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Before going into what eclampsia is all about, it is crucial to touch on pre-eclampsia. This, according to Doctor Waziri Durojaye, a gynaechologist at the National Hospital, Abuja, is when a pregnant woman has high blood pressure; protein in her urine with or without swelling of the legs and ankles (oedema) after 20 weeks of pregnancy.

The doctor however notes that hypertension in pregnancy is defined differently from hypertension in other periods of an individual’s life.

He says, if the systolic blood pressure is 30ml of Hg (mercury) above the booking systolic blood pressure, then there is hypertension.

What this mean is that a woman books with a blood pressure of 90/60 before 20 weeks of pregnancy, but goes to 120/80 of 15ml mercury above the booking blood pressure after her twentieth week.

It is also defined as a mean arterial blood pressure above 105ml of mercury.

Basically to determine hypertension in pregnancy, the blood pressure at booking time is compared with the blood pressure after 20th week and this shows if the woman has become hypertensive in pregnancy or not. On this note the doctor advises women to book for antenatal before the pregnancy reaches 20 weeks. This would assist them a lot.

Eclampsia on the other hand is when a woman with pre-eclampsia convulses. In other words it is a precondition to eclampsia. It is also called a worsened pre-eclampsia.

Types of eclampsia

Ante partum: when the woman convulses during delivery.

Intra partum- when she convulses during labour.

Post partum- when the woman convulses after delivery.

Speaking further on this, the doctor says the eclampsy process does not stop until six weeks after delivery. He adds that post partum eclampsia is caused majorly because people usually abandon the woman once she has delivered. Meanwhile the blood pressure can still rise. The family members and friends also worsen the situation by not allowing her to rest. This is coupled with the fact that the baby also demands for her attention in the night when she ought to be sleeping.

Some women on their parts would not even attend post natal clinic where they could be reviewed after six weeks.

Doctor Durojaye cautions: "the fact that a blood pressure is normal during delivery does not mean it would be normal thereafter".

Causes

According to him,the cause is not known. "We are only working on theories that are just based on probability." Some of these theories are:

The placental factor: it is said that placenta being a foreign body could be a cause of this condition.

First pregnancy to a partner: even if a woman has had four children, if she changes husband and is carrying a baby for him, this is considered as her first pregnancy. The new husband’s gene is different and new in her body.

Genetic tendency: if the mother had it the daughter is also likely to have it.

Other factors include hormonal and immunological factors; age factor (a woman above 35 and teenager below 16); smoking; diabetic and hypertensive condition.

Who is at risk?

Just like the explanation above, the doctor says that women who are at risk are those carrying pregnancy for the first time: those who have it in their family trees, hypertensive and diabetic women as well as those above 35 or below 16.

Can one have it twice?

"One can have it more than once. Some have it throughout their pregnancies. The major thing is for them to be monitored properly and closely." he warns.

Symptoms

For eclampsia the cardinal feature is the convulsion though there are warning signs too. At this stage you call it imminent signs. And these include headache. "Many pregnant women take paracetamol rather than checking their blood pressure", the doctor observes.

Other signs are blurring of vision; vomiting and epigastric pain and right hypochondriac pain (in the liver).

For pre-eclampsia, symptoms are protein in the urine: hypertension with or without oedema. Most women with pre-eclampsia do not end up with problem if they are well monitored.

Hypertension, according to him, is the second common cause of maternal mortality in Nigeria after haemorrhage. The next is infection.

Does swelling in the feet translate to pre-eclampsia?

The doctor says this is not a major sign once the blood pressure is normal and protein is absent in the urine.

How can this affect the baby?

_The doctor says eclampsia makes the blood supply to the placental to be reduced. When this happens the baby receives less blood and would not grow well (intra-uterine growth retardation)

_high blood pressure can also lead to obstruction of the placenta and this can lead to distress of the baby and eventually this baby can be lost. If however the patient is seen ealier the baby can be saved.

Effects on the mother

_Eclamptic condition causes lot of bleeding to the brain.

_The mother could sustain trauma if she falls during convulsion. She could sustain head injury.

_She could have bruises and tongue biting.

_She could get her liver damaged, ruptured or have bood form in her liver (hematoma).

_Kidney could also be damaged which can lead to uraemia and eventually death.

_There could be clot disorder though this can be rectified by giving her fresh blood.

_Bleeding is another complication

Management

The main aim here is to prevent eclampsia from occurring. Once it occurs then the expert would:

_Secure airway to ensure that the patient is getting enough air

_Control the convulsion

_Control the blood pressure

_Ensure that sharp objects are kept from that area so she does not injure herself.

The doctor says there are drugs that are used to control the convulsion. These include valium injection, magnesium sulphate and so on. Anti hypertensive can also be given to control the blood pressure.

When the convulsion is under control then the delivery can be planned. "This could be through caesarean section or induction. If the woman is already well dilated, for instance at nine CM or if the baby is dead already there is no need to cut the woman, you could induce the labour so that the baby can come out. Whatever the case the baby has to come out, once its out things would begin to return to normal. This is put as the last on the list because it is the life of the mother that is more important", doctor Waziri explains.

Are there long term effects on the mother?

Once they recover, recovery is complete. Some may however develop hypertension later in life.

What happens in subsequent pregnancies?

"Such a woman has to be monitored by a specialist during ante-natal visits and not by mid-wives. She is a ‘doctor’s patient’, he adds.