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Eclampsia and Pre-eclampsia

★ CMTO Exam Focus

Eclampsia and pre-eclampsia are categories of pregnancy-induced hypertension (PIH) that develop after the 20th week of pregnancy. Pre-eclampsia involves hypertension accompanied by proteinuria (protein in the urine) and/or systemic edema, while eclampsia is a severe, life-threatening progression marked by tonic-clonic convulsions or coma. The exact cause is unknown, but evidence points to placental dysfunction causing widespread endothelial dysfunction in the mother's blood vessels. Eclampsia is an absolute contraindication for all massage therapy.

Recognition

  • Pre-eclampsia signs: Blood pressure 140/90 mmHg or higher on two occasions. Proteinuria. Visible swelling in face, hands, and feet with pitting edema. Blurred vision or seeing spots/lights. Sudden intense headache. Hyperreflexia and tremors
  • Eclampsia signs: Tonic-clonic convulsions (the defining feature of eclampsia). Altered consciousness or coma
  • HELLP syndrome: Hemolysis, Elevated Liver enzymes, Low Platelet count — jaundice and upper right quadrant pain. A life-threatening complication
  • Beck triad risk factors: First pregnancy, teenagers, women over 40, obesity, multiple gestations, pre-existing diabetes or lupus
  • Key pathology: Placental dysfunction releases toxic mediators causing widespread endothelial dysfunction. This leads to vasospasm, increased vascular permeability, and organ damage (kidneys, liver, brain)

MT Relevance

  • Eclampsia: Absolute contraindication for all massage therapy
  • Mild PIH (physician-cleared): Gentle bodywork may reduce anxiety, but avoid intrusive abdominal work. Be vigilant for red flag symptoms
  • Positioning: Never place pregnant women in the third trimester supine. Use left side-lying. If supine is briefly needed, place a wedge under the right hip to prevent inferior vena cava compression
  • Postpartum vigilance: PIH risk remains high during the first few days after delivery. Monitor new mothers for sudden edema or headaches

Required Actions

  • Emergency protocol: If a client exhibits convulsions, ensure client safety (prevent injury), stop all treatment, activate emergency medical services immediately
  • Refer immediately for any sudden onset of headache, vision changes, or severe edema in the third trimester — these constitute a medical emergency
  • Document and communicate any blood pressure readings above 140/90 in a pregnant client

Key Takeaways

  • Eclampsia is an absolute contraindication for massage. Pre-eclampsia requires physician clearance for gentle bodywork
  • HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is a life-threatening complication
  • Positioning is critical: never supine in the third trimester. Use left side-lying to protect the vena cava
  • Sudden headache, vision changes, or severe edema in the third trimester constitutes a medical emergency
  • PIH risk persists postpartum. Continue monitoring new mothers in the days following delivery

Related Conditions

Sources

  • Rattray, F., & Ludwig, L. (2000). Clinical massage therapy: Understanding, assessing and treating over 70 conditions. Talus Incorporated.
  • Werner, R. (2020). A massage therapist's guide to pathology (7th ed.). Books of Discovery.
  • Norris, T. L. (2019). Porth's essentials of pathophysiology (5th ed.). Wolters Kluwer.
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