Neurological complications in eclampsia: a case series.
OBJECTIVE
Neurological abnormalities contribute significantly to maternal mortality in eclampsia. We studied the epidemiology and neurological and obstetric outcome of such patients.


METHODS
A retrospective analysis was done at a referral center. 19 cases of eclampsia with recurrent convulsions (n = 8) or coma without convulsions (n = 5) or cerebrovascular accidents (n = 4) or blindness (n = 2) were studied. We excluded cases with primary neurological abnormalities. Management included initial stabilization followed by early delivery. Primary anticonvulsant was magnesium sulphate.


RESULTS
The incidence of eclampsia was 0.71%. Among 61 cases, 19 (31.14%) had neurological abnormalities; 15 patients had no antenatal care. Three cases were postpartum. Comatose patients had the highest mean arterial pressure (MAP) (mean 154.66 mm Hg, p = 0.027). Fundoscopy was usually normal. Computerized tomography revealed mild cerebral edema in six cases and accurately diagnosed all cerebrovascular accidents. Phenytoin controlled convulsions in 7/8 cases with recurrent seizures. The cesarean section rate was 37.5% and admission to delivery interval was 10.38 hours. Five perinatal and two maternal deaths were recorded among 19 cases. Neurological recovery was complete in all survivors.


CONCLUSIONS
Critical care back-up is essential at tertiary referral centers for a large proportion of neurological abnormalities in eclampsia. High MAP and accompanying thrombocytopenia may be key factors in cerebral pathology. CT scan is a simple and effective investigation in these cases. Phenytoin is an effective second-line anticonvulsant. No maternal death was related directly to cesarean section. Early delivery prevents worsening of systemic status.
Tank
Parikshit D
PD
Department of Obstetrics and Gynecology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, India.
Chauhan
Anahita R
AR
Bhattacharya
Moudhulika S
MS
Warke
Himangi S
HS
Raut
Vanita S
VS
D000927:Anticonvulsants / Q000627:therapeutic use; D001766:Blindness / Q000209:etiology; D002493:Central Nervous System Diseases / Q000453:epidemiology / Q000209:etiology*; D003128:Coma / Q000209:etiology; D036861:Delivery, Obstetric / Q000379:methods; D004461:Eclampsia / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008278:Magnesium Sulfate / Q000627:therapeutic use; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D020521:Stroke / Q000209:etiology; D013997:Time Factors
D000927:Anticonvulsants; D008278:Magnesium Sulfate