From the Guidelines
Preeclampsia and eclampsia are distinct pregnancy complications, with preeclampsia characterized by high blood pressure and proteinuria after 20 weeks of gestation, and eclampsia being a more severe progression of preeclampsia that includes seizures. The primary difference between the two conditions lies in their severity and symptoms. Preeclampsia may involve swelling, headaches, vision changes, and upper abdominal pain, while eclampsia is marked by the onset of seizures in addition to the symptoms of preeclampsia 1. Key characteristics of preeclampsia include:
- High blood pressure (typically >140/90 mmHg)
- Proteinuria (excess protein in the urine)
- Development after 20 weeks of pregnancy in previously normotensive women
- Possible involvement of swelling, headaches, vision changes, and upper abdominal pain Eclampsia, on the other hand, is characterized by the addition of seizures to the symptoms of preeclampsia, indicating a more severe progression of the condition 1. Treatment approaches differ between the two conditions:
- Preeclampsia: close monitoring, blood pressure management with medications like labetalol, nifedipine, or methyldopa, and in severe cases, magnesium sulfate for seizure prevention 1
- Eclampsia: immediate intervention with magnesium sulfate to control seizures, antihypertensive therapy, and urgent delivery regardless of gestational age 1 The underlying cause of both conditions is believed to be abnormal placental development leading to systemic inflammation and endothelial dysfunction, highlighting the importance of early detection and management of preeclampsia to prevent progression to eclampsia 1. In terms of management, the most recent guidelines recommend:
- Automated blood pressure measurement for screening
- Use of dipstick proteinuria testing followed by quantitative testing
- Key definitions and classification of preeclampsia, including a broad definition that encompasses proteinuria and maternal end-organ dysfunction
- Preeclampsia prevention with aspirin
- Treatment of severe hypertension with intravenous labetalol, oral nifedipine, or intravenous hydralazine
- Magnesium sulfate for eclampsia treatment and prevention among women with severe preeclampsia 1
From the Research
Definition and Diagnosis
- Preeclampsia is defined as the development of hypertension with systolic blood pressure (BP) of at least 140 mmHg and/or diastolic BP of at least 90 mmHg, associated with end-organ failure and proteinuria after 20 weeks of pregnancy 2.
- Eclampsia is the occurrence of seizures in a pregnant woman with preeclampsia, which cannot be attributed to other causes 3, 4.
- The diagnosis of preeclampsia is based on the presence of hypertension and proteinuria, while eclampsia is diagnosed by the occurrence of new-onset seizures in a woman with preeclampsia 5, 6.
Risk Factors and Causes
- Risk factors for preeclampsia include nulliparity, a family history of the disorder, essential hypertension or renal disease, and a twin or molar pregnancy 3.
- The direct cause of preeclampsia is unknown, but it is linked to abnormalities of placentation, including trophoblast invasion and physiological alterations of placental vessels 5.
- Eclampsia is a complication of preeclampsia, and its occurrence is often unpredictable 6.
Treatment and Management
- The only treatment for preeclampsia is delivery, while magnesium sulfate is used to prevent and treat eclampsia 5, 4.
- Magnesium sulfate is the drug of choice to prevent and treat eclampsia, and its use is validated by large, randomized, and placebo-controlled trials 4.
- Antihypertensive agents, such as hydralazine, are used to control blood pressure in severely preeclamptic or eclamptic patients 3.