Eclampsia is an acute and life-threatening complication of pregnancy, is characterized by the appearance of tonic-clonic seizures, usually in a patient who had developed preeclampsia. (Preeclampsia and eclampsia are collectively called ''Hypertensive disorder of pregnancy'' and ''toxemia of pregnancy''.)
Eclampsia excludes seizures and coma that happen during pregnancy but are due to preexisting or organic brain disorders.
Eclampsia, like preeclampsia, tends to occur more commonly in first pregnancies and young mothers where it is thought that novel exposure to paternal antigens is involved. Further, women with preexisting vascular diseases (hypertension, diabetes, and nephropathy) or thrombophilic diseases such as the antiphospholipid syndrome are at higher risk to develop preeclampsia and eclampsia.
Conditions with a large placenta (multiple gestation, hydatiform mole) also predispose for toxemia. Further, there is a genetic component; patients whose mother or sister had the condition are at higher risk. Patients with eclampsia are at increased risk for preeclampsia/eclampsia in a later pregnancy.
While multiple theories have been proposed to explain preeclampsia and eclampsia, it occurs only in the presence of a placenta and is resolved by its removal. Preclinical markers of the disease process are signs of increased platelet and endothelial activation
Adrenomedullin, a potent vasodilator, is produced in diminished quantities by the placenta in preeclampsia (and thus eclampsia). Other vasoactive agents are at play including prostacyclin, thromboxane A2, nitric oxide, and endothelins leading to vasoconstriction.
Eclampsia is seen as a form of hypertensive encephalopathy in the context of those pathological events that lead to preeclampsia. It is thought that cerebral vascular resistance is reduced, leading to increased blood flow to the brain. In addition to abnormal function of the endothelium, this leads to cerebral edema. Typically an eclamptic seizure will not lead to lasting brain damage; however, intracranial hemorrhage may occur.
Detection and management of preeclampsia is critical to reduce the risk of eclampsia. Appropriate management of patients with preeclampsia generally involves the use of magnesium sulfate as an agent to prevent convulsions, and thus preventing eclampsia.
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