The eclampsia [ ɛklampsiː , including: eklampsiː ] ( ancient Greek ἐκλάμπειν eklámpein , German , shine forth ' , shine forth', here in the sense of suddenly occur ') is only part of a pregnancy occurring (particularly in the last third) symptom complex . It is a sudden, serious illness that involves seizures . Other symptoms of this gestosis (formerly called "pregnancy poisoning") are high blood pressure , swelling (edema) , kidney damage and loss of protein . Eclampsia can also occur shortly after childbirth or during the puerperium . The preliminary stage is known as preeclampsia .
About one in 2000 to 3500 pregnant women is affected. 80% of all eclampsia cases affect first-time women. It is six times more common in multiple pregnancies than in single pregnancies. Also diabetes during pregnancy and especially obesity are risk factors for pre-eclampsia and / or eclampsia.
Diagnosis among hospital patients in Germany: years, discharged patients
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Eclampsia usually does not occur without a history. Most patients have previously had preeclampsia , which is characterized by water retention ( edema ), protein excretion in the urine ( proteinuria ) and high blood pressure ( arterial hypertension ).
Against this background, tonic-clonic spasms occur in eclampsia with or without loss of consciousness (postpartum 44%, antepartum 38%, intrapartum 18%). Harbingers of such an attack can be a rapid increase in blood pressure with strong (usually frontal) headache , flickering before the eyes, foggy double or blurred vision, neurological symptoms: confusion, possibly blindness, coma, focal motor deficits, liver and kidney failure, and nausea and vomiting to be .
- Vasoactive, α-adrenergic substances lead to vascular spasms
- Fibrin thrombi
- Liver cell necrosis
- maternal lethality : 3–5%; Child mortality: 30–50%
Monitoring the fetus
- Determination of estriol , HPL , SP 1
- Ultrasound fetometry (growth retardation!)
- Cardiotocography : non-stress or stress CTG
Eclampsia requires intensive medical monitoring of the patient. Complications such as acute kidney failure , brain edema , thrombosis , retinal damage , bleeding and placental insufficiency can endanger the child.
Seizures are treated with anticonvulsants , such as: B. diazepam , clonazepam or lorazepam . Intravenously administered magnesium lowers blood pressure and anticonvulsant (anti-spasmodic). Magnesium is superior to both diazepam and phenytoin in effectiveness . A feared side effect of intravenous administration of magnesium is respiratory failure . It usually announces itself by failure of the muscle reflexes ( areflexia ); For early detection of this complication, it is therefore advisable to check the patellar tendon reflex , which should always be easy to trigger. Therefore magnesium should be injected intravenously very slowly.
If necessary, the pregnancy must be terminated prematurely by initiating childbirth or a caesarean section so that the mother's metabolic situation improves.
- Monitoring of the patient (heart rate, breathing rate), stable lateral position, keeping the airways free, administering O 2, setting up venous access. Shielding against external stimuli, balancing the fluid intake. CTG controls of the child (see above)
- Seizure treatment, prophylaxis: anticonvulsant medication , diazepam 10 mg iv over 2 min.
- Anticonvulsive therapy: magnesium sulfate ( beware of overdose : continuous monitoring of the patient's heart and respiratory rate, checking of the patellar tendon reflex , in the event of symptoms of overdose: 1 g calcium gluconate )
- antihypertensive therapy: see preeclampsia . (constant RR checks! fundus!)
- Fluid balance (balance, adequate fluid replacement: 80 ml / kg / h or: amount of urine excretion in the last hour plus 30 ml)
- Treatment of acute kidney failure: diuretics and human albumin after CVD control
- Low-dose heparinization
Pregnant women should undergo regular preventive examinations, which can be carried out by a gynecologist and, in some cases, by a midwife. In the event of abnormalities, a medical consultation is essential. In this way, the preliminary stages of eclampsia can usually be identified early and, if necessary, treated with medication. Thanks to a simple blood analysis, the relationship between sFlt-1 / PlGF ( soluble fms-like tyrosine kinase-1 / placental growth factor ) can be determined, which means that the precursors of eclampsia can be identified at an early stage.
- post partum: intensive monitoring for 24 h, RR setting, magnesium sulfate for 24 h, fluid balance
- Postpartum work-up for peripartal seizures: anamnesis , EEG , CT / M, clinical picture (RR, proteinuria , edema ), laboratory parameters
- After the pregnancy, a detailed check for any previous damage and late neurological damage
- Abstract of: An automated method for the determination of the sFlt-1 / PlGF ratio in the assessment of preeclampsia . In: Am J Obstet Gynecol . tape 202 , no. 2 , February 2010, p. 161.e1–161.e11 (English, litbot.doccheck.com ).
- Lois Jovanovic, Genell J. Subak-Sharpe: Hormones. The medical manual for women. (Original edition: Hormones. The Woman's Answerbook. Atheneum, New York 1987) From the American by Margaret Auer, Kabel, Hamburg 1989, ISBN 3-8225-0100-X , p. 372.
- Frauenaerzte-im-netz.de ( Memento of the original from December 20, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- Eclampsia Trial Collaborative Group .: Which anticonvulsant for women with eclampsia? In: Lancet . tape 345 , 1995, pp. 1455-1463 .
- L. Lucas, K. Leveno, G. Cunningham: A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. In: N Engl J Med . tape 333 , 1995, pp. 201-205 .