Andrea K. Walker, The Baltimore Sun
1:58 PM CST, February 20, 2013
A popular "Downton Abbey" character died in childbirth from eclampsia in a storyline that shocked audiences. But what exactly is eclampsia, and does it kill modern-day moms?
Barbara Deller, a nurse-midwife and senior maternal and newborn health adviser at Jhpiego, an international health non-profit organization and affiliate of the Johns Hopkins University, fills us in on the illness.
What is eclampsia and what kind of dangers does it pose to pregnant women?
Eclampsia is a serious, potentially fatal complication of pregnancy in which the woman, usually after the 20th week of pregnancy, develops high blood pressure, protein in her urine (proteinuria) and seizures. While the availability of good prenatal care in the United States has drastically reduced maternal deaths from eclampsia in this country, 15 percent to 30 percent of maternal deaths globally are attributed to conditions in which blood pressure is elevated.
Eclampsia may be preceded by a condition known as "pre-eclampsia," in which the woman also develops hypertension and proteinuria, but without seizures. The woman with eclampsia or pre-eclampsia may also have headaches, blurred vision, dizziness, severe abdominal pain and/or swelling in her face and hands. However, she may also develop the condition without any symptoms or visible signs.
What causes eclampsia?
Although eclampsia was recognized almost 2,000 years ago, the causes of pre-eclampsia and eclampsia are still not well understood. Some believe it may involve a combination of factors including the blood vessels, the central nervous system, diet and genetics. Poor nutrition has sometimes been associated with development of pre-eclampsia. A study published this month in the British Medical Journal Open even suggests that it may be tied to exposure to ozone, but no one knows for sure the exact cause.
Who is more likely to get the condition?
Although any pregnant woman may develop eclampsia, some factors that may increase a woman's chance of getting eclampsia include being younger than 20 or older than 40, a history of high blood pressure, obesity, diabetes or kidney disease prior to pregnancy, first pregnancy and multiple pregnancies.
Is there any way of preventing eclampsia?
Because it is impossible to predict which women will develop the condition, every pregnant woman needs to see a health care provider regularly during pregnancy to check her blood pressure and urine. Detecting pre-eclampsia early may help prevent eclampsia. While there is little evidence from well-designed studies that nutrition plays a definite role in the prevention of eclampsia, there is some evidence that for women with calcium deficiency, calcium supplements may be beneficial. Actually, a good balanced diet with adequate vitamins and minerals is important in any pregnancy, and so ensuring adequate nutrients during pregnancy is a healthy practice whether or not you are at risk for pre-eclampsia.
What other pregnancy complications may eclampsia cause?
Eclampsia can permanently damage the woman's vital organs, including brain, kidneys and liver, and can deprive the placenta, and thus the baby, of sufficient oxygen. Without treatment, pre-eclampsia can cause the destruction of red blood cells, elevated liver enzymes and low platelet count (HELLP syndrome) and become life-threatening. In addition, left untreated, eclampsia can cause stroke, coma and death for both the mother and baby.
How is eclampsia treated?
The only cure for pre-eclampsia or eclampsia is delivery, although some women have been known to have a seizure during the first hours and days after the birth. The woman is at increased risk of stroke, problems with the placenta, and possibly severe bleeding until her blood pressure is controlled. Of course, if it is too early in the pregnancy, delivery may not be the best thing for the baby. In these cases, the woman should rest in a hospital where her condition and the condition of the baby can be closely monitored, and treatment provided as indicated by their conditions. Drugs can be used to reduce the woman's blood pressure, and a drug, magnesium sulfate, can be given to prevent or treat seizures.