Obstetrics and Gynecology - A.M. Hromova 2000

Early pregnancy toxicoses. Late gestosis
Late gestosis
Eclampsia

Eclampsia is a clinically manifest syndrome of multiple organ failure (resulting from Late gestosis), accompanied by one or more convulsive seizures that are not etiologically related to such pathological conditions as Epilepsy or cerebrovascular disorders. Eclampsia may occur both during Pregnancy and during labor. Typically, seizures cease after delivery and recur only when remnants of the gestational sac remain in the uterine cavity. Therefore, postpartum periods complicated by severe forms of gestosis require Curettage of the uterine cavity.

Depending on the severity of the convulsive syndrome, the following clinical courses of eclampsia are distinguished:

— a single convulsive seizure;

— eclamptic status – a series of convulsive seizures occurring one after another at short intervals;

— eclamptic coma – loss of consciousness following a convulsive seizure;

— "eclampsia without eclampsia" – sudden loss of consciousness without a convulsive seizure.

The onset of eclampsia is marked by the first convulsive seizure, which is most often followed by a coma. Each convulsive seizure lasts 1–2 minutes and proceeds through several successive phases:

Phase I (pre-convulsive) – characterized by subtle twitching of the facial Muscles. The eyelids close, only the whites of the eyes are visible, and the corners of the Mouth droop.

Phase II (tonic seizures) – the shortest and most dangerous phase due to the risk of partial asphyxia. It is characterized by titanic contraction of the muscles throughout the body: the torso tenses, breathing stops, and the face turns cyanotic.

Phase III (clonic seizures) – manifests as violent convulsive twitching of the Muscles of the torso and extremities. Breathing is labored or absent.

Phase IV (resolution) – the patient begins to breathe noisily, and Blood-tinged foamy saliva appears from the mouth due to Tongue biting. After the resolution phase ends, the patient remains in a comatose state for some time before gradually regaining consciousness, remembering nothing of what happened. Sometimes a coma can transition into a new convulsive seizure without the patient regaining consciousness. Due to increased Central Nervous system irritability, any stimuli (pain, noise, bright light, medical manipulations, etc.) can trigger a new eclamptic seizure. The number of seizures can range from 1–2 to 10 or more, though nowadays their number is typically small. Eclampsia is characterized by profound disruptions of vital body Functions and is accompanied by complications that are hazardous to both the mother and the fetus and frequently lead to fatal outcomes.

Maternal complications:

1. Cardiac:

- arrhythmias;

- Heart Failure;

- pulmonary edema.

2. Cerebral:

- intracranial hemorrhages;

- cerebral vascular thrombosis;

- cerebral Hypoxia;

- Brain edema.

3. Hematological:

- disseminated intravascular coagulation (DIC) syndrome with subsequent massive hemorrhages;

- microangiopathic hemolytic anemia.

4. Hepatic:

- hepatic tissue necrosis;

- periportal or subcapsular Hemorrhage;

- rupture of Glisson's capsule.

5. Pulmonary complications:

- bronchopneumonia;

- acute airway obstruction;

- «Shock lung» (adult respiratory distress syndrome).

6. Renal complications:

- renal failure;

- acute tubular or cortical necrosis;

- subcapsular hemorrhage.

7. Retinal detachment and retinal hemorrhage.

8. Hemorrhages in the Adrenal Glands, Pancreas, Spleen, and other Organs.

9. HELLP syndrome (Hemolysis - red blood Cell destruction; Elevated Liver Enzymes - increased concentration of liver enzymes in Blood Plasma; Low Platelet count - thrombocytopenia).

Fetal complications:

1. Premature detachment of a normally positioned Placenta.

2. Preterm birth.

3. Acute Fetal hypoxia.

4. Intrauterine fetal death.