Pre-eclampsia and Eclampsia

Pre-eclampsia is a pregnancy complication marked by new-onset high blood pressure and protein in the urine after 20 weeks of gestation. Eclampsia is the occurrence of seizures in a woman with pre-eclampsia, and both are medical emergencies for mother and baby.

• High blood pressure detected after 20 weeks of pregnancy
• Protein in the urine (proteinuria)
• Swelling of the face, hands, or legs
• Severe headache, visual disturbances, or upper abdominal pain in severe pre-eclampsia
• Seizures — defining eclampsia — in a woman with pre-eclampsia

• The exact cause is not fully understood but involves abnormal development of the placenta and blood vessels.
• Risk is increased by a first pregnancy, multiple pregnancy (twins or more), pre-existing hypertension or diabetes, obesity, and a personal or family history of pre-eclampsia.

• Diagnosed when blood pressure is 140/90 mmHg or higher after 20 weeks of pregnancy together with proteinuria on urine testing.
• Severe features include very high blood pressure, severe headache, visual disturbance, upper abdominal pain, or abnormal blood test results.
• Eclampsia is diagnosed when seizures occur in this setting, after ruling out other causes where possible without delaying treatment.

Pre-eclampsia and eclampsia are managed at hospital level as obstetric emergencies. Magnesium sulphate is the medicine of choice to prevent and treat seizures, given by a loading dose followed by a maintenance regimen with close monitoring for signs of toxicity.

Severe hypertension is controlled with an antihypertensive such as intravenous hydralazine or oral nifedipine to reduce the risk of stroke.

Delivery of the baby is the definitive treatment for pre-eclampsia and is planned according to gestational age and disease severity, in consultation with obstetric and, where needed, newborn care teams.

Any pregnant woman with high blood pressure, severe headache, visual changes, or convulsions should be referred urgently for emergency obstetric care.

• Attend all scheduled antenatal care visits, where blood pressure and urine are checked routinely.
• Seek urgent care for severe headache, visual changes, or upper abdominal pain in pregnancy.
• Women with known risk factors should be monitored more closely during antenatal care.
• Low-dose aspirin may be recommended from early pregnancy for women at high risk, as advised by an antenatal care provider.