Puerperal eclampsia


Puerperal eclampsia

Description, Causes and Risk Factors:

Convulsions and coma associated with hypertension, edema, or proteinuria occurring in a woman following delivery.

Puerperal eclampsia is a convulsive disease of pregnancy, characterized by tonic and clonic mulscular contractions, resembling epilepsy. In other words it is a utero-gestative disorder, occurring more often between the seventh month and time of confinement than, at any other period of gestation. Because of the peculiar nature of this affeetion it is frequently regarded as a sort of neurosis and by many is accordingly treated.

puerperal eclampsia

Puerperal eclampsia may be defined as a disease peculiar to the pregnant woman, and almost invariably manifesting its presence by convulsions of a tonic or clonic character, accompanied by unconsciousness and followed by coma or sleep. It may occur either during gestation, immediately before, during, or after confinenient, and may be extremely slight in the manifest symptoms, or so terrible and grave as to kill immediately or within a few hours of the occurrence of the first convulsion. It is most usual to occur in the latter part of pregnancy, rarely before the fifth month, and verv rarely before the fourth month; generally a short time before term, less frequently in labour, and least frequently after labour. Its frequency varies from 1 in 500 cases to 1 in 250, according to various tables. About 70 to 80 percent of all cases occur in primiparae. It is very difficult to estimate the incidence exactly, because most figures are taken from clinics to which patients are sent on account of the convulsions, whereas in ordinary private practice thev would be treated at home. We know that 80 percent or between 75 and 80 percent according to various statistics, of those women attacked by the disease recover, and it is important to note that thiey recover under all kinds of treatment. Therefore there is a mortality of about 20 or 25 percent a terrible mortality in any disease.

Etiology: This part of the subject may be divided into (a) causes residing in the mother, (b) causes residing in the fetus.

Of the causes which reside in the motlher, two great theories have been in vogue:

    The pressure, or mechanical theory, due to increased intra-abdominal pressure, and the pressure of the enlarging uterus.

  1. The toxaemic theory. These, again, may be divided into predisposing and exciting causes. The predisposing causes may be said to include:

    • Any disease of the kidney, or any condition which causes faulty elimination, because, of course, if elimination is interfered with, waste products must be retained in the circulation, and may damage the kidneys, as well as other organs.

    • Pressure on the renal veins, or on the ureters, by an unusually large uterus, as in twin pregnancy, causing retention of urine.

    • Abnormally large fetus or fetal head.

    • Small pelvis.

Symptoms:

A mother may experience a single isolated seizure or a series of fits following delivery. In general, a seizure lasts for about one minute and involves facial twitching, pauses in breathing, and foaming from the mouth. Muscles in the face and body begin to contract and relax spontaneously for several seconds at the end of an episode. A temporary coma can set in following a seizure, followed by a period of confusion and extreme fatigue. In most cases, women do not remember seizing or losing consciousness after the event.

Diagnosis:

The health care provider will do a physical exam to check for possible causes of seizures. Blood pressure and breathing rate will be checked and monitored.

Blood and urine tests may be done to check:

    Blood clotting factors.

  • Creatinine.

  • Hematocrit.

  • Uric acid.

  • Liver function.

  • Platelet count.

  • Protein in the urine.

Treatment:

The treatment of this disease must be prompt and heroic. We can not always wait to find out causes before doing something. The condition of the sufferer often calls for immediate relief; and unless this is had the patient succumbs. Under two headings; namely, surgical and medical, the treatment of most cases may properly be carried on. Surgical where hopes are entertained that by immediate delivery recurrent attacks will be cut short and prevented. In nine cases out of ten, when the uterus is emptied the convulsions cease. If they continue after this is done, it is because we have poor elimination due to abnormal conditions of the kidneys, liver or intestinal tract, one or all of which lead to a reabsorption of toxic products. When convulsions do not - cease following surgical intervention, efforts must be made to eliminate by medical means or procedures.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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