What Is Eclampsia?

Eclampsia is a severe complication of pregnancy that presents with seizures. It is a progression of preeclampsia, a pregnancy condition characterized by high blood pressure and abnormal amounts of protein in the urine. However, some pregnant people do not show any signs of preeclampsia before having a seizure.

Eclampsia may occur during pregnancy (most commonly in the third trimester), labor, or in the days after giving birth. The treatment for preeclampsia and eclampsia is the delivery of the fetus, but a medication called magnesium sulfate reduces the risk of seizures in women with preeclampsia with severe features or eclampsia.

Signs and Symptoms of Eclampsia

Symptoms of eclampsia can be severe and life-threatening. It is important to recognize the early warning signs of preeclampsia in order to limit the risk of complications escalating to eclampsia.

Sometimes preeclampsia can be very mild, with no notable symptoms, so regular prenatal care that includes screening for clinical signs of preeclampsia is essential.

Elevated blood pressure and protein in the urine are the most obvious clinical signs of preeclampsia.

Swelling of the face and hands is also a common symptom. However, some swelling during pregnancy is normal, and this alone does not necessarily indicate preeclampsia and is not used in making the diagnosis.

Additional symptoms may include:

• Headaches
• Unusual weight gain
• Nausea, vomiting, and abdominal pain
• Trouble with vision, especially blurry vision

If preeclampsia progresses to eclampsia, a person will experience more severe symptoms, such as: 

• Seizures
• Confusion and agitation 
• Loss of consciousness

Causes

It is not definitively known what causes eclampsia and preeclampsia, but the cause may be related to the placenta’s shallow attachment to the uterus.

Genes or a pregnant person’s pre-existing medical conditions, like diabetes or high blood pressure, may play a role in causing the placenta to not anchor deeply enough in the uterus in the first trimester. 

Placental abnormalities may affect how a pregnant person’s blood vessels and organs operate during pregnancy. Arteries, in particular, may function ineffectively, leading to swelling, high blood pressure, and inefficient blood supply to the placenta and other organs.

Diagnosis

Since eclampsia is usually a sudden escalation of preeclampsia, screening and diagnosis focus on identifying preeclampsia. Diagnosis of preeclampsia is made by checking a person’s blood pressure and evaluating levels of protein in a urine sample.

A pregnant person will be diagnosed with preeclampsia if after 20 weeks' gestation higher than normal blood pressure levels and proteinuria (high levels of protein in the urine) have persisted. It is important to note that both criteria must be present in order for the diagnosis to be made.

Diagnostic criteria for preeclampsia include blood pressure that is equal to or higher than 140 mmHg systolic (the top number) or 90 mmHg diastolic (the bottom number) or both on more than one occasion at least four hours apart, and proteinuria of greater than 0.3 grams, or 5 grams in severe cases. Eclampsia is diagnosed when a person with preeclampsia has seizures.

Treatment

There is no certain way to prevent preeclampsia and eclampsia, but those at higher risk for developing these complications may be advised to take low-dose aspirin starting in the second trimester.

Eclampsia is a medical emergency and always requires immediate treatment. Because eclampsia can be fatal to you and the fetus, it is necessary to deliver the fetus no matter the gestational age.

The only curative treatment for preeclampsia is delivery of the fetus. However, if the pregnancy has not yet reached 37 weeks and the preeclampsia is not severe, some other options might be considered.

Close Monitoring

Keeping a close eye on your symptoms and on the fetus is important when you have preeclampsia. Your healthcare provider will frequently assess your blood pressure and measure your blood and urine to monitor how your organs are functioning.

Magnesium Sulfate

Magnesium sulfate is a mineral that can be given intravenously to prevent seizures. People who receive this treatment must stay in the hospital.

Often, magnesium sulfate is also given throughout labor and during the postpartum recovery period. It is the drug of choice to prevent and treat seizures in people with severe preeclampsia and eclampsia.

Too much magnesium can be toxic, however, so your healthcare provider will closely monitor you while receiving the treatment. Signs that you may have magnesium sulfate toxicity include a significant drop in blood pressure, a slowed heart rate, breathing difficulties, nausea or vomiting, confusion, and loss of consciousness. 

Hospital Management

Sometimes, hospitalization is required to treat preeclampsia. If your healthcare provider suggests an inpatient stay, you may need any of the above treatments and/or medication to manage your blood pressure and steroids to help speed the fetal lungs' development.

Risk Factors

While a definitive cause of eclampsia and preeclampsia is unknown, certain things may put someone at higher risk for developing these complications.

If you have had eclampsia or preeclampsia or experienced other complications in a previous pregnancy, you may be more likely to develop eclampsia or preeclampsia again. Pregnancies of multiples and certain health conditions, like high blood pressure or diabetes, are also risk factors for developing eclampsia and preeclampsia.

Those with chronic kidney disease are considered 10 times more likely to develop preeclampsia. In fact, preeclampsia affects up to 40% of pregnancies in people who have chronic kidney disease.

The following may also increase your risk:

• Obesity
• Advanced maternal age (over 35)
• Your race: Black, Native American, and Alaskan Native people have a higher risk

Black people have disproportionate rates of pregnancy complications and outcomes across the board. The same is true for eclampsia and preeclampsia.

An expert review published in 2020 explains how structural racism plays a role in pregnancy complications and outcomes. One survey found that Black pregnant people experienced preeclampsia or eclampsia complications in 69.8 of every 1,000 deliveries, while White people experience it in 43.3 per 1,000 deliveries.

Coping

Eclampsia and preeclampsia put a significant burden on your body and emotions. The stress of having a complication and the treatments involved can be overwhelming. Also, pregnancy complications can lead to higher incidences of postpartum mood disorders.

Understanding what is happening in your pregnancy and what you can expect next can help. Asking your healthcare provider questions about the next steps may help you feel more secure. 

Connecting with others who have experienced something similar can also help. Online pregnancy groups and talking to friends or family members who have gone through something similar can be great ways to find support and encouragement.

While dealing with pregnancy complications and recovery, you may need support with everyday tasks, like laundry and meals, so don’t be afraid to ask for help. School, work, neighborhood groups, and churches are all places that you might consider reaching out to for a helping hand.

A Word From Verywell

A diagnosis of eclampsia or preeclampsia can be scary. Remember, prenatal care with adequate screening means that most of the time, preeclampsia is discovered and treated before it develops into eclampsia.

Most people who experience this complication have a healthy baby and fully recover. However, having had eclampsia and preeclampsia does increase the risk of cardiovascular diseases such as high blood pressure, heart disease, and stroke, so it is important to continue to follow up with your medical visits even after you recover.

If you are concerned that you or someone you know may be exhibiting eclampsia or preeclampsia symptoms, don’t wait until your next appointment. Contact your healthcare provider right away or get emergency medical care.