- Pre-eclampsia: A hypertensive disorder occurring after 20 weeks of gestation with BP ≥140/90 mmHg and proteinuria (≥300 mg/24 hours) or organ dysfunction.
- Eclampsia: Pre-eclampsia complicated by generalized tonic-clonic seizures, unrelated to epilepsy or other causes.
Pathophysiology of Pre-eclampsia
- Abnormal placentation → Defective spiral artery remodeling → Placental ischemia.
- Endothelial dysfunction → Release of antiangiogenic factors (sFlt-1, Endoglin).
- Vasospasm, inflammation, & coagulation abnormalities → Multi-organ dysfunction.
Risk Factors for Pre-eclampsia & Eclampsia
- Maternal Factors:
- Primigravida
- Age <20 or >35 years
- Obesity, chronic hypertension, diabetes
- Family history of pre-eclampsia
- Pregnancy-Related Factors:
- Multiple pregnancy
- Molar pregnancy
- Fetal growth restriction (IUGR)
Clinical Features of Pre-eclampsia
Mild Pre-eclampsia:
- BP ≥140/90 mmHg (on two occasions, 4 hours apart).
- Proteinuria ≥300 mg/24 hrs (Dipstick ≥1+).
- Mild edema (face, hands, legs).
Severe Pre-eclampsia:
- BP ≥160/110 mmHg.
- Severe proteinuria (>5 g/24 hrs, Dipstick ≥3+).
- Oliguria (<500 mL/day).
- Neurological symptoms:
- Severe headache
- Visual disturbances (scotoma, blurred vision)
- Hyperreflexia
- Epigastric or RUQ pain (Liver involvement).
- HELLP Syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets).
Clinical Features of Eclampsia
- Pre-eclampsia + Generalized Tonic-Clonic Seizures.
- Warning signs before seizures:
- Persistent headache
- Visual disturbances
- Severe hypertension
- Hyperreflexia
Complications of Pre-eclampsia & Eclampsia
Maternal Complications:
- Eclampsia (Seizures, Stroke, Coma).
- HELLP Syndrome.
- Disseminated Intravascular Coagulation (DIC).
- Pulmonary Edema.
- Acute Renal Failure.
- Placental Abruption.
Fetal Complications:
- Intrauterine growth restriction (IUGR).
- Preterm birth.
- Intrauterine fetal demise (IUFD).
- Neonatal respiratory distress syndrome.
Diagnosis of Pre-eclampsia & Eclampsia
Investigations:
- Blood Pressure Measurement: ≥140/90 mmHg.
- Urine Protein:
- ≥1+ on dipstick (screening).
- ≥300 mg/24-hour urine collection (confirmatory).
- Complete Blood Count (CBC):
- Low platelets (<100,000) in HELLP syndrome.
- Liver Function Tests (LFTs):
- ↑ AST, ALT (Liver damage).
- Renal Function Tests (RFTs):
- ↑ Serum creatinine, ↓ Urine output.
- Coagulation Profile:
- Prolonged PT, APTT in DIC.
Imaging:
- Ultrasound:
- Assess fetal growth restriction (IUGR).
- Amniotic fluid index (AFI) for oligohydramnios.
Management of Pre-eclampsia
Mild Pre-eclampsia (BP <160/110 mmHg, No severe symptoms)
- Monitor BP & urine protein every 2 weeks.
- Frequent fetal growth monitoring by ultrasound.
- BP control (if needed):
- Labetalol (First-line).
- Methyldopa or Nifedipine.
- Avoid ACE inhibitors & ARBs.
- Delivery at 37 weeks.
Severe Pre-eclampsia (BP ≥160/110 mmHg or Severe Symptoms)
- Hospital Admission & Monitoring.
- BP Control:
- Labetalol IV (First-line).
- Hydralazine IV (Alternative).
- Nifedipine (Oral for stable cases).
- Seizure Prophylaxis:
- Magnesium Sulfate (MgSO₄) IV/IM:
- Loading dose: 4 g IV over 20 min.
- Maintenance dose: 1–2 g/hr IV infusion.
- Monitor for toxicity:
- Loss of deep tendon reflexes (DTR).
- Respiratory depression.
- Antidote: Calcium Gluconate IV.
- Delivery Decision:
- ≥34 weeks: Immediate delivery.
- <34 weeks: Corticosteroids for fetal lung maturity & close monitoring.
Management of Eclampsia (Seizures Present)
- Seizure Control:
- Magnesium sulfate IV/IM (same regimen as above).
- Airway & Oxygenation:
- Place patient in left lateral position.
- Maintain oxygen & IV access.
- BP Control:
- Labetalol IV or Hydralazine IV.
- Delivery:
- Emergency delivery (vaginal or C-section).
Prevention of Pre-eclampsia
- Low-dose Aspirin (75–150 mg daily) from 12 weeks in high-risk women.
- Calcium supplementation (1–2 g/day) in high-risk women.
- Regular BP & proteinuria screening in antenatal care.
Summary Table: Pre-eclampsia vs. Eclampsia
|
Feature |
Pre-eclampsia |
Eclampsia |
|
Definition |
Hypertension + Proteinuria/Organ Dysfunction |
Pre-eclampsia + Seizures |
|
BP Criteria |
≥140/90 mmHg |
≥140/90 mmHg |
|
Proteinuria |
Present (≥300 mg/24 hrs) |
Present |
|
Seizures |
Absent |
Present |
|
Management |
BP control, MgSO₄, Delivery at 37 weeks |
MgSO₄, BP control, Emergency delivery |
Key Points
- Pre-eclampsia = High BP + Proteinuria or Organ Dysfunction.
- Eclampsia = Pre-eclampsia + Seizures.
- Magnesium Sulfate is the drug of choice to prevent & treat seizures.
- Definitive treatment = Delivery of the baby.
