Understanding Eclampsia

An eclampsia diagnosis can be frightening, especially when it follows unexpected symptoms during pregnancy, labor, or the weeks after delivery. This page can help you understand what eclampsia is, how it is treated, and when questions about the care you and your baby received may warrant a closer review.

What is eclampsia?

Eclampsia is a pregnancy-related medical emergency involving one or more new-onset seizures, usually generalized tonic-clonic seizures, in a patient with preeclampsia or signs of a hypertensive disorder of pregnancy when another cause of seizure is not identified. It most often occurs after 20 weeks of pregnancy, during labor, or after delivery, and it can arise even when preeclampsia was not previously diagnosed.

Preeclampsia involves new or worsening high blood pressure after 20 weeks of pregnancy, often with signs that organs such as the brain, liver, kidneys, blood, or lungs are being affected. Eclampsia describes the point at which seizures occur. Because seizures can threaten breathing, circulation, and maternal and fetal well-being, immediate emergency care is essential.

Signs and symptoms

Some patients have warning signs of severe preeclampsia before a seizure, while others have few or no clear symptoms. Any seizure during pregnancy or the postpartum period should be treated as an emergency.

• A new-onset seizure or convulsions
• Loss of consciousness, confusion, or reduced alertness
• A severe or persistent headache that does not improve
• Blurred vision, seeing spots, light sensitivity, or temporary vision loss
• Pain in the upper right abdomen, upper abdomen, or shoulder
• Nausea or vomiting later in pregnancy
• Shortness of breath or difficulty breathing
• Sudden swelling of the face or hands
• Severely elevated blood pressure or abnormal laboratory findings identified by the medical team

Warning signs can also begin after delivery, including after a patient has returned home. New neurologic symptoms, breathing problems, or a seizure in the weeks after childbirth require urgent medical evaluation.

What causes eclampsia?

The exact biological cause of eclampsia is not fully understood. It is generally considered a severe neurologic complication of preeclampsia, a condition associated with abnormal placental development and widespread blood-vessel dysfunction.

Processes believed to contribute may include:

• Abnormal blood flow and signaling involving the placenta
• Inflammation and dysfunction in the lining of blood vessels throughout the body
• Changes in blood flow to the brain and disruption of the blood-brain barrier
• Brain swelling or other neurologic changes associated with severe preeclampsia
• Progression of preeclampsia, even when the condition was not previously diagnosed or did not present with every classic finding

A prior history of preeclampsia, chronic high blood pressure, kidney disease, diabetes, autoimmune disease, a multiple pregnancy, a first pregnancy, obesity, older maternal age, and a family history of preeclampsia are among the factors associated with higher risk. Risk factors do not mean eclampsia was inevitable, and some patients develop it without an obvious warning pattern.

When eclampsia may be medical malpractice

Not every case of eclampsia is caused by medical malpractice. The condition can develop rapidly and may occur despite appropriate care. However, the following circumstances may point to negligence when a provider’s failure to meet accepted standards contributes to preventable harm:

• Failing to recognize or respond to repeated high or severely elevated blood pressure readings
• Dismissing severe headaches, vision changes, upper abdominal pain, breathing difficulty, or other warning symptoms
• Failing to order or properly interpret appropriate blood, urine, or fetal assessments when preeclampsia is suspected
• Inadequately monitoring the mother or baby after concerning symptoms or abnormal test results
• Failing to administer magnesium sulfate when clinically indicated, or failing to monitor the patient’s response and safety during treatment
• Delaying medication for persistent severe hypertension
• Delaying stabilization or delivery when maternal or fetal conditions indicate that urgent delivery is needed
• Responding inadequately to a seizure, including failures involving airway protection, oxygenation, aspiration precautions, or emergency escalation
• Providing inadequate postpartum monitoring, discharge instructions, or follow-up for a patient at risk of postpartum preeclampsia or eclampsia
• Failing to urgently evaluate postpartum symptoms that may signal severe hypertension or neurologic complications

Wais, Vogelstein, Forman, Koch & Norman, LLC works with qualified medical experts to review prenatal, labor and delivery, and postpartum records and determine whether the care met accepted standards.

Treatment and long-term outlook

Treatment begins with emergency stabilization. The medical team must protect the patient’s airway, breathing, and circulation, prevent physical injury during the seizure, and assess both the patient and baby. Persistent severe hypertension may require prompt treatment with fast-acting blood pressure medication.

If the patient is still pregnant, delivery is generally recommended after stabilization because the placenta is central to the disease process. The timing and method of delivery depend on the patient’s condition, fetal status, gestational age, and labor progress. Care may also include blood and urine testing, continuous fetal monitoring, oxygen or respiratory support, brain imaging when the presentation is atypical, and close observation after delivery.

Many patients recover with prompt treatment, but eclampsia can cause serious complications such as stroke, aspiration, fluid in the lungs, kidney or liver injury, placental abruption, preterm birth, and periods of reduced oxygen for the baby. Long-term needs vary. Families may need follow-up with obstetric, neurologic, cardiac, neonatal, or developmental specialists, especially if the mother or baby experienced a significant complication.