[CHAPTER XIII]
Eclampsia Parturientium
The term Eclampsia was first used to describe the sudden exaltation, flashing forth (eklampsis), of the vital faculties at puberty; later it was applied to convulsions, but now it is restricted to convulsions in pregnancy which sometimes begin suddenly, as in a flash. The disease is characterized by a series of violent convulsive movements, loss of consciousness, and coma, and is one of the most dangerous complications of gestation. All convulsions and comas in pregnancy, not due to hysteria, epilepsy, cervical tuberculosis, apoplexy, pneumonia, phosphorus, strychnia and like poisons, uremia, and meningitis, are commonly classed as eclamptic. When the symptoms of eclampsia are present with the exception of the convulsions, a rare condition, this state also is said to be eclampsia. Reineke[121] reported a case like this. After death the heart, kidneys, and liver showed all the signs of eclampsia.
The eclamptic attack may occur without warning, but almost always there are premonitory symptoms for from a few hours to some weeks. The preëclamptic symptoms are headache (commonly frontal), nausea and vomiting, vertigo, nervous excitement or somnolence, muscle twitching, occasional delirium, cramps in the calves, disturbances of sight, tinnitus, and pain in the epigastrium. Epigastric pain, headache, and disturbances of the optic tract are important symptoms. If these last signs are present in a woman who has some edema and nephritis, the eclampsia will certainly occur, if proper means to relieve the condition are not promptly taken. When the prodromata appear there is nephritis, as a rule, but exceptions are observed.
When the attack comes, if the patient is standing she falls unconscious. The pupils dilate, the eyes and head are turned to the side. She opens her mouth, and the jaw is pulled laterally. The woman stiffens, her face is distorted, her arms bent, and the whole body curves sidewise in a tonic spasm. After a few seconds her jaws chop, and if her tongue is between the teeth it is lacerated; twitching runs down from the face and ends in a violent convulsion of the whole body, which may toss the patient from the bed, and she may even fracture her skull or long bones in the fall. The breathing stops, the bloodshot eyes stick out, the face swells and darkens, the lips become purple. Gradually the convulsions wane, and the woman appears to be dying; but after deep sighing she begins to breathe stertorously; then she sinks into a coma, or, in favorable cases, revives.
After a few minutes to an hour or more another convulsion may befall her, or she may have no more than one. In very grave cases consciousness may never return after the first fit. The convulsions may run up into extraordinary numbers—a hundred or more. There is a pseudoeclampsia where the convulsions have been as many as two hundred. If there are many attacks in the first twenty-four hours with no clear evidence of subsidence, the woman nearly always dies. Fever begins in such cases, and goes up to 103 or even 107 degrees. In an untreated case Black found a temperature of 110 degrees before death. The average number of attacks in these cases is from five to fifteen, and the convulsions are from a half minute to two or three minutes apart. Olshausen had six patients who recovered after having had from twenty-two to thirty-six convulsions, but those who have above fifteen commonly die.
If the convulsions are severe the woman as a rule aborts, and often rapidly. After the child is delivered the eclamptic symptoms may subside, or they may come on again, even a week after labor. Often the fetus dies during the attack; rarely it survives and is carried to term; again, it may die and the eclampsia may subside, but the fetus remains in the uterus for some time.