Neurological complications in eclampsia: a case series

Abstract

Objectives: 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.