Puerperal Convulsions, Or Puerperal Eclampsia (Lat. puer, child, and parere, to bring forth), a dangerous disease occurring during the puerperal or lying-in period of women, either before, during, or after delivery. It has been the source of much discussion and disagreement, and although recent advances in physiological chemistry have shed much light on the causes of the disease, many points remain in dispute. It has been asserted by Dr. Karl Braun of Vienna that it is commonly the result of uraemic poisoning, and is produced mostly by carbonate of ammonia in the blood, arising from decomposition of urea; but although it is conceded that uraemic poisoning is a frequent cause of puerperal convulsions, the ammonia theory, which originated with Dr. Frerichs of Berlin, is not generally accepted, and many believe that a variety of causes other than urea in the blood are competent to produce convulsions by acting upon the highly developed nervous system of the puerperal woman; Even when the attacks are connected with organic or functional disease of the kidneys, and when the urine is albuminous, the presence of urea in the blood is not always made out; and in many marked cases of albuminuria during pregnancy convulsions do not occur.
Constipation, retention of urine, extreme pain, and great mental distress may, it is contended, bring on in the puerperal state convulsions precisely similar in character to those produced by uraemia. According to Braun and Wieger, more than half of all the cases occur during labor, but others consider the relative frequency during the three epochs to be in the order, pregnancy, labor, delivery. It is more likely to occur in first than in succeeding labors. The frequency of the disease, as indicated by statistics, is about one case in 350 labors. There are usually, but not always, premonitory symptoms. One of the most important and common of these is oedema or dropsy, especially of the ankles and feet, which is usually developed some weeks before the appearance of the first fit. When this symptom is present, an examination of the urine is almost sure to reveal by the ordinary tests of heat and nitric acid the presence of a large quantity of albumen; and there may generally be found, by the aid of the microscope, several tube casts, sometimes accompanied with blood corpuscles, or there may be evidence of a more advanced stage of Bright's disease. Pregnancy disposes toward this condition by reason of obstruction to the circulation from pressure of the gravid uterus.
There are three objective premonitory symptoms which are also important: extremely acute headache, derangement of vision, and pain in the epigastrium. The headache is generally in the frontal region, at first intermittent, but gradually becoming continuous. Derangement of vision is a grave symptom; sometimes there is cloudiness or dimness, at others objects appear to change color; there is often double vision, or only half of an object may be seen; there are flashes of light, and sometimes the sight is suddenly lost. The convulsive seizure is characteristic, and to have witnessed it once will impress its prominent features upon the memory. After a few precursory symptoms the patient seems deeply absorbed and preoccupied; then her gaze becomes fixed and her whole body motionless. This is soon succeeded by twitchings of the eyelids and facial muscles. The eyeballs roll upward so that only the whites are seen. The contractions of the muscles from being spasmodic or clonic become tonic, as it is called; that is, they become more persistent. The angles of the mouth are strongly drawn to one side, the muscles of the neck drawing the head in the same direction. After a few moments these parts will be drawn in the contrary direction.
From the head the convulsive phenomena rapidly extend to other parts of the body. The extensor muscles of the trunk contract, producing the condition called opisthotonos, and the whole trunk becomes perfectly rigid. The neck swells, the jugular veins becoming prominent, and the carotid arteries beat violently. Contraction of the muscles of the larynx causes suspension of respiration, the capillary circulation becomes impeded, and the face assumes a livid hue. The tongue is often severely bitten between the convulsively closed jaws. In about half a minute these tonic convulsions are generally succeeded by those of a clonic character, and jerking movements of all the muscles succeed, the countenance becoming frightfully distorted. The pulse, strong and full at the commencement, is rapidly accelerated by the convulsions, but at the height of the paroxysm is very feeble. It is during the middle stage, that of tonic convulsions, that death is immediately imminent, when the respiration is suspended and the condition is that of profound asphyxia.
When recovery from the attack takes place, the symptoms gradually abate; the convulsive movements become less violent and then less frequent; the respiration becomes more regular but stertorous, and the circulation more active; and the skin resumes its natural color. The patient does not immediately regain consciousness, but remains in a comatose condition, the duration of which depends upon the intensity of the paroxysm; sometimes only a few minutes elapse, at others several hours. But recovery from the tonic stage may not take place, or there may be a succession of fits with intervals so brief that consciousness is not recovered between them, and the patient dies in a state of coma. In case of recovery, on regaining sensibility a confused feeling with headache is complained of, and she has no recollection of what has taken place. Sometimes there is impairment of vision or of hearing, or both. As to the effects of these convulsions, they may, if occurring before the lying-in period, bring on premature labor and destroy the life of either the mother or the child, or both, or they may happily terminate in recovery.
When the attack precedes delivery, it frequently happens that the birth of a child removes the conditions upon which the convulsions depend, and the patient is immediately relieved. After delivery the attack may be followed by dangerous haemorrhage, from non-contraction of the uterus, due to exhausted nervous energy or to the impoverished state of the blood. In some cases the recovery is surprising, and it often takes place contrary to the predictions of the most experienced. The treatment is prophylactic or preventive, and curative. The prophylactic treatment consists in eliminating the urea from the system when present, by the use of diuretics and purgatives, and in relieving excessive plethora by bloodletting, which may sometimes be freely employed with advantage.