. Organ dysfunction

Outcome of eclampsia

Recurrence rate of preeclampsia is 25% and  for eclampsia is 2%. These patients have increased risk of heart attack, heart failure, kidney disease, stroke.

It is associated with increased risk of long term heart disease, cognitive difficulties related to memory.

Supportive care during Seizures.

1.  Stay calm
2. Keep the person safe-  move away the sharp objects, Gently help them to ground if standing, Turn them on their side so that all the saliva drool out of the mouth and person can breathe easily.
3. Cushion their head with soft pillow or cloth.
4. Loosen the tight clothing especially around the neck so that the person can breathe
5. Note the duration of seizure
6. Do not restrain the person
7. Reassure the person once he regains consciousness
8. Do not give anything by mouth until the person is alert.
9. Any sign of seizure, raised BP , deranged blood investigations then consult your gynaecologist immediately.
10. Once the pregnant female is diagnosed with eclampsia termination of pregnancy is the only treatment. Route of delivery depends on the gestational age, fetal condition, cervical status.

Prevention of eclampsia

Eclampsia is a serious complication of pregnancy which can be life threatening to both mother and the child. It can only be managed and prevented by early diagnosis and managing preeclampsia. Following measures can be taken to prevent eclampsia and preeclampsia:

1. Early and regular antenatal checkups especially when your older and have previous history of eclampsia or  preeclampsia.
2. Lifestyle modifications like healthy diet, avoid excess salts, yoga, walk. avoid alcohol, smoking, drug abuse.
3. One should take her medicines regularly
4. Consult your gynaecologist and plan your delivery timely.
5. Pregnant females and their families should be educated and made aware of the warning signs and symptoms of eclampsia. And should consult their doctor as soon as possible.