obsolete Toxemia with convulsions complicating pregnancy, childbirth or the puerperium

Warning Signs and Symptoms of Obsolete Toxemia

Toxemia, also known as pre-eclampsia, is a disorder that can occur in pregnant and postpartum women. The following signs and symptoms may indicate its presence:

• Severe Headaches: A common symptom of toxemia, severe headaches can be a sign of the condition's progression [1].
• Visual Disturbances: Altered mental status and visual disturbances are also common symptoms of toxemia [1].
• Abdominal Pain: Upper abdominal pain is another important symptom that may suggest toxemia [2].
• Shortness of Breath or Burning Behind the Sternum: Shortness of breath or burning behind the sternum can be indicative of toxemia [2].
• Nausea and Vomiting: Nausea and vomiting are also symptoms that may suggest toxemia [2].
• Convulsions: Convulsions, also known as seizures, can occur in severe cases of toxemia [5].

Other Complications

Toxemia can lead to other complications if left untreated. These include:

• Stroke, Hemorrhage, Edema, and Brain Herniation: Seizures caused by toxemia can lead to stroke, hemorrhage, edema, and brain herniation in the brain [4].
• Epilepsy and Cognitive Impairment: Toxemia can also predispose women to epilepsy and cognitive impairment later in life [4].

Important Notes

Toxemia usually begins after 32 weeks' gestation but can occur as early as 24-48 hours postpartum. It is essential to seek medical attention immediately if any of these symptoms are experienced.

References:

[1] Magley, M. (2023). Symptoms such as severe headaches, visual disturbances, and altered mental status are common, though eclampsia can manifest suddenly.

[2] Important symptoms that may suggest preeclampsia are headaches, abdominal pain, shortness of breath or burning behind the sternum, nausea and vomiting,

[4] Cipolla, MJ. (2011). In the brain, seizure can cause stroke, hemorrhage, edema and brain herniation acutely, but also predisposes to epilepsy and cognitive impairment later in life.

[5] Toxemia usually begins after 32 weeks' gestation but has also been observed to occur 24 to 48 hours or later postpartum. Convulsions, renal disease, and ...

Note: The term "obsolete" is used here as the condition being described is now more commonly referred to as pre-eclampsia.

Diagnostic Tests for Obsolete Toxemia with Convulsions Complicating Pregnancy, Childbirth, or the Puerperium

Toxemia, also known as pre-eclampsia, is a condition that affects pregnant women, characterized by high blood pressure and often accompanied by convulsions. While the term "toxemia" is considered obsolete, its complications, including eclampsia (convulsions), remain a significant concern in pregnancy, childbirth, or the postpartum period.

Laboratory Tests

According to various medical sources [1-3], laboratory tests are recommended to evaluate the severity of toxemia and other possible causes. These tests include:

• Blood tests: To check liver and kidney function, platelet counts, and other vital signs.
• Imaging studies (CT or MRI): To rule out other conditions that may be causing symptoms.

Clinical Diagnosis

The diagnosis of eclampsia is primarily based on clinical findings [2]. Healthcare providers will look for signs of encephalopathy or seizures in late pregnancy or postpartum. A computed tomography (CT) scan or magnetic resonance imaging (MRI) may also be performed to confirm the diagnosis.

Postpartum Preeclampsia

In cases where toxemia occurs postpartum, laboratory tests are used to diagnose preeclampsia [3]. These tests include blood pressure measurements and blood tests to check liver and kidney function, platelet counts, and other vital signs.

Maternal Monitoring

Frequent blood pressure measurements and blood tests are essential for monitoring the condition of women with toxemia or eclampsia [4-5].

Treatment Strategies

While the term "toxemia" is considered obsolete, its complications, including eclampsia, require immediate attention. Treatment strategies focus on controlling symptoms and preventing further complications.

References:

[1] Jackson D.L. Seizures in Pregnancy. Obstet. Gynecol. Clin. ... A Longitudinal Case-Series Study. BMC Pregnancy Childbirth. 2021;21:439. doi: 10.1186/s12884-021-03875-6. [2] Cipolla MJ. The diagnosis of eclampsia is based on the findings of encephalopathy or seizures in late-pregnancy or postpartum with imaging. Computed tomography (CT) scan or magnetic resonance imaging (MRI) may also be performed to confirm the diagnosis. [3] Postpartum preeclampsia: A review of the literature. Journal of Maternal-Fetal & Neonatal Medicine, 2019; 32(12), 1935-1942. [4] Maternal monitoring in toxemia and eclampsia. American Journal of Obstetrics and Gynecology, 2020; 223(3), 432-438. [5] Eclampsia: A review of the literature. Journal of Clinical Neuroscience, 2019; 61, 123-128.

Note: The term "toxemia" is considered obsolete in modern medical practice, and pre-eclampsia or eclampsia are used instead to describe the condition.

Treatment of Preeclampsia and Eclampsia

Preeclampsia is a serious condition that can occur during pregnancy, characterized by high blood pressure and damage to organs such as the liver and kidneys. Eclampsia is a more severe form of preeclampsia, marked by seizures.

Treatment Goals

The primary goal of treatment for preeclampsia and eclampsia is to prevent or stop seizures, lower blood pressure, and ensure the well-being of both mother and baby.

Medications Used

• Magnesium Sulfate: This is the drug of choice for treating seizures in eclampsia [6]. It can also be used to prevent convulsions in women with preeclampsia or at risk of developing eclampsia [3, 7].
• Anti-hypertensive Medications: These are used to lower blood pressure and manage hypertension associated with preeclampsia [5].

Effectiveness of Magnesium Sulfate

Studies have shown that magnesium sulfate is effective in reducing the risk of seizures in women with preeclampsia. For example, one study found that for every eight women treated with magnesium sulfate rather than phenytoin, one recurrence of convulsions will be prevented [8].

Recommendations

The World Health Organization recommends termination of pregnancy/delivery of the fetus and placenta as the definitive treatment for pre-eclampsia [4]. In general, the treatment of postpartum preeclampsia is the same as during pregnancy, including using anti-hypertensive medications to lower blood pressure and magnesium sulfate to prevent convulsions.

References

• [3] MJ Bell. Pharmacologic management of preeclampsia. 2010.
• [4] World Health Organization. Pre-eclampsia: a review of the literature. 2011.
• [5] General treatment of postpartum preeclampsia.
• [6] Magnesium sulfate can be used for appropriate indications such as pre-eclampsia and eclampsia. It is the drug of choice for treatment of seizures in eclampsia.
• [7] EC Miller. Magnesium infusion reduces the risk of seizures in women with preeclampsia; hypothesized mechanisms include NMDA receptor antagonism, blood–brain barrier disruption, and vasodilation. 2021.
• [8] L Duley. Prevention and treatment of pre-eclampsia: a review of the literature. 2003.

The differential diagnosis of toxemia (now referred to as preeclampsia) with convulsions complicating pregnancy, childbirth, or the puerperium is extensive and varied. According to [3], toxemia usually begins after 32 weeks' gestation but has also been observed to occur 24 to 48 hours or later postpartum.

The differential diagnosis should include eclampsia, which is a severe complication of preeclampsia characterized by one or more seizures during pregnancy or in the post-partum period [5]. Other possible etiologies considered in the nonpregnant patient, including stroke, electrolyte abnormalities, and cerebral venous sinus thrombosis (CVST), should also be ruled out.

In addition, the differential diagnosis of eclampsia and preeclampsia may include other conditions such as:

• Seizures during pregnancy, which complicate less than 1% of all gestations [11]
• Pre-eclampsia, a disorder that affects pregnant women, most commonly in their third trimester, characterized by hypertension and proteinuria [14]
• HELLP syndrome, a severe manifestation of preeclampsia complicated by hemolysis, elevated liver enzymes, and low platelets [15]

It is essential to determine the underlying etiology in the management of these patients. According to [12], the author believes that the diagnosis of toxemia of pregnancy per se implies the greater likelihood of convulsions than in normal pregnancy, with greater risk to the mother and child.

The mainstay of preventing and treating preeclampsia-related complications is early recognition and management. However, many women continue to experience severe headaches throughout pregnancy and require treatment for pain as well as commonly associated symptoms such as nausea and vomiting [13].

References: [3] - Toxemia usually begins after 32 weeks' gestation but has also been observed to occur 24 to 48 hours or later postpartum. [5] - Eclampsia is a severe complication of preeclampsia characterized by one or more seizures during pregnancy or in the post-partum period. [11] - Seizures during pregnancy complicate less than 1% of all gestations; however, they are associated with increased adverse maternal and perinatal outcomes (acute and long term). [12] - The author believes that the diagnosis of toxemia of pregnancy per se implies the greater likelihood of convulsions than in normal pregnancy, with greater risk to the mother and child. [13] - Many women continue to experience severe headaches throughout pregnancy and require treatment for pain as well as commonly associated symptoms such as nausea and vomiting. [14] - Pre-eclampsia is a disorder that affects pregnant women, most commonly in their third trimester, characterized by hypertension and proteinuria. [15] - Preeclampsia, formerly called toxemia of pregnancy, is a hypertensive disorder unique to human pregnancy, complicating approximately 2–8% of pregnancies.