What’s the Difference Between Preeclampsia and Eclampsia?
Key takeaways:
Preeclampsia is a pregnancy-related disorder that can affect multiple organs. It can lead to serious complications for the mother and baby.
An early diagnosis can help to reduce possible complications of preeclampsia.
Though there’s no prevention for preeclampsia, there may be ways to reduce the risk for some.
Preeclampsia is a common complication of pregnancy that causes high blood pressure and other problems. Luckily, it’s mild in most cases. But in its severe form, preeclampsia can lead to problems for you and your baby. Eclampsia is an even more serious form of this condition, which causes seizures. Together these disorders are often referred to as “preeclampsia-eclampsia.”
If you are pregnant or planning a pregnancy, understanding the risks of preeclampsia is very important. Here we’ll discuss risk factors as well as diagnosis and treatment of preeclampsia.
How is preeclampsia-eclampsia diagnosed?
If you have ever been pregnant, then you know that at each visit your healthcare team checks your blood pressure. They also collect a urine sample at every visit. This is to look for preeclampsia.
Your provider will suspect preeclampsia if you have high blood pressure (140/90 or higher) and protein in your urine. Preeclampsia affects your kidneys, which causes protein to leak from your kidneys into your urine. Preeclampsia can also affect other parts of your body — like your liver, brain, and blood cells.
Further testing will confirm the diagnosis of preeclampsia. It can also help determine if you have a mild or a severe form of preeclampsia. These tests include:
Urine tests: measure the protein in your urine over a 24-hour period
Blood tests: look at your liver function, kidney function, and blood cells
There are three main categories for diagnosis:
Mild preeclampsia: Your provider will diagnose this if your blood pressure is only a little elevated and you have only a small amount of protein in your urine.
Severe preeclampsia: You may get this diagnosis if you have very high blood pressure (160/110 or higher), or if there’s a large amount of protein in your urine. If any of your blood tests are abnormal, this also signals severe disease.
Eclampsia: Severe preeclampsia can sometimes progress to eclampsia. Your provider will make this diagnosis if you have a seizure after a diagnosis of preeclampsia.
When is preeclampsia usually detected?
Preeclampsia is most often diagnosed later in pregnancy, around the last month. But it can sometimes start as early as your fifth month of pregnancy. When there’s a preeclampsia diagnosis before 8.5 months, it’s considered severe preeclampsia.
In some cases, preeclampsia may not occur until after delivery. This is called “postpartum preeclampsia.”
What are the symptoms of preeclampsia and eclampsia?
Preeclampsia often develops without you even knowing there may be a problem. But there are some symptoms you can look for that may signal preeclampsia:
Swelling, especially in your face and hands: Sometimes swelling can also cause sudden weight gain.
Constant headache: An occasional mild headache in pregnancy is common. But a headache that won’t go away or is very severe may be a sign of preeclampsia.
Changes in vision: This can be a sign of high blood pressure and preeclampsia.
Severe pain in the upper part of your belly: This is the location of your liver, which preeclampsia can affect.
Vomiting that starts later in your pregnancy: This may also be a sign of liver involvement.
Trouble breathing: This may be due to fluid in your lungs, which can happen with severe preeclampsia.
If you have any of these symptoms, get medical attention right away.
The only sign of eclampsia is seizure in someone who has preeclampsia.
How are they treated?
The only treatment for preeclampsia is delivery. But the timing can be complicated, depending on how far along you are. Babies born after 37 weeks generally do well, so it might benefit your baby to wait until you reach that point. On the other hand, waiting longer can increase your chance of progressing to severe preeclampsia.
Mild preeclampsia
If you have mild preeclampsia at or after 37 weeks of pregnancy, experts recommend labor induction. If you have a diagnosis of mild preeclampsia before 37 weeks, your healthcare team will make every attempt to delay delivery and give the baby a bit more time to mature. In most cases you will need to visit your provider once or twice a week to be sure your preeclampsia isn’t getting worse. If you or your baby show signs of worsening preeclampsia, then you may need to deliver sooner.
Severe preeclampsia
Severe preeclampsia requires earlier delivery, most likely by 34 weeks of pregnancy. If you have preeclampsia before 34 weeks, you’ll need to stay in the hospital for monitoring. In the case of an early delivery, experts recommend a steroid medication to help the baby’s lungs mature. This medication needs 48 hours to work best, so delaying delivery for even a few days may be beneficial.
Preeclampsia can progress to eclampsia at any time. But the risk of developing eclampsia is highest during labor. This risk remains high during the first day or two after delivery. To reduce this risk, once labor begins providers recommend magnesium sulfate, a medication that prevents seizures. You’ll receive this medication until 24 hours after delivery.
If your blood pressure gets too high, your care team will treat it with blood pressure medication to get it back down. That’s because blood pressure control decreases your risk of a stroke.
Eclampsia
If you have an eclamptic seizure, your care team will closely monitor you and your baby to keep you both safe. Seizures often stop on their own, but providers always treat eclamptic seizures to prevent them from happening again. Treatment is a high dose of intravenous (IV) magnesium sulfate.
After stabilizing your seizure, your care team will deliver your baby, regardless of how far along you are in the pregnancy. You will continue to receive magnesium sulfate for 24 hours after delivery to prevent further seizures.
How serious is preeclampsia-eclampsia?
Preeclampsia is often mild, but severe disease can be very dangerous for you and your baby. Mild preeclampsia can progress to severe disease, or even eclampsia, in a matter of days. Preeclampsia remains one of the three leading causes of pregnancy-related deaths worldwide.
Preeclampsia can damage many organs in your body, sometimes permanently. It can cause:
Kidney damage
Liver damage
Seizures
Stroke
Serious bleeding problems
Having preeclampsia increases your chances of having it again in a future pregnancy. It also puts you at higher risk of having high blood pressure problems later in life. So it’ll be important to follow up with your care team if you have a history of preeclampsia.
Unfortunately, preeclampsia can also affect your baby. It can cause:
Placental damage: Preeclampsia can damage the placenta, the organ that feeds the baby during pregnancy. This can affect your baby’s growth.
Placental abruption: This occurs when the placenta separates from the wall of the uterus. Babies cannot survive without the placenta, so an abruption is life-threatening.
Severe preeclampsia may also require early delivery. Babies that are born prematurely (too early) may have problems with breathing, feeding, hearing, and vision.
How can you prevent preeclampsia-eclampsia?
Unfortunately, there’s nothing that can completely prevent preeclampsia. But if you have certain high-risk conditions, low-dose (81 mg) aspirin may decrease your preeclampsia risk. Your provider may recommend low-dose aspirin if:
You had preeclampsia in a prior pregnancy
You had high blood pressure before pregnancy
You have another chronic condition, like diabetes or kidney disease
You are pregnant with twins or multiples
Experts also recommend low-dose aspirin if you meet two or more of the following:
You are pregnant for the first time
You are 35 years old or older
Your body mass index (BMI) is greater than 30
Your mother or sister had preeclampsia
You have a low income or you are Black (these put you at higher risk due to health inequities)
The recommendation for those at higher risk is to take daily, low-dose aspirin starting after 12 weeks of pregnancy, until delivery. Experts don’t recommend aspirin for those at low risk for preeclampsia. Your provider can help you understand your level of risk and whether aspirin is a good idea.
The bottom line
Preeclampsia is often mild, but severe disease can be very dangerous for you and your baby. It often happens without any warning signs. This is one of the many reasons it’s important to keep in touch with your provider throughout your pregnancy. Low-dose aspirin may decrease your chance of developing preeclampsia if you are at higher risk.
Why trust our experts?
References
Altman, D., et al. (2002). Do women with preeclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: A randomised placebo-controlled trial. Lancet (London, England).
American College of Obstetricians and Gynecologists. (2020). Gestational hypertension and preeclampsia.
American College of Obstetricians and Gynecologists. (2021). Preeclampsia and high blood pressure during pregnancy.
Ghulmiyyah L., et al. (2012). Maternal mortality from preeclampsia/eclampsia. Seminars in Perinatology.
March of Dimes. (2021). Placental abruption.
MedlinePlus. (2022). Eclampsia.
MedlinePlus. (2022). Seizures.
Preeclampsia Foundation. (2021). What is preeclampsia.
Rolnik, D. L., et al. (2017). Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. The New England Journal of Medicine.
U.S. Preventive Services Task Force. (2021). Aspirin use to prevent preeclampsia and related morbidity and mortality: US Preventive Services Task Force Recommendation Statement. JAMA.
