Background:

Preceded by pre-eclampsia
Occurs when trophoblastic cells do not invade the myometrium
(1)
Causes seizures and coma during pregnancy
Can result in the infant and mothers death if untreated
Known as hypertensive disorder of pregnancy
80% of cases occur during 3rd trimester or 48 hours after
delivery
About 50,000 deaths worldwide per year (2)

Eclampsia
Biology 119
Winter Quarter 2014
Sarah Dietderich, Kenzie Nix, Radhiyya Roun, Varun Sharma

Risk Factors:
Most frequent in first pregnancies with a partner
Maternal diabetes, hypertension, hyperlipidemia,
increased BMI, maternal age (over 40), thrombophilia,
smoking, obesity (3)

Figure 7: Clinical trial showed if magnesium sulfate benefited women

with pre-eclampsia and its side effects. Study concluded it reduced the
risk and showed no harm to the baby by more than fifty percent (11)

Preventions:
h#p://bioserv.u.edu/~walterm/human_online/blood1/blood_lecture.htm

Early detection and close monitoring reduces

risk factors.

Figure 3: Complication of eclampsia, premature hemolysis

Symptoms:

Pathophysiology:

Pre-eclampsia: high blood pressure (at least 140/90

systolic to diastolic), proteinuria, rapid weight gain
Eclampsia: muscle aches/pains, unconsciousness, severe
agitation, seizures caused by neurotransmitter
abnormalities(4)

Swelling in the brain caused by vasogenic

edema
Increased permeability allows influx of
plasma into the extracellular space
Compression on the brain causes
headaches, convulsions and other
symptoms (6)
Impaired cerebral auto regulation
Abnormal invasion of trophoblastic tissue in
the uterine wall in the first few months of
gestation
Trophoblastic cells do not divide into
decidual and myometrial layers- increased
resistance and decreasing blood flow (7)
Increased peripheral resistance due to
generalized vasoconstriction
Placental hypoperfusion and impaired
uteroplacental vasculature
Hypothesized that overexpression of
arginase inhibits argin in the placenta,
reducing the activity of the vasodilator nitric
oxide (8)

Complications:
Separation of the placenta
Premature delivery
Blood clotting- activation of fibrinolytic system, early
platelet activation
Damage to liver and blood cells causes HELLP (hemolysis,
elevated liver enzymes, low platelets) syndrome
HELLP syndrome: associated with increased maternal
mortality, Higher risk of complication in mothers who
develop antepartum eclampsia, and more so if eclampsia
develops remote from term(5)

Intravenous medication given to mother if the

blood pressure becomes too high

h#p://hyper.ahajournals.org/content/50/1/14.full

Figure 5: The effect on cerebral fliud by pregnancy and eclampsia

Bariatric surgery to reduce hypertension in

obese patients

Epidemiology
10% to 15% of direct maternal deaths overall are
associated with preeclampsia and eclampsia
Mortality by eclampsia is much more abundant
in middle and low income countries (9)
Research indicates some genetic factors
influence Pre-eclampsia and eclampsia
development, but not clear
Women with first-degree relative who had preeclampsia, men who were born form a preeclamptic pregnancy more likely to develop (7)

Medication given to prevent seizures in

mothers.
Magnesium Sulfate causes vasodilation,
increasing uteroplacental blood flow and
decreasing blood pressure
Aspirin reduces platelet production of
thromboxane relative to prostacyclin
Dietary calcium to reduce hypertension
Monitoring for the growth of pre-eclampsia is
the only way to predict severity of outcome. (3)
(5)

h#p://bioserv.u.edu/~walterm/human_online/blood1/blood_lecture.htm

Figure 6: Size of Territory drawn according to proportion of

maternal deaths (2006)

Figure 1: Premature Blood Clotting due to Platelet and Fibrin Network

Treatment
Primary cure is delivery of the baby, symptoms
subside in a few weeks (10)
Bed rest reduces blood pressure

Figure 8: Vascular Mechanism of Magnesium Sulfate

References:
nd

1)Behera, K Susanta. 2012. Slideshare .MCJG Medical College, Berhampur, Odisha. Accessed Feb. 22 , 2014.< hGp://www.slideshare.net/susanta12/eclampsia-15019916>
(2)Ross, G M.; Ramus, M R. 2013. Eclampsia. University of California, Los Angeles. Accessed Feb. 22nd 2014. <hGp://emedicine.medscape.com/arXcle/253960-overview#showall>
(3) Turner, Judi A. 2010. Diagnosis and management of pre-eclampsia: an update. Int J Womens Health. 2: 327-337
(4) Storck, Susan. 2013. Eclampsia. Accessed Feb. 2nd, 2014. hGp://www.nlm.nih.gov/medlineplus/ency/arXcle/000899.htm
(5) Eunice Kennedy Shriver NaXonal InsXtute of Child Health and Human Development. 2012. Preeclampsia and eclampsia: condiXon informaXon. Accessed Feb. 2, 2014.
hGp://www.nichd.nih.gov/health/topics/preeclampsia/condiXoninfo/Pages/default.aspx
(6) Cipolla, Marilyn J. 2007. Cerebrovascular funcXon in pregnancy and eclampsia. Hypertension. 50: 14-24.
(7) Judi A. 2010. Diagnosis and management of pre-eclampsia: an update. Int J Womens Health. 2: 327-337.
(8) Noris, Marina, Noberto Perico, Gluseppe Remuzzi. 2005. Mechanisms of disease: pre-eclampsia. Nature Clinical PracXce Nephrology. 1: 98-114
(9) Duley, Lelia. 2009. The global impact of pre-eclampsia and eclampsia. Seminars in Perinatology. 33 (3): 130-137.
(10)Chhabra S, Tyagi S, Bhavani M, and Gosawi M. 2012. Late postpartum eclampsia. Journal of Obstetrics and Gynaecology : the Journal of the InsXtute of Obstetrics and Gynaecology. 32 (3):
(

h#p://www.sanescohealth.com/pa<ent-area/

Figure 2: Seizures caused by abnormalities in neurotransmitters of the brain:

http://www.karger.com/Article/FullText/101801

Figure 4: Reaction Mechanism of Eclampsia

264-6.

(11) The Magpie Trial CollaboraXve Group 2002. Do women with pre-eclampsia, and their babies, benet from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled
trial. The Lancet. 359-9321: 1877-1890