Certain Convulsions in Pregnancy is life threatening

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Eclampsia

Eclampsia is the occurrence of convulsions in association with features of pre-eclampsia classically in the second half of pregnancy, labour and up to 10 days of delivery having ruled out other causes of convulsion. Eclampsia prior to 20 weeks of gestation is rear and should raise the possibility of an underlying molar pregnancy or antiphospholipid syndrome.



It is a significant cause of maternal and perinatal morbidity and mortality in Africa, being among the top three causes of maternal death in West African sub region. There are known risks factors associated or that predispose to pre-eclampsia and eclampsia. It is common in;
nulliparous women
multiple gestation
extremes of reproductive age
diabetes
chronic hypertensive disease
Afro – Caribbean ethnicity
More prevalent during cold seasons.
It is also described as pathology of poverty because of the higher incidence in the developing countries .Other differential diagnosis of eclampsia includes meningitis, cerebral malaria, epilepsy, diabetes coma, cerebral hemorrhage, abscesses and tumours.



The definitive treatment of eclampsia is delivery,either vaginally or abdominally,depending on the state of the cervix. However patients must be stabilized by initial resuscitation, controlling the convulsion and the high blood pressure. Magnesium sulphate is given as anticonvulsant which is the gold standard for preventing convulsion due to its advantages in that it does not cause neonatal depression, hypotonia or poor sucking reflex unlike diazepam;as such the Apgar scores are better than that of neonates whose mother had diazepam. Intravenous hydrallazine can be used to control the blood pressure which should be administered intermittently, being readily available, affordable and effective. It produces direct vascular relaxation although with reflex tachycardia and increase cardiac output. It is also believes to maintain placenta perfusion. Other antihypertensive that can be used are labetalol,Diazoxide,Dihydrallazine and Verapamil.
There are preventive measures to prevent pre-eclampsia/ eclampsia such as ;
Low dose of aspirin
Calcium supplementation
Use of fish oils
Magnesium and antihypertensive
Until there is a clear understanding of the pathophysiology of the disease in patients, the role of prophylaxis is limited.



The incidence and complications of eclampsia will be reduced if there is adequate early antenatal identification of high-risk patients for prompt management.



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