Eclampsia

Eclampsia – the late form of a gestosis which is characterized by sharp rise in the arterial pressure posing threat to life to mother and a fruit. A gestosis – the disturbance of the normal course of pregnancy which is shown disturbance of functioning of systems of an organism. The eclampsia can develop to, in time and after pregnancy.

Eclampsia: reasons of development of a disease

The eclampsia is the most severe form of a gestosis, TsNS which is characterized by disturbance of activity and at untimely stopping of symptoms – a coma and the death of mother and a fruit. Now there is no consensus about the reasons of development of an eclampsia. The eclampsia is not an independent disease, and represents the irregular combined shape of a gestosis. There are about 30 theories of emergence of a state from which also distinguish the virus nature of disturbance.

Distinguish from the main reasons for development of eklampsichesky states:

• Defects of genes;
• Infections;
• Thrombophilias.

Today there is no test capable to authentically predict development of an eclampsia of pregnant women. The eclampsia generally develops after 22 weeks of pregnancy that is caused by pre-natal fetation. To this term the fruit is not capable to survival out of mother's womb because of incomplete formation of the highest structures of a brain. On the 22nd week of development in a fruit for the first time there are neurospecific proteinaceous connections which at penetration through the damaged placental barrier cause the system immune inflammation which is characterized by a vasospasm. It explains development of an eclampsia against the background of fetoplacental insufficiency (the state caused by dysfunction of a placenta).

The condition of an eclampsia is preceded by a preeclampsia which is characterized by the high arterial pressure, availability of protein in blood, nausea, a headache, disturbance of reflexes. The preeclampsia demands medical control and timely correction of symptoms. The only thing efficiently of treatment of an eclampsia is delivery.

The eclampsia is specific injury of a brain at gestoses when it is at the same time observed:

• Critical decrease in cerebral circulation;
• Brain ischemia;
• Loss of self-control of cerebral circulation;
• Cytotoxic wet brain;
• Disturbance of a cellular ionic hemostasis, functioning of structures of a brain, emission of the toxic neurotransmitters and stressorny genes provoking approach of unconsciousnesses, a convulsive syndrome, pregnant woman's coma.

These factors explain features of development of an eclampsia:

• Emergence rarity (the state is shown only at 5% of pregnant women);
• Molniyenosnost of development of symptomatology and critical states of the pregnant woman.

Algorithm of development of an eclampsia following:

• The long gestosis (which is often characterized by a heavy current);
• Preeclampsia (optional stage);
• Short-term loss of consciousness;
• Tonic, clonic spasms;
• Recovery (after delivery).

In certain cases the eclampsia can have very serious consequences as comas, functional insufficiency of kidneys, a liver, lungs or in extreme cases – brain death. During an eklampsichesky attack the hypoxia of a fruit and its death can develop.

Eclampsia of pregnant women: risk factors

There are certain risk factors of development of an eclampsia of pregnant women from which distinguish:

• Early, as well as late (after 40 years) the first pregnancy;
• Eclampsia in the family anamnesis;
• Obesity;
• Polycarpous pregnancy;
• Chronic diseases (diabetes, hypertensia, diseases of kidneys and cardiovascular system, anti-phospholipidic syndrome);
• Time interval between childbirth of 10 years and more.

Allocate also a number of the factors provoking development of an eclampsia of pregnant women:

• Improper feeding;
• The weakened uterine blood circulation;
• Disturbance of water-salt balance of an organism of the pregnant woman.

Puerperal eclampsia: probability of development

The probability of development of an eclampsia in the pregnant woman makes:

• During pregnancy – from 67 to 75%;
• In labor – to 25%;
• In a puerperal period – 1-2%.

As a rule, the puerperal eclampsia develops in the first 48 hours after the delivery, after end of this period the risk of development of a state is minimum. The puerperal eklampsichesky state is caused by hemodynamic, metabolic, hypoxemic frustration of an organism during incubation of a fruit. Symptoms of an eclampsia are after the delivery similar to a symptom complex of a prenatal and patrimonial eclampsia. Also approach of a puerperal eclampsia can be provoked by painful shock and external factors (bright light, a loud sound).

Eclampsia symptoms

The main symptoms of an eclampsia are:

• Small reductions of muscles;
• Tonic myotonia of skeletal muscles;
• Clonic myotonia of a trunk;
• Short-term loss of consciousness;
• Cyanosis (posineniye of integuments and mucous membranes);
• Eklampsichesky coma.

Other symptoms of an eclampsia are also the breath irregularity (development of asphyxia), foam from a mouth, is frequent with blood impurity.

Symptoms of the coming attack of an eclampsia are:

• The increased drowsiness, weakness;
• Nausea, the uncontrollable vomiting which is not caused by other causes;
• Increase in arterial pressure;
• Development of hypostases;
• Disturbances of visual function (indistinct sight, "front sights" before eyes);
• Proteinuria (availability of protein in urine).

The eclampsia can be shown by both one long attack, and a number of short-term attacks.

Treatment of an eclampsia: forecasts and methods

The forecast in treatment of an eclampsia is defined by a number of the following factors:

• Weight of a condition of the pregnant woman (the expressed hypostases, composition of urine, level of arterial pressure);
• Frequency of approach of attacks, their weight;
• Timeliness of assistance and stopping of attacks;
• The complications caused by attacks.

At suspicion of an eclampsia at the pregnant woman continuous monitoring of arterial pressure, a hemodynamics of mother and a fruit is conducted. The electrolyte-deficient diet is shown to patients.

The termination of attacks, increase in an otkhozhdeniye of urine is a good sign that will allow to postpone need of immediate delivery.

Temperature increase, arrhythmia, sharp lowering of arterial pressure after hypertensia are indications to immediate delivery.

The main treatment of an eclampsia consists in simplification of a symptomatic complex:

• Stopping of an attack and elimination of a vascular spasm;
• Normalization of pressure;
• Blood oxygenation;
• The dehydrational therapy promoting strengthening of an urination and reduction of puffiness.

At an eklampsichesky attack the intensive care which has character of cardiopulmonary resuscitation in combination with the therapy directed to recovery of function of a brain that allows to warn repeated attacks is applied.

The decision on delivery is made depending on weight of a gestosis and a condition of the patient during an eklampsichesky attack.