Convulsion is a sudden, violent, irregular movement of the body, caused by involuntary contraction of muscles. It can be very fatal if it occurs in a pregnant woman to both the mother and the unborn child. Convulsion caused by pregnancy itself is called eclampsia. Convulsion in pregnancy should be treated as an emergency. delay in response can lead to death of the mother and the unborn child.
Some other causes of convulsion not directly related to pregnancy include;
- Infections such as; meningitis, cerebral malaria, cerebral abscess, encephalitis
- Febrile convulsion; this convulsion due to elevated body temperature.
- Cerebrovascular accidents such as venous thrombosis, cerebral infarction, hemorrhage
- Drug withdrawal from cocaine, alcohol
- Metabolic conditions such low sodium, potassium or elevated sodium and potassium.
Eclampsia is the new-onset of convulsion after 20 weeks of pregnancy in a patient with preeclampsia and no previous neurological (brain) disease. Criteria for preeclampsia includes; systolic blood pressure >160mmhg and diastolic blood pressure > 90mmhg (severe hypertension), edema and protein in urine. Eclampsia is one of the major causes of maternal mortality especially in developing countries where access to prompt and good health care facilities are lacking. Preeclampsia complicates about 2%-10% of pregnancies worldwide. It commonly affects women carrying their first babies. Preeclaampsia is commonly found in developing countries with an incidence that varies from 1;100 to 1;1700 while in developed countries prevalence is 1:2000.
Epilepsy is a chronic neurological disorder in which the person has repeated seizures over time. Seizures are episodes of disturbed brain activity that causes change in behavior or attention. It can occur anytime during the pregnancy and there is usually a previous history of a fit. There is usually no history of hypertension or protein in urine. The prevalence of epilepsy among pregnant women is 3.33 per 1000
It is important to take good history and examine the woman properly. Certain investigations can also be done to determine the cause of the seizure. They include;
- Electroencephalogram and MRI can be done in suspected case of epilepsy
- Complete blood count can be done in cases of suspected infection
- Coagulation profile is usually deranged in women with eclampsia
- Liver function test can also be done.
The following treatments are given when the diagnosis has been made;
Anticonvulsants are given to women with epilepsy
Antipyretics are given to women with febrile convulsion
Antibiotics are used to treat convulsions caused by infection
Underlying causes need to be treated as this will help in the resolution of the convulsion
Emergency caesarean section is done for patients with continuous generalized (tonic clonic) seizure which cant be controlled during labour.
Prompt presentation to the hospital is very important so as to reduce mortality and morbidity to both mother and child.
Precautions to take when you see a pregnant woman convulsing
When a woman is convulsing it is important to keep all objects she can injure herself with away from her.
Don’t put objects or spoon in her mouth as this can dislodge the tooth and cause obstruction of airway
Place her on the left lateral side so as to prevent aspiration and to allow for adequate blood return to the heart. This also improves blood flow to the baby
Don’t put pepper in her eyes or mouth as this will cause more harm to the woman.
Don’t burn her feet with fire, this can lead to an ulcer which can be harmful to both the baby and the mother.