Eclampsia is a serious and potentially life-threatening condition that occurs during pregnancy or the postpartum period.

Characterized by the sudden onset of seizures in patients with hypertensive disorders related to pregnancy, it demands urgent medical attention to prevent severe outcomes for both the mother and the unborn child.

Defining Eclampsia

Eclampsia manifests as new-onset seizures in pregnant individuals who have underlying hypertensive conditions such as preeclampsia. These seizures can be generalized tonic-clonic or focal and are not attributed to other neurological disorders like epilepsy or cerebrovascular events. The condition most commonly arises after 20 weeks of gestation and can develop before, during, or after childbirth, with the highest risk period within the first week postpartum.

Contrary to past beliefs, eclampsia may emerge suddenly and unpredictably even without clear preceding signs such as elevated blood pressure or proteinuria. This factor makes vigilance essential during prenatal and postnatal care.

Pathophysiology and Risk Factors

The exact biological mechanisms behind eclampsia remain incompletely understood. However, it is closely associated with a cluster of pregnancy-related hypertensive disorders characterized by endothelial dysfunction, systemic inflammation, and impaired placental blood flow. These factors can disrupt the central nervous system, leading to increased cerebral excitability and seizure susceptibility.

Certain conditions increase the likelihood of eclampsia, including a history of hypertensive disorders in pregnancy, multiple gestations, first pregnancy, advanced maternal age, and preexisting hypertension or diabetes. Additionally, inadequate prenatal care and low socioeconomic status can contribute indirectly by delaying diagnosis and treatment.

Clinical Presentation and Diagnosis

Symptoms preceding eclampsia often reflect neurological distress and may include severe headaches, visual disturbances such as blurred vision or flashing lights, and altered mental status. Seizure activity itself can range from brief convulsions to prolonged episodes resulting in loss of consciousness and muscle rigidity.

Diagnostic evaluation focuses on excluding other causes of seizures and confirming pregnancy-related hypertension. Monitoring includes blood pressure measurement, laboratory assessments for function, and analysis for proteinuria, although eclampsia can sometimes occur without prominent findings in these tests.

Management Strategies

Eclampsia constitutes a medical emergency requiring immediate intervention. Stabilization involves airway protection, seizure control, and preventive measures to avoid injury during convulsions. Magnesium sulfate is the gold standard medication to prevent and treat seizures associated with eclampsia, administered intravenously with monitored dosing to prevent toxicity.

Delivery of the baby remains the definitive treatment, as the condition usually resolves after birth. Decisions regarding timing and mode of delivery depend on gestational age, maternal and fetal stability, and the severity of symptoms. Cesarean section is often favored for its expediency in critical cases. Postpartum monitoring is vital for at least 72 hours to detect and manage recurrent seizures or other complications. Continuing magnesium sulfate therapy during this period reduces seizure risk.

Long-Term Implications and Follow-up

While many patients recover fully with timely treatment, eclampsia can have lasting effects, including potential cognitive impairments especially following multiple seizures or delayed management. It also signals increased risk for future cardiovascular and hypertensive disorders, necessitating long-term medical follow-up. Preventive strategies emphasize early detection and management of preeclampsia and prompt treatment of any hypertensive pregnancy disorders.

Dr. Agnès Ditisheim, internist and co-founder of the Centre de médecine fœto-maternelle: "Women at risk include those in their first pregnancy, suffering from hypertension, diabetes, obesity, autoimmune diseases (such as lupus), twin pregnancies or using MAP. Screening in the 1st trimester and low-dose aspirin are real preventive measures."

Eclampsia is a complex, acute hypertensive complication of pregnancy characterized by the occurrence of seizures that can severely affect maternal and fetal health. This condition often arises unexpectedly and requires urgent management with anticonvulsants, blood pressure control, and ultimately delivery. Maintaining high clinical suspicion and ensuring rapid multidisciplinary care are key to reducing morbidity and mortality.