Atypical eclampsia

Comparison of outcomes after typical and atypical eclampsia: a retrospective study

OBJECTIVE

To evaluate the characteristics, clinical features and maternal-perinatal outcomes after atypical eclampsia.

METHODS

In a retrospective study, we compared demographics, clinical characteristics and outcomes between typical and atypical eclampsia.

RESULTS

Of 90 eclamptic patients, 56 had typical eclamptic features and 34 had atypical features. Compared to typical eclampsia, atypical eclampsia had higher gestational age (37.6 ± 3.3 vs. 34.6 ± 4.2 weeks, p = 0.001), a higher incidence of no antenatal risk factors [25 (73.5%) vs. 12 (21.4%), p < 0.001], less antepartum seizures [11 (32.4%) vs. 45 (80.4%), p < 0.001], a lower incidence of prodromal symptoms [20 (58.5%) vs. 49 (87.5%), p = 0.002], and a higher incidence of no lesion in brain imaging [16 (47.1%) vs. 12 (21.4%), p = 0.010). Although atypical eclampsia was associated with a lower odd ratio (OR) in composite perinatal complications (OR = 0.22, 95% CI = 0.08-0.60, p = 0.003), composite maternal complications did not differ between the two groups (OR = 0.52, 95% CI = 0.08-0.60, p =0.191).

CONCLUSIONS

Maternal outcomes did not differ between the two groups. Therefore, more attention should be focused on atypical eclampsia.

Atypical preeclampsia and eclampsia: report of four cases and review of the literature

Classically, most women who develop preeclampsia (hypertension and proteinuria) present some time after 20 weeks of gestation up to 48 h postpartum;and this is especially true in otherwise healthy, nulliparous pregnancies. Recent data suggest that in some women, preeclampsia and even eclampsia may develop in the absence of hypertension or proteinuria. Here, we report four atypical cases: eclampsia in the absence of hypertension and proteinuria (case 1), a partial seizure following eclampsia with antecedent proteinuria, but no hypertension (case 2), a case presenting with fetal distress, but no hypertension (case 3), and a case with unusually rapid progression and massive proteinuria that was unresponsive to therapy (case 4). Problems with atypical forms of eclampsia lie in its unpredictable onset; timely diagnosis and management are critical in avoiding complications. The purpose of this review is to increase the awareness of atypical forms of hypertensive disorders during pregnancy.

Atypical postpartum eclampsia: status epilepticus without preeclamptic prodromi

BACKGROUND

Eclampsia remains as a major obstetric problems that plagues a large percentage of women resulting in a large percentage of maternal and perinatal morbidities. In general, most women will have a classical presentation of preeclampsia. However, studies have suggested that some women will develop eclampsia without the classical findings.

CASE REPORT

We report a case of postpartum eclampsia with the first manifestation of convulsions resistant to diazepam and magnesium sulfate. In this patient high blood pressure was first detected after the seizures. Electroencephalography and CT scan of brain were normal. Patient's blood pressure returned to normal 1 month after parturition.

CONCLUSION

Postpartum eclampsia can manifest without a preceding preeclampsia phase. Therefore, eclampsia is not always preventable. Pregnancies complicated by eclampsia require a well-formulated management plan.