Classically, pre‐eclampsia and eclampsia are considered hypertensive disorders of pregnancy, and current diagnostic criteria include hypertension with proteinuria or other laboratory abnormalities or symptoms suggestive of end‐organ damage. However, atypical presentations can occur in the absence of elevated blood pressures. We present the case of a pregnant patient who developed status epilepticus at 24 weeks and 4 days of gestation, followed by altered mental status and severely elevated transaminases. She had no elevated blood pressures during her prenatal care or hospital course. Following delivery, she experienced normalization of transaminase levels and a return to her baseline mental status. Pre‐eclampsia and eclampsia can occur in the absence of elevated blood pressures, which highlights the limitations of using standard diagnostic criteria in normotensive patients with end‐organ damage. In such cases, it is important to include pre‐eclampsia and eclampsia in the differential diagnosis, as the diagnosis usually warrants preterm delivery to minimize maternal morbidity and mortality.

INTRODUCTION:This study aimed to determine whether suture material in history-indicated cerclage is associated with spontaneous preterm delivery (sPTD).METHODS:We conducted a retrospective cohort study of patients with singleton pregnancies who underwent history-indicated transvaginal cerclage at a tertiary care center from June 2015 to January 2022. The primary outcome was sPTD before 24 weeks of gestation. Secondary outcomes included sPTD at less than 26, 28, 32, and 34 weeks of gestation, chorioamnionitis, days in neonatal intensive care unit, and various adverse neonatal outcomes. Baseline characteristics and outcomes were compared using chi-square and Fisher’s exact tests according to type of suture material: 5-mm braided polyester fiber (Mersilene tape) versus monofilament suture (Prolene). Odds ratios (ORs) for sPTD were estimated using multivariable logistic regression.RESULTS:A total of 64 patients were included in the study, with 50 (78%) patients receiving Mersilene and 14 (22%) receiving Prolene. Mersilene, compared to Prolene, was associated with significantly lower rates of sPTD at less than 24 weeks (6% versus 29%, P=.02) and less than 26 weeks (8% versus 29%, P=.04). At more advanced gestational ages, Mersilene still resulted in lower rates of sPTD compared to Prolene, but statistical significance was lost. After adjusting for race and ethnicity, body mass index, use of postoperative progesterone, and gestational age at cerclage placement, patients with Prolene had increased odds of delivery less than 24 weeks (OR 7.69, 95% CI 1.04–56.6). Secondary outcomes were similar between the two groups.CONCLUSION:In patients undergoing history-indicated cerclage, Mersilene compared to Prolene was associated with a significantly lower risk of previable pregnancy loss.

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