Complication of gestosis
Eclampsia is the most terrible acute complication of gestosis (or preeclampsia): we are talking about a complex syndrome exclusive to pregnancy, characterized by the appearance of convulsions, mental confusion, headache, altered vision and coma.
Eclampsia is a potentially fatal disease, which unfortunately still claims many victims: pregnant women suffering from hypertension, edema and proteinuria (trilogy of symptoms that mark preeclampsia) must be constantly monitored, because they are more exposed to the risk of eclampsia.
Complications
A state of preeclampsia can rapidly precipitate into eclampsia: the collapse of the clinical picture is always symptomatic - therefore the woman is aware of the problem - and is characterized by marked convulsive crises.
In addition to seizures, headaches, mental confusion and coma, pregnant women with eclampsia can experience serious complications:
- Liver changes
- Temporary / permanent blindness: the visual disturbances typical of eclampsia can degenerate into total blindness (sometimes reversible)
- Disseminated intravascular coagulation
- Neurological complications: coma + motor deficits
- Coagulation defects: ↓ fibrinogen, ↑ prothrombin time, presence of circulating fibrin degradation products
- Intracranial hemorrhage (or hematoma)
- Cerebral infarction
- Kidney failure
- Maternal and / or fetal death
- Rupture of the liver capsule: rare complication that leads both mother and fetus to death
- Respiratory distress syndrome
- Haemolytic-uremic syndrome: microangiopathy + thrombocytopenia + renal failure + haemolytic anemia
- Cerebral vein thrombosis
Diagnosis
The appearance of convulsions in a pregnant woman is not necessarily synonymous with eclampsia. The differential diagnosis is therefore of primary importance, and must be placed with all the diseases that can induce seizures: cerebral aneurysm, convulsions due to a drug reaction, brain tumor.
The most useful diagnostic tests to ascertain a suspicion of eclampsia are:
- Kidney function test
- Liver function test
- Blood clotting capacity analysis: evaluation of prothrombin time and plasma fibrinogen concentration
- Plasma concentration
- Urinalysis: as we know, proteinuria is one of the recurrent symptoms in gestosis and eclampsia. From what has been said, it is understandable how urinalysis in 24 hours is essential to diagnose any "proteinuria (protein:> 300mg / 24 h or> 1g / L urine).
- Complete blood count: complete laboratory examination, useful for evaluating the quantity of blood components and for determining the level of hemoglobin and hematocrit.
- Trans-abdominal ultrasound: used to estimate gestational age. This diagnostic test is also used to ascertain or deny a possible abruption of the placenta, a symptom that clearly complicates the clinical picture of eclampsia.
When seizures occur during the first trimester of gestation, it is thought that the cause lies in changes in the CNS. To ascertain or deny the hypothesis, the woman can be subjected to several diagnostic tests: CT of the head (computed tomography), lumbar puncture or rachycentesis (to ascertain or deny a "hypothetical meningitis or bleeding in progress), determination of electrolyte levels in the urine.
No laboratory tests are useful for predicting maternal or fetal outcome in women with eclampsia.
Prognosis
A state of preeclampsia (gestosis) increases the risk of complications such as fetal growth retardation, low birth weight, preterm delivery, respiratory distress syndrome and, of course, eclampsia.
The maternal mortality rate from eclampsia is estimated to be 1.8%; 35% of women with eclampsia experience at least one of the serious complications.
In the next article we will try to understand what therapeutic strategies can be undertaken to prevent and treat eclampsia.
Other articles on "Eclampsia: Complications, Diagnosis, Prognosis"
- Eclampsia
- Eclampsia: Treatment and Prevention
