Pre eclampsia and eclampsia are hypertensive disorders in pregnancy. Hypertensive disorders are those disorders in which the blood pressure of a person is more than normal. Following is the difference between these two conditions.

Pre eclampsia vs Eclampsia

Definition:

Pre eclampsia:

Pre eclampsia is defined as hypertension (high blood pressure) of at least 140/90 mmHg (normal 120/90 mmHg) recorded on two separate occasions, at least 4 hours apart and the presence of proteinuria (300 mg or more protein in urine), arising after 20th week of pregnancy in a previously normotensive female and resolving completely by the 6th week postpartum.

Eclampsia:

Eclampsia is defined as grand mal convulsions associated with the sign of pre eclampsia during pregnancy, labour, or within 7 days of delivery and not caused by epilepsy or other convulsive disorder. It is an obstetric emergency and is a serious and life threatening complication of pre eclampsia.

Risk factors:

Risk factors are those factors that increase the risk of certain diseases.

Pre eclampsia:

Following are the risk factors that may increase the risk of pre eclampsia:

  • First time pregnancy
  • History of previous pre eclampsia
  • More than 10 years since the last baby
  • Age (more than 40 years are at high risk)
  • Body mass index (BMI) more than 35 years
  • Proteinuria of more than 1+
  • Certain pre existing medical conditions (hypertension, renal disease, diabetes, and anti phospholipid antibodies).

Eclampsia:

Following are the risk factors that may increase the risk of having eclampsia:

  • Nulliparity (a female who hasn’t given birth to a child before)
  • Multiple gestations
  • Extremes of ages
  • Diabetes mellitus
  • History of hypertension
  • Family history positive for hypertension.

Types:

Pre eclampsia:

Following are the different types of pre eclampsia:

  • Mild pre eclampsia (systolic blood pressure 140 to 149 mmHg or diastolic blood pressure 90 to 99 mmHg)
  • Moderate pre eclampsia (systolic blood pressure 150 to 159 mmHg or diastolic blood pressure 100 to 109 mmHg)
  • Severe pre eclampsia (systolic blood pressure of more than 160 mmHg or diastolic blood pressure of more than 110 mmHg).

Eclampsia:

Following are the different types of eclampsia:

  • Antenatal (during pregnancy) eclampsia
  • Intrapartum (during labour) eclampsia
  • Postnatal (after childbirth till 7 days) eclampsia.

Signs and symptoms or clinical presentation:

Pre eclampsia:

Signs and symptoms may vary depending on the type of pre eclampsia. The most common presentation of pre eclampsia is the following:

  • May be asymptomatic
  • Frontal headache
  • Visual disturbance (blurred vision, scotomas, photopsia, or diplopia)
  • Epigastric pain
  • Flu like symptoms
  • Raised blood pressure
  • Edema
  • Brisk reflexes
  • Ankle clonus
  • Uterus and fetus are small for gestational age.

Eclampsia:

Signs and symptoms may vary depending on the type of eclampsia. The most common presentation of eclampsia is the following:

  • Seizures or fits
  • Altered consciousness
  • Agitation
  • Hypertension
  • Headache
  • Visual disturbance
  • Abdominal pain
  • Nausea and vomiting
  • Edema
  • Difficulty in urinating.

Investigations or lab tests:

Pre eclampsia:

Following are the investigations to diagnose pre eclampsia:

  • Complete blood count (CBC)
  • Urine test
  • Coagulation profile (PT, INR)
  • Renal function tests (RFTs)
  • Liver function tests (LFTs)
  • Plasma urate concentration
  • Ultrasound
  • Amniotic fluid volume
  • Uterine and umbilical artery Doppler
  • Cardiotocography (CTG).

Eclampsia:

Following are the investigations to diagnose eclampsia:

  • Complete blood count (CBC)
  • Urine test
  • Clotting profile
  • Cross matching
  • Liver function tests (LFTs)
  • Urea and electrolytes.

Treatment:

Pre eclampsia:

Following are the treatment options for pre eclampsia:

  • Admit the patient to the hospital
  • Monitor blood pressure 4 or more times a day
  • Antihypertensive (labetalol oral or intravenous)
  • In severe cases, prompt delivery is indicated.

Eclampsia:

Following are the treatment options for eclampsia:

  • Admit the patient to the hospital
  • Maintain airway, breathing, and circulation
  • Maintain I/v line
  • Antihypertensive drug (labetalol)
  • Anticonvulsant drug (magnesium sulphate MGSO4)
  • Fluid balance
  • Prompt delivery.

Complications:

Pre eclampsia:

Following are the complications of pre eclampsia:

  • Eclampsia
  • HELLP syndrome
  • Cerebral hemorrhage
  • Disseminated intravascular coagulation (DIC)
  • Renal failure
  • Placental abruption.

Eclampsia:

Following are the complications of eclampsia:

  • Cerebral hemorrhage
  • Pulmonary edema
  • HELLP syndrome
  • Acute renal failure
  • Liver capsule rupture
  • Cerebrovascular accident (CVA)
  • Fetal distress
  • Intrauterine death (IUD)
  • Intrauterine growth restriction (IUGR).

Conclusion:

Pregnant ladies at risk of having hypertensive disorders must take precautionary measures. The best preventive measure your doctor may advise is low dose aspirin during pregnancy to avoid hypertensive disorders. By- Dr.Pashmina