19.5  Clinical features of eclampsia

Eclampsia occurs when the woman hasn’t been able to get adequate treatment when she had severe pre-eclampsia. It is the most life-threatening complication of severe pre-eclampsia. It can occur before labour, during labour and after delivery. Sometimes, eclampsia can occur as long as 24 hours after the delivery, even in women who gave birth with normal blood pressure and without any danger symptoms before and during labour. Therefore, if a woman comes to you with a history of convulsion, after a normal labour and delivery and even some time at home, the first clinical problem you need to consider is eclampsia. But you should also know that there are other medical causes of convulsion, such as blood sugar being too low or too high (hypo or hyperglycaemia), malaria affecting the brain, bacterial infection in the brain (e.g. meningitis), stroke, drugs, or poisoning.

As you learned above, the diagnosis of eclampsia is made when the clinical features of pre-eclampsia are present, plus:

• Convulsion/fits
• Coma in the absence of other causes.

The convulsion in eclampsia is usually sudden in onset, but in some cases there may be warning signs and symptoms that make the occurrence of eclampsia inevitable (see Box 19.2).